基于^(68)Ga-PSMA-11 PET/CT和mpMRI构建临床模型预测前列腺单独靶向穿刺的准确性

A clinical prediction model based on ^(68)Ga-PSMA-11 PET/CT and mpMRI parameters to determine the diagnostic accuracy of targeted biopsy alone in prostate cancer population

目的基于^(68)Ga-前列腺特异性膜抗原(PSMA)-11正电子发射断层扫描/计算机断层扫描(PET/CT)和多参数核磁共振(mpMRI)构建临床预测模型,帮助临床实现对需行前列腺穿刺的可疑临床显著性前列腺癌(csPCa)患者进行合理分层以避免不必要的系统穿刺。方法回顾性收集南京大学医学院附属鼓楼医院2020年1月-2023年2月在前列腺靶向穿刺联合系统穿刺前接受了^(68)Ga-PSMA-11 PET/CT和mpMRI扫描的96例可疑csPCa患者,纳入^(68)Ga-PSMA-11 PET/CT中的最大标准摄取值(SUVmax)和mpMRI中的最小表观扩散系数(ADCmin)以及其他临床参数,通过单因素和多因素logistic回归分析,确定单独靶向穿刺有效诊断的独立预测因子,并根据这些参数构建临床预测模型。结果多因素logistic回归分析显示SUVmax(OR=0.878,95%CI:0.804~0.959,P=0.004)和ADCmin(OR=1.005,95%CI:1.001~1.010,P=0.027)是单独靶向穿刺有效诊断的独立预测因子。以SUVmax和ADCmin构建的临床预测模型的灵敏度、特异度、准确性及受试者工作特征曲线下面积(AUC)值分别为0.80、0.80、0.83、0.84。结论基于^(68)Ga-PSMA-11 PET/CT和mpMRI参数构建的临床预测模型有助于提高单独靶向穿刺的有效诊断,根据该模型对可疑csPCa患者进行合理分层,安全避免系统穿刺,有效平衡获益和风险。

Objective To develop a clinical prediction model based on ^(68)Ga-prostate-specific membrane antigen-11(^(68)Ga-PSMA-11),positron emission tomography/computed tomography(PET/CT)and multiparametric magnetic resonance imaging(mpMRI)parameters to stratify prostate cancer patients undergoing targeted biopsy,so as to avoid unnecessary systematic biopsy.Methods A total of 96 clinically significant prostate cancer(csPCa)patients who underwent ^(68)Ga-PSMA-11 PET/CT and mpMRI prior to prostate targeted biopsy with systematic biopsy during Jan.2020 and Feb.2023 in Nanjing Drum Tower Hospital were retrospectively analyzed.By univariate and multivariate logistic regression analyses,maximum standard uptake value(SUVmax)in 68 Ga-PSMA-11 PET/CT and minimum apparent diffusion coefficien(ADCmin)in mpMRI,as well as clinical parameters were evaluated to identify the independent predictors correlative with the effective diagnosis of targeted biopsy,and a clinical prediction model was constructed.Results Multivariate logistic regression analysis showed that SUVmax(OR=0.878,95%CI:0.804-0.959,P=0.004)and ADCmin(OR=1.005,95%CI:1.001-1.010,P=0.027)were independent predictors of the effective diagnosis of targeted biopsy alone.The sensitivity,specificity,accuracy and area under the receiver operator characteristic curve(AUC)of the model were 0.80,0.80,0.83 and 0.84,respectively.Conclusion The clinical prediction model based on ^(68)Ga-PSMA-11 PET/CT and mpMRI parameters is helpful to improve the effective diagnosis of targeted biopsy alone,and has practical value to stratify patients with csPCa so as to safely avoid systematic biopsy and effectively balance the benefits and risks.