18F-前列腺特异性膜抗原PET/CT不同表达参数对老年人前列腺癌转移风险的预测价值

The predictive value of ^(18)F-PSMA PET/CT-derived prostate specific membrane antigen expression parameters for the risk of metastasis in elderly prostate cancer patients

目的探讨18F-前列腺特异性膜抗原(PSMA)PET/CT各种表达参数包括肿瘤最大标准化摄取值(SUVmax)、PSMA受体表达体积(PSMA-TV)、所有前列腺癌病灶PSMA受体表达量(TL-PSMA)对60岁及以上老年人前列腺癌转移风险的预测价值.方法回顾性分析2019年1月至2021年5月北京医院收治的39例经病理确诊为前列腺癌患者的临床资料及同期治疗前18F-PSMA PET/CT的影像资料.以SUVmax的40%作为阈值测量前列腺癌病灶的SUVmax、PSMA-TV和TL-PSMA.评价18F-PSMA PET/CT对临床TNM分期的影响,比较有、无转移组间各指标包括总前列腺特异性抗原(tPSA)水平、Gleason评分及PSMA表达参数的差异,分析PSMA表达参数与tPSA和Gleason评分的相关性,用受试者工作特征(ROC)曲线下面积(AUC)判断不同指标对前列腺癌转移风险的预测能力,采用多因素Logistic回归分析筛选前列腺癌转移的独立预测指标.结果39例前列腺癌患者(年龄60~83岁,中位年龄67岁)的中位Gleason评分为7.0(7.0,8.0)分,中位PSA水平为14.83(7.37,30.93)μg/L.发生转移的有11例(转移组,28.2%),未发生转移的有28例(无转移组,71.8%).PET/CT改变了5例(12.8%)患者的临床N、M分期,但也漏诊了2例(5.1%)患者的盆腔淋巴结转移.转移组和无转移组的中位年龄分别为63(60~79)岁和69(60~83)岁,差异无统计学意义(P=0.115).转移组和无转移组tPSA分别为54.0(9.9,75.8)μg/L和10.2(6.8,22.8)μg/L,SUVmax分别为29.1(16.8,35.3)和7.7(6.0,13.6),PSMA-TV分别为41.5(22.4,90.9)cm3和6.8(3.6,9.3)cm3,TL-PSMA分别为279(139.7,996.4)和25.5(15.9,37.0),Gleason评分分别为8.0(7.0,8.0)分和7.0(7.0,8.0)分,其中tPSA(Z=-2.528,P=0.011)、SUVmax(Z=-4.151,P<0.001)、PSMA-TV(Z=-3.995,P<0.001)以及TL-PSMA(Z=-4.213,P<0.001)差异具有统计学意义;SUVmax(r=0.537,P<0.01)、PSMA-TV(r=0.496,P<0.01)和TL-PSMA(r=0.508,P<0.01)均与tPSA呈正相关,SUVmax(r=0.547,P<0.01)、PSMA-TV(r=0.412,P<0.01)和TL-PSMA(r=0.433,P<0.01)亦均与Gleason评分呈正相关;ROC曲线分析显示SUVmax、PSMA-TV、TL-PSMA和tPSA预测前列腺癌转移的AUC分别为0.932、0.916、0.938和0.763;多因素Logistic回归分析结果显示SUVmax(OR=1.203,95%CI:1.001~1.445,P=0.049)是前列腺癌转移的独立预测因子.结论18F-PSMA PET/CT PSMA表达参数对老年人前列腺癌转移风险具有良好的预测价值,其中SUVmax可作为独立预测前列腺癌转移的一个潜在分子影像学指标.

Objective To investigate the value of 18F-PSMA PET/CT-derived prostate specific membrane antigen(PSMA)expression parameters,including maximum standardize uptake value(SUVmax),PSMA receptor expressing tumor volume(PSMA-TV),and total lesion PSMA receptor expression(TL-PSMA),in predicting the risk of metastasis in elderly prostate cancer patients aged 60 years and older.Methods Clinical data of 39 patients with prostate cancer diagnosed in our hospital from January 2019 to May 2021 and imaging data of 18F-PSMA PET/CT before treatment were analyzed retrospectively.PSMA-TV and TL-PSMA of primary tumor tissue were calculated from PET/CT images with 40%of the SUVmax as the threshold value.The influence of 18F-PSMA PET/CT on clinical TNM staging was evaluated.The Mann-Whitney U test was used to compare the differences in values of various indicators between the groups with or without metastasis,including the total prostate-specific antigen(tPSA)level,Gleason score and PSMA expression parameters.The correlation of PSMA expression parameters with tPSA and Gleason score was analyzed.The area under the receiver operating characteristic(ROC)curve(AUC)was used to determine the predictive ability of different indicators for the risk of prostate cancer metastasis,and multivariate logistic regression analysis was used to screen for independent predictors of prostate cancer metastasis.Results The Gleason score of 39 prostate cancer patients(median age:67 years,age range:60-83 years)was 7.0(7.0,8.0),and the median prostate specific antigen(PSA)level was 14.83(7.37,30.93)μg/L.There were 11 cases(28.2%)with metastasis(the metastasis group),and 28 cases(71.8%)without metastasis(the non-metastasis group).Based on PET/CT,the clinical N and M stages of five patients(12.8%)were changed,but two cases(5.1%)with pelvic lymph node metastasis were missed.The median ages of the metastasis group and the non-metastasis group were 63(60-79)years and 69(60-83)years,respectively,and the difference was not statistically significant(P=0.115).The metastasis group and the non-metastasis group had tPSA levels at 54.0(9.9,75.8)μg/L and 10.2(6.8,22.8)μg/L,the SUVmax at 29.1(16.8,35.3)and 7.7(6.0,13.6),the PSMA-TV at 41.5(22.4,90.9)cm3 and 6.8(3.6,9.3)cm3,TL-PSMA at 279(139.7,996.4)and 25.5(15.9,37.0),Gleason scores at 8.0(7.0,8.0)and 7.0(7.0,8.0),respectively.There were statistically significant differences in tPSA(Z=-2.528,P=0.011),SUVmax(Z=-4.151,P<0.001),PSMA-TV(Z=-3.995,P<0.001)and TL-PSMA(Z=-4.213,P<0.001)between the two groups.SUVmax(r=0.537,P<0.01),PSMA-TV(r=0.496,P<0.01)and TL-PSMA(r=0.508,P<0.01)were all positively correlated with tPSA.Furthermore,SUVmax(r=0.547,P<0.01),PSMA-TV(r=0.412,P<0.01)and TL-PSMA(r=0.433,P<0.01)were also positively correlated with Gleason score.ROC curve analysis showed that the AUCs of SUVmax,PSMA-TV,TL-PSMA and tPSA in predicting prostate cancer metastasis were 0.932,0.916,0.938 and 0.763,respectively.Multivariate Logistic regression analysis showed that SUVmax(OR=1.203,95%CI:1.001-1.445,P=0.049)was an independent predictor of prostate cancer metastasis.Conclusions These PSMA expression parameters of 18F-PSMA PET/CT have a good value in predicting the risk of metastasis in elderly prostate cancer patients,and SUVmaxmay serve as a potential molecular imaging indicator to independently predict prostate cancer metastasis.