定量ADC联合Gleason评分与前列腺癌骨转移和淋巴结转移的相关性研究

Correlation between quantitative ADC combined with Gleason score and bone metastasis and lymph node metastasis of prostate cancer

目的探讨表观扩散系数(apparent diffusion coefficient,ADC)与前列腺癌(prostate cancer,PCa)骨转移和淋巴结转移的相关性。方法选择2017年4月~2020年10月哈尔滨医科大学附属第四医院就诊的经病理证实为前列腺癌患者73例,既往均行前列腺3.0T磁共振扫描。查看病理结果记录Gleason评分,测量病灶的ADC值,探究病灶ADC值与Gleason评分的相关性,并分析ADC值、Gleason评分与PCa骨转移和淋巴结转移发生的相关性。结果Gleason评分≤7分的中低危组19例,其ADC值为(1.17±0.368)×10^(-3)mm^(2)/s,评分≥8分的高危组54例,其ADC值为(0.77±0.249)×10^(-3)mm^(2)/s,ADC值与Gleason评分呈负相关,组间差异有统计学意义(P<0.05)。患者中骨转移组14例,ADC值为(0.74±0.270)×10^(-3)mm^(2)/s,无骨转移组59例,ADC值为(0.95±0.359)×10^(-3)mm^(2)/s,骨转移组的ADC值明显低于无骨转移组,两组间差异有统计学意义(P<0.05)。当ADC截断值为0.835×10^(-3)mm^(2)/s时,ROC曲线下面积为为0.666,敏感度为0.576,特异性为0.778;ADC联合Gleason评分预测该组的AUC为0.714,敏感度为0.857,特异性为0.542。患者中淋巴结转移组19例,ADC值约为(0.74±0.258)×10^(-3)mm^(2)/s,无淋巴结转移组54例,ADC值为(0.96±0.363)×10^(-3)mm^(2)/s,淋巴结转移组的ADC值明显低于无骨转移组,组间差异有统计学意义(P<0.05);ADC联合Gleason评分预测该组的AUC为0.787,敏感度为0.929,特异性为0.441。结论定量ADC与PCa骨转移及淋巴结转移之间均有较好的相关性,联合Gleason评分可提高预测PCa转移的敏感度。

Objective To explore the correlation between apparent diffusion coefficient(ADC)of MRI diffusion weighted imaging and prostate cancer(PCa)bone metastasis and lymph node metastasis.Methods A total of 73 patients with PCa confirmed pathologically in the Fourth Affiliated Hospital of Harbin Medical University from April 2017 to October 2020 were retrospectively selected.All of them underwent prostate 3.0 T magnetic resonance scanning in the past.Gleason score and the ADC value were recorded according to the pathological results.The correlation between ADC value,Gleason score and PCa bone metastasis and lymph node metastasis were analyzed subsequently.Results A total of 19 cases in the low-and medium-risk group with Gleason score≤7 had ADC values of(1.17±0.368)×10^(-3)mm^(2)/s,and 54 cases in the high-risk group with Gleason scores≥8 had ADC values of(0.77±0.249)×10^(-3)mm^(2)/s.The ADC value was negatively correlated with the Gleason score,and there was a significant difference between the two groups(P<0.05).Among the patients,there were 14 cases in the bone metastasis group,the ADC value was(0.74±0.270)×10^(-3)mm^(2)/s,and 59 cases in the non-bone metastasis group,the ADC value was(0.95±0.359)×10^(-3)mm^(2)/s.The ADC value of the bone metastasis group was significantly lower than that of the non-bone metastasis group,and there was a significant difference between the two groups(P<0.05).When the ADC cutoff value was 0.835×10^(-3)mm^(2)/s,the area under the ROC curve was 0.666,the sensitivity was 0.576,and the specificity was 0.778.The ADC combined with Gleason score predicted group’s AUC was 0.714,the sensitivity was 0.857,and the specificity was 0.542.Among the patients,there were 19 cases in the lymph node metastasis group,with an ADC value of about(0.74±0.258)×10^(-3)mm^(2)/s,and 54 cases in the non-lymph node metastasis group,with an ADC value of(0.96±0.363)×10^(-3)mm^(2)/s.The ADC value of the lymph node metastasis group was significantly lower than that of non-bone metastasis group,there was a significant difference between the two groups(P<0.05);the ADC combined with Gleason score predicted the group’s AUC was 0.787,the sensitivity was 0.929,and the specificity was 0.441.Conclusion There is a good correlation between quantitative ADC and PCa bone metastasis and lymph node metastasis,and combined with Gleason score greatly could improve the sensitivity of predicting PCa metastasis.