^(68)Ga-PSMA PET/CT代谢体积参数与前列腺癌临床病理特点的相关性

Correlation Between Metabolic Volume Parameters of ^(68)Ga-PSMA PET/CT and Clinicopathological Features in Prostate Cancer

目的探讨^(68)Ga-前列腺特异性膜抗原(PSMA)PET/CT代谢体积参数与初诊前列腺癌患者临床病理特征之间的相关性。资料与方法回顾性纳入中山大学附属第三医院2017年11月—2021年1月行术前^(68)Ga-PSMA-11 PET/CT检查并经根治性切除术治疗的初诊前列腺癌33例。通过阈值自动分割法测量前列腺病灶^(68)Ga-PSMA PET/CT半定量指标,包括最大标准化摄取值(SUVmax)、代谢体积参数如肿瘤PSMA表达体积(PSMA-TV)和肿瘤PSMA表达总量(TL-PSMA)。分析不同代谢参数与前列腺癌临床病理特点的关系,采用受试者工作特征(ROC)曲线获得诊断临床病理特点的最佳阈值及诊断效能。结果术前血清总前列腺特异抗原与SUVmax(r_(s)=0.622,P<0.001)、PSMA-TV(r_(s)=0.385,P=0.027)、TL-PSMA(r_(s)=0.695,P<0.001)呈显著正相关。病理格林森评分(GS)≤7分组与GS>7分组SUVmax(Z=−2.395,P=0.016)、TL-PSMA(Z=−3.406,P=0.001)差异有统计学意义,诊断GS>7分的ROC曲线下面积分别为0.754(95%CI 0.575~0.993)和0.861(95%CI 0.735~0.987)。手术切缘状态阳性与阴性组SUVmax(Z=−3.648,P<0.001)、TL-PSMA(Z=−0.257,P=0.009)差异有统计学意义,诊断手术切缘状态的ROC曲线下面积分别为0.881(95%CI 0.768~0.994)和0.769(95%CI 0.609~0.930)。精囊腺侵犯、区域淋巴结转移阳性与阴性组TL-PSMA差异有统计学意义(Z=−2.115、−2.026,P=0.034、0.043),诊断精囊腺侵犯及区域淋巴结转移的ROC曲线下面积分别为0.735(95%CI 0.566~0.903)和0.753(95%CI 0.577~0.929)。结论术前^(68)Ga-PSMA PET/CT代谢体积参数TL-PSMA与前列腺癌多项临床病理特点存在相关性,与常规代谢参数SUVmax相比,在前列腺癌术前的临床病理特点预测方面可能提供更有利的价值。

Purpose To investigate the relationship between metabolic volume parameters of ^(68)Ga-prostate specific membrane antigen(PSMA)PET/CT and clinicopathological features of patients with newly diagnosed prostate cancer.Materials and Methods A total of 33 newly diagnosed prostate cancer patients who underwent preoperative ^(68)Ga-PSMA-11 PET/CT and radical resection in the Third Affiliated Hospital of Sun Yat-sen University from November 2017 to January 2021 were retrospectively enrolled.Semi-quantitative indices of ^(68)Ga-PSMA-11 PET/CT on prostate lesions were measured by automatic segmentation algorithm method,including maximum standardized uptake value(SUVmax),metabolic volume parameters such as PSMA-derived tumor volume(PSMA-TV)and total lesion PSMA(TL-PSMA).The relationship between SUVmax,PSMA-TV,TL-PSMA and clinicopathological characteristics of prostate cancer patients were analyzed.The optimal cut-off value and diagnostic efficacy were measured and obtained by receiver operating characteristic(ROC)curve analysis.Results Preoperative serum total PSA was positively correlated with SUVmax(r_(s)=0.622,P<0.001),PSMA-TV(r_(s)=0.385,P=0.027)and TL-PSMA(r_(s)=0.695,P<0.001),respectively.There were significant differences in SUVmax(Z=2.395,P=0.016)and TL-PSMA(Z=3.406,P=0.001)between Gleason score(GS)≤7 group and GS>7 group,and the area under the curve were 0.754(95%CI 0.575-0.993)and 0.861(95%CI 0.735-0.987),respectively.There were statistical differences in SUVmax(Z=−3.648,P<0.001)and TL-PSMA(Z=−0.257,P=0.009)between positive and negative of surgical margin status.The area under the curve were 0.881(95%CI 0.768-0.994)and 0.769(95%CI 0.609-0.0.930),respectively.There were statistical differences in TL-PSMA(Z=−2.115,−2.026;P=0.034,0.043)between the positive and negative groups with seminal vesicular invasion and regional lymphatic metastasis,and the area under the curve were 0.735(95%CI 0.566-0.903)and 0.753(95%CI 0.577-0.929),respectively.Conclusion The preoperative ^(68)Ga-PSMA PET/CT metabolic volume parameter such as TL-PSMA is correlated with several clinicopathological features of prostate cancer,and may provide more favorable value in predicting preoperative clinicopathological features of prostate cancer compared with conventional SUVmax.