18F-FDG PET/CT显像联合血清学指标在前列腺癌原发灶诊断及骨转移评估中的价值研究

Research on the value of 18F-FDG PET/CT imaging combined with serological indicators in diagnosing primary lesion of prostate cancer and evaluating osseous metastasis

目的:探讨18F-氟代脱氧葡萄糖(18F-FDG)PET/CT显像和前列腺血清学指标检测在鉴别前列腺癌(PCa)与前列腺增生(BPH)及是否合并骨转移中的价值。方法:选取在医院就诊的因怀疑前列腺恶性肿瘤而行穿刺活检的132例患者,确诊后将其分别纳入PCa组(92例)和BPH组(40例);另将PCa组患者分为PCa骨转移组(67例)和非骨转移组(25例)。分析PCa组和BPH组患者、PCa骨转移组和非骨转移组患者的18F-FDG PET/CT最大标准摄取值(SUVmax)与血清前列腺特异性抗原(PSA)检测结果,比较组间前列腺SUVmax及血液中总PSA(T-PSA)、游离PSA(f-PSA)、f/T-PSA、PSA密度(PSAD)、(f/T-PSA)/PSAD水平的差异,并采用受试者工作特征(ROC)曲线下面积(AUC)分析各指标对PCa骨转移的诊断价值。结果:除f/T-PSA指标外,PCa组患者原发病灶SUVmax与血液中各肿瘤标记物水平均明显高于BPH组(t=11.10,t=13.80,13.68,t=10.77,t=-5.98;P=0.05);PCa骨转移组患者PSAD与(f/T)/PSAD水平明显高于非骨转移组(t=2.186,t=-3.183;P<0.05),前列腺原发灶(f/T)/PSAD和PSAD的AUC分别为0.734和0.704,(f/T)/PSAD的AUC大于PSAD。结论:SUVmax值、T-PSA、f-PSA、PSAD和(f/T)/PSAD能很好鉴别PCa与BPH;PSAD和(f/T)/PSAD能提高PCa骨转移诊断的敏感性和特异性,且(f/T)/PSAD的诊断价值更高。

Objective:To explore the values of 18F-Fludeoxyglucose positron emission tomography/computed tomography(18F-FDG PET/CT)imaging and the examination of prostate serological indicators in identifying the difference between prostatic cancer(PCa)and benign prostatic hyperplasia(BPH),as well as whether comorbid with osseous metastasis or not.Methods:132 patients with suspected malignant tumor of prostate who underwent aspiration biopsy were selected,and they were divided into PCa group(92 cases)and BPH group(40 cases)after they were confirmed.And patients of PCa group were further divided into PCa with osseous metastasis group(67 cases)and PCa without osseous metastasis group(25 cases).The detection results of maximum standardized uptake value(SUVmax)of 18F-FDG PET/CT and serum prostate specific antigen(PSA)between PCa group and BPH group,and between PCa with osseous metastasis group and PCa without osseous metastasis group were analyzed.And the differences of prostate SUVmax,total PSA(T-PSA)of blood,free PSA(f-PSA),f/T-PSA,PSA density(PSAD)and(f/T-PSA)/PSAD between different groups were compared.And the area under curve(AUC)of receiver operating characteristic(ROC)was adopted to analyze the diagnosis value of each indicator in diagnosing osseous metastasis of PCa.Results:Excepted f/T-PSA,the SUVmax of primary lesion and tumor marker levels of blood in PCa group were significantly higher than that in BPH group(t=11.1,t=13.8,t=13.68,t=10.77,t=-5.98,P<0.05),respectively.The PSAD and(f/T)/PSAD level of PCa with osseous metastasis group were significantly higher than that of PCa without osseous metastasis group(t=2.186,t=-3.183,P<0.05).The AUCs of(f/T)/PSAD and PSAD of primary lesion of prostate were 0.734 and 0.704,respectively,and that of(f/T)/PSAD was larger than that of PSAD.Conclusions:SUVmax,T-PSA,f-PSA,PSAD and(f/T)/PSAD can distinguish PCa and BPH well.In addition,PSAD and(f/T)/PSAD can improve the sensibility and specificity in diagnosing osseous metastasis of PCa,and(f/T)/PSAD has more diagnosis value.