^(18)F-PSMA-1007 PET/CT对前列腺癌初诊患者转移灶的检出率及其影响因素分析

The value of ^(18)F-PSMA-1007 PET/CT in detecting the risk of metastasis in patients newly diagnosed with prostate cancer

目的明确^(18)F-PSMA-1007 PET/CT对前列腺癌初诊患者转移灶的评估作用,并探索其与临床转移风险指标的关系。方法回顾性收集我院2019年3月至2021年4月初诊未治并行^(18)F-PSMA-1007 PET/CT检查的前列腺癌患者257例。所有图像均由两名高年资PET/CT诊断医师进行判读。根据D’Amico危险度分级将患者分为低、中和高危组,依据Gleason评分(GS)将患者分为≤6分组、=7分组和≥8分组,依据患者血清总前列腺特异性抗原(tPSA)水平高低将患者分为<10 ng/mL组、10~20 ng/mL组和>20 ng/mL组。最后,在D’Amico危险度分级的各组内,再依据tPSA水平和GS进行亚分组,并比较各亚组间^(18)F-PSMA-1007 PET/CT对转移灶探测情况的差异。结果本研究共纳入257例患者,总体血清tPSA的中位数为16.34(3.38~783.12)ng/mL,GS中位数为8(6~10)分,D’Amico低危、中危和高危组分别为10例(3.89%)、36例(15.01%)和211例(80.10%)。在D’Amico高危组、GS≥8分组以及tPSA>20 ng/mL组中患者发生转移的比率最高,分别是45.02%、46.50%和47.02%;低危组、GS≤6分和tPSA<10 ng/mL组患者发生转移的比率较低,分别为0、8.82%和15.63%。当tPSA<10 ng/mL时,低危前列腺癌发生转移的比率(0)低于高危前列腺癌(33.33%)。当tPSA处于10~20 ng/mL时,中危前列腺癌转移的比率(7.69%)低于高危前列腺癌(38.71%)。当GS≤6分时,低危前列腺癌发生转移的比率(0)低于高危前列腺癌(38.71%)。结论PSMA-1007 PET/CT对初诊前列腺癌患者的转移灶检出率与GS、术前tPSA水平和的D’Amico危险度分级具有正相关性。

Objective To investigate the diagnostic efficiency of^(18)F-PSMA-1007 PET/CT in assessing the metastasis of newly diagnosed prostate cancer(PC),and evaluate its relationship with clinical risk classification.Methods The clinical data of 257 newly diagnosed PC patients who underwent^(18)F-PSMA-1007 PET/CT between March 2019 and April2021 were retrospectively reviewed in this study.All images were interpreted by two senior PET/CT diagnostic specialists.According to the D’Amico risk classification,the patients were divided into low-,intermediate-and high-risk groups.According to Gleason score(GS),the patients were divided into GS≤6,GS=7,and GS≥8 groups.According to the level of serum total prostate-specific antigen(tPSA),the patients were divided into<10 ng/mL,10-20 ng/mL,and>20 ng/mL groups.Finally,in the groups with D’Amico risk classification,the subgroups were divided according to tPSA level and GS,and the differences of^(18)F-PSMA-1007 PET/CT in the detection of metastasis were compared among the subgroups.Results A total of 257 patients were enrolled with a median tPSA 16.34(3.38-783.12)ng/mL and median Gleason score(GS)8(range:6-10).There were 10(3.89%),36(15.01%),and 211(80.10%)PC patients in the low-,intermediate-,and high-risk groups,respectively.The rate of metastasis in high-risk group,GS≥8 group,and tPSA>20 ng/mL group was 45.02%,46.50%,and 47.02%,respectively.The rate of metastasis in low-risk group,GS≤6 group and tPSA<10 ng/mL group was 0,8.82%,and 15.63%,respectively.When tPSA<10 ng/mL,the rate of metastasis in low-risk group(0)was lower than that in high-risk group(33.33%).When tPSA was 10-20 ng/mL,the rate of metastasis in intermediate-risk group(7.69%)was lower than that in high-risk group(38.71%).When GS≤6,the rate of metastasis in low-risk group(0)was lower than that in high-risk group(38.71%).Conclusion The detection rate of metastasis in patients with newly diagnosed prostate cancer by^(18)F-PSMA-1007 PET/CT is positively correlated with GS,preoperative tPSA level,and D’Amico risk grade.