PSMA-PET/CT对寡转移前列腺癌的诊断和预后预测价值研究

Study on the diagnostic and prognostic predictive value of PSMA⁃PET/CT for oligometastatic prostate cancer

目的评估PSMA-PET/CT在接受新辅助治疗的寡转移前列腺癌患者中诊断及预后预测效能。方法回顾性纳入初治寡转移前列腺癌男性患者共50名,所有患者在基线时接受PSMA-PET/CT检查和其他评估,并接受4~6周期新辅助内分泌治疗合并化疗后,全麻下行机器人辅助下前列腺癌根治术加盆腔淋巴结清扫术,术后患者继续接受内分泌治疗。计算并比较PSMA-PET/CT成像特征与其他临床特征的关系,使用Logistic回归分析各临床因素对预后的影响。结果PSA各水平组和各ISUP评分组间的SUVmax无显著差异;转移局限于盆腔组与出现盆腔外转移患者的SUVmax水平具有显著差异(21.01 vs 47.06,P=0.0059);单因素Logistic回归显示,SUVmax(OR=1.032,95%CI=1.002~1.063,P=0.040)和PSMA-PET/CT发现转移病灶是否位于盆腔范围内(OR=5.630,95%CI=1.648~19.232,P=0.006)与预后显著相关;多因素Logistic回归显示,PSMA-PET/CT发现转移病灶是否位于盆腔范围内(OR=3.879,95%CI=1.066~14.121,P=0.040)是预后预测的独立因素。结论PSMA-PET/CT能更准确估计转移范围,其成像结果也可以在一定程度上预测患者手术后的中短期预后。本文可为制定个性化精准化的治疗方案提供参考。

Objective To evaluate the diagnostic and prognostic efficacy of PSMA⁃PET/CT in patients with oligometastatic prostate cancer receiving neoadjuvant therapy.Methods A total of 50 men with de novo oligometastatic prostate cancer were retrospectively enrolled.All patients underwent PSMA⁃PET/CT and other assessments at baseline and received 4⁃6 cycles of neoadjuvant androgen deprivation combined with chemotherapy,followed by robotic⁃assisted radical prostatectomy with pelvic lymph node dissection under general anesthesia,after which patients continued to receive androgen deprivation therapy.The relationship between PSMA⁃PET/CT imaging and other clinical factors was compared,and the influence of each clinical factor on prognosis was analyzed using Logistic regression.Results There was no significant difference in SUVmax level between the PSA level groups and the ISUP score groups.There was a significant difference in SUVmax level between the pelvic confined group and extrapelvic group(21.01 vs.47.06,P=0.0059).Univariate Logistic regression showed that SUVmax(OR=1.032,95%CI=1.002⁃1.063,P=0.040)and whether pelvic confined or not(based on PSMA⁃PET/CT)(OR=5.630,95%CI=1.648⁃19.232,P=0.006)were significantly associated with prognosis.Multivariate Logistic regression revealed that whether pelvic confined or not(based on PSMA⁃PET/CT)was an independent predicting factor of prognosis(OR=3.879,95%CI=1.066⁃14.121,P=0.040).Conclusion The PSMA⁃PET/CT can more accurately estimate the site of metastasis,and also predict the short⁃and medium⁃term post⁃operation prognosis outcomes to a certain extent,which provides a reference for the development of individualized treatment regime.