^(68)Ga-PSMA-11 PET/CT与 ^(18)F-FDG PET/CT在前列腺癌术前TNM分期中的对比研究

Comparison of ^(68)Ga-PSMA PET/CT and ^(18)F-FDG PET/CT for preoperative TNM staging of patients with prostate cancer

目的比较^(68)Ga-前列腺特异膜抗原(PSMA)-11 PET/CT与^(18)F-脱氧葡萄糖(FDG)PET/CT在前列腺癌根治术前TNM分期中的诊断效能。方法回顾性研究2018年7月至2019年12月间上海交通大学医学院附属仁济医院67例根治性手术病理确诊前列腺癌的患者,年龄(67.5±6.8)岁,均在术前行^(68)Ga-PSMA-11 PET/CT与^(18)F-FDG PET/CT全身显像。将PET/CT结果与手术病理学检查结果进行对比。采用χ^(2)检验对比^(68)Ga-PSMA-11 PET/CT与^(18)F-FDG PET/CT行术前TNM分期的诊断效能,2种显像原发灶最大标准摄取值(SUV max)的比较行Mann-Whitney U检验。另将患者分层为低危、中危、高危进行分层分析。结果67例中,低危9例、中危19例、高危39例。对于T分期,88.06%(59/67)的患者^(68)Ga-PSMA-11 PET/CT显像阳性,67例中位SUV max为13.80(7.30,22.40);46.27%(31/67)的患者^(18)F-FDG PET/CT显像阳性,67例中位SUV max为4.00(3.10,5.60);2种显像检出的前列腺癌原发灶SUV max差异有统计学意义(U=62,P<0.05)。分层分析示,^(68)Ga-PSMA-11 PET/CT对中危患者的检出率高于^(18)F-FDG PET/CT(17/19与6/19;χ^(2)=4.920,P<0.05)。67例中,术后病理示N1期10例。^(68)Ga-PSMA-11 PET/CT和^(18)F-FDG PET/CT检测阳性区域淋巴结的灵敏度、特异性、准确性、阳性预测值、阴性预测值分别为6/10、87.72%(50/57)、83.58%(56/67)、6/13、92.59%(50/54)和4/10、89.47%(51/57)、82.09%(55/67)、4/10、89.47%(51/57)。^(68)Ga-PSMA-11 PET/CT共检出M1期患者15例(22.39%,15/67),^(18)F-FDG PET/CT共判定9例(13.43%,9/67),二者对远处转移的检出率差异有统计学意义(χ^(2)=35.436,P<0.05)。结论对于前列腺癌T分期,^(68)Ga-PSMA-11 PET/CT的检出率在中危患者中优于^(18)F-FDG PET/CT。N、M分期时,^(68)Ga-PSMA-11 PET/CT的检出率亦高于^(18)F-FDG PET/CT。

Objective To compare the diagnostic efficacy of ^(68)Ga-prostate specific membrane antigen(PSMA)-11 PET/CT and ^(18)F-fluorodeoxyglucose(FDG)PET/CT in TNM staging before radical prostatectomy.Methods From July 2018 to December 2019,a total of 67 patients((67.5±6.8)years)with prostate cancer diagnosed pathologically by radical surgery in Renji Hospital,School of Medicine,Shanghai Jiao Tong University were retrospectively enrolled.All patients underwent ^(68)Ga-PSMA-11 PET/CT and ^(18)F-FDG PET/CT whole-body scans before surgery.Results of PET/CT were compared with pathological diagnosis after surgery to compare the diagnostic efficiencies of ^(68)Ga-PSMA-11 PET/CT and ^(18)F-FDG PET/CT for preoperative TNM staging(χ^(2) test).The differences of the maximum standardized uptake value(SUVmax)in primary lesions between 2 imaging methods were compared by Mann-Whitney U test.Patients were divided into low-risk,intermediate-risk and high-risk for stratified analysis.Results Among 67 patients,9 were with low-risk,19 were with intermediate-risk,39 were with high-risk.For T staging,59(88.06%,59/67)patients showed positive results by ^(68)Ga-PSMA-11 PET/CT imaging,with median SUVmax of 13.80(7.30,22.40)for 67 patients;31(46.27%,31/67)patients showed positive results in ^(18)F-FDG PET/CT imaging,with median SUVmax of 4.00(3.10,5.60)(U=62,P<0.05).Stratifed analysis showed that the detection rate of ^(68)Ga-PSMA-11 PET/CT was higher than that of ^(18)F-FDG PET/CT in intermediate-risk patients(17/19 vs 6/19;χ^(2)=4.920,P<0.05).Among 67 patients,10 were diagnosed as N1 stage based on the pathological results.The sensitivities,specificities,accuracies,positive predictive values and negative predictive values of ^(68)Ga-PSMA-11 PET/CT and ^(18)F-FDG PET/CT for detecting positive regional lymph nodes were 6/10,87.72%(50/57),83.58%(56/67),6/13,92.59%(50/54)and 4/10,89.47%(51/57),82.09%(55/67),4/10,89.47%(51/57),respectively.^(68)Ga-PSMA-11 PET/CT detected 15 patients(22.39%,15/67)with M1 stage,and ^(18)F-FDG PET/CT identified 9 patients(13.43%,9/67;χ^(2)=35.436,P<0.05).Conclusions As for T staging,the detection rate of ^(68)Ga-PSMA-11 PET/CT in the intermediate-risk group is better than ^(18)F-FDG PET/CT.In N and M staging,the detection rates of ^(68)Ga-PSMA-11 PET/CT are higher than those of ^(18)F-FDG PET/CT.