^(18)F-PSMA-1007 PET/CT在前列腺癌寡转移与疗效评估中的价值

The value of ^(18)F-PSMA-1007 PET/CT in evaluating oligometastatic and curative effects of prostate cancer

目的探讨前列腺癌患者血清前列腺特异性抗原(PSA)水平、Gleason评分和PSMA PET/CT中最大标准化摄取值(SUVmax)预测前列腺癌转移范围以及影响前列腺癌寡转移患者治疗方式中的价值。方法回顾性收集经病理证实的前列腺癌患者170例,其中未经治疗者97例,根据转移情况分为无转移组、寡转移组(转移灶≤5)和广泛转移组;前列腺癌寡转移行根治术者28例,前列腺癌寡转移内分泌治疗者45例。比较未经治疗的三组患者SUVmax、PSA和Gleason评分组间差异,同时对原发癌灶SUVmax与Gleason评分、PSA水平进行相关性分析。根据Gleason评分对前列腺癌寡转移患者再进行分组(≤7分为中-低危组,≥8为高危组),比较组间转移灶SUVmax和总体血清PSA水平。结果随转移灶数量增多,SUVmax、PSA水平及Gleason评分均呈上升趋势,三组间差异存在统计学意义(P=0.029,P=0.001,P=0.046)。事后检验发现,寡转移组与其余两组Gleason评分之间差异具有统计学意义(P=0.043,P=0.002);原发灶SUVmax水平与Gleason评分、PSA之间存在相关性(P=0.002,r=0.315;P<0.001,r=0.430)。前列腺癌寡转移根治术后组和内分泌治疗组间PSA水平差异具有统计学意义(P=0.017);在Gleason评分中、低危组中,PSA在两种治疗方式间的差异持续存在(P=0.021)。结论SUVmax、PSA水平和Gleason评分对前列腺癌寡转移的鉴别中具有一定价值;对于前列腺癌寡转移患者,特别是Gleason评分中-低危人群,根治术是非常有效的治疗策略。

Objective To investigate the value of prostate-specific antigen(PSA)level,Gleason score,and PSMA PET/CT maximum standardized uptake value(SUVmax)in predicting prostate cancer(PCa)metastasis and the treatment option of oligometastatic PCa.Methods We retrospectively recruited 170 patients with PCa confirmed by pathology,97 of whom were untreated,and divided them into nonmetastatic group,oligometastatic group(metastasis≤5),and polymetastatic group.In addition,28 patients with oligometastatic PCa underwent radical prostatectomy and 45 patients underwent androgen-deprivation therapy.We compared the differences in SUVmax,PSA,and Gleason scores between the three sub-groups of untreated patients,and also analyzed the correlation between SUVmax of local cancer lesions,Gleason score and PSA level.We further compared the differences in SUVmax and PSA levels between radical prostatectomy and androgen-deprivation therapy of oligometastatic PCa patients.According to Gleason score,patients with oligometastatic PCa were divided into two groups(low-intermediate risk group with Gleason score≤7 and high-risk group with Gleason score≥8),and the levels of SUVmax and PSA between the groups were compared.Results With the increasing number of metastases,SUVmax,PSA levels and Gleason scores all showed an upward trend,and there were significant differences among the three groups(P=0.029,P=0.001,P=0.046).The post-hoc test found significant difference in Gleason score between the oligometastatic group and the other two groups(P=0.043,P=0.002)as well as correlation of SUVmax level of the primary tumor with Gleason score and PSA(P=0.002,r=0.315;P<0.001,r=0.430).There was significant difference in PSA level between the two groups after radical prostatectomy and androgen-deprivation therapy(P=0.017).The difference in PSA between the two treatments persisted in the low-intermediate risk groups(P=0.021).Conclusion PSA level,Gleason score and SUVmax have some value in predicting PCa metastasis.Radical prostatectomy is an effective treatment strategy for patients with oligometastatic PCa,especially those with lowintermediate Gleason score.