^(18)F-PSMA PET/CT联合双参数磁共振对根治性前列腺切除术后病理升级的预测价值

Combining 18F-PSMA PET/CT and biparametric MRI predicts pathological upgrading after radical prostatectomy for prostate cancer

目的探讨^(18)F-前列腺特异性膜抗原(PSMA)PET/CT的最大标准摄取值(SUV_(max))联合双参数磁共振(bpMRI)的最小表观扩散系数(ADC_(min))对预测根治性前列腺切除术(RP)后病理升级的应用价值。方法回顾性分析2019年4月至2023年10月北京医院收治的89例局限性前列腺癌患者的资料。年龄(68.4±7.0)岁,前列腺特异性抗原(PSA)7.7(5.4,12.9)ng/ml,前列腺体积34.6(26.9,47.1)ml,肿瘤直径1.3(1.0,1.8)cm。前列腺影像报告和数据系统(PI-RADS)评分5分29例(32.6%),临床分期≥T_(3)期13例(14.6%)。靶向穿刺国际泌尿病理学会(ISUP)分级分组1组31例(34.8%),2组36例(40.4%),3组11例(12.4%),4组11例(12.4%)。所有患者在RP术前均接受^(18)F-PSMAPET/CT和bpMRI检查,以病理大切片中Cleason评分最高的病灶为主要病灶,分别勾画主要病灶的感兴趣区域,并通过软件计算SUV_(max)和ADC_(min)值。病理升级定义为RP术后主要病灶ISUP分级分组高于靶向穿刺ISUP分级分组。比较病理升级组与病理未升级组患者的临床资料。采用Spearman相关系数分析SUV_(max)与ADC_(min)之间的相关性。采用多因素logistic回归分析评估各因素对病理升级的影响。采用受试者工作特征(ROC)曲线分析各指标预测病理升级的价值。结果89例中,共31例出现病理升级,发生率为34.8%(31/89)。病理升级组较病理未升级组的SUV_(max)[11.3(8.1,16.4)与6.7(4.6,9.2)]、SUV_(max)/ADC_(min)比值[3.1(2.0,4.6)与1.4(0.9,2.1)]、PSA[9.8(6.3,15.6)ng/ml与7.1(5.1,10.5)ng/ml]PSA密度[0.3(0.2,0.5)ng/m^(2)与0.2(0.1,0.3)ng/m^(2)]和RP术后ISUP分级分组[≥3组17例(54.8%)与13例(22.4%)]更高,而ADC_(min)[3.8(3.0,5.3)×10^(-4)mm^(2)/s与5.2(3.6,6.1)×10^(-4)mm^(2)/s]和靶向穿刺ISUP分级分组[≤2组27例(87.1%)与40例(69.0%)]更低(均P<0.05)。Spearman相关性分析结果显示SUV_(max)与ADC_(min)之间存在负相关(R=-0.227,P=0.032)。多因素logistic回归分析结果显示,SUV_(max)(OR=1.108,95%CI 1.020~1.238)、ADC_(min)(OR=0.607,95%CI 0.390~0.874)、SUV_(max)/ADC_(min)比值(OR=1.815,95%CI1.282~2.949)是前列腺癌病理升级的独立预测因素。SUV_(max)/ADC_(min)比值预测病理升级的ROC曲线下面积(AUC=0.817)高于SUV_(max)(AUC=0.774)和ADC_(min)(AUC=0.686),预测效能更高。结论SUV_(max)、ADC_(min)、SUV_(max)/ADC_(min)比值均可独立预测前列腺癌靶向穿刺病理升级,但SUV_(max)/ADC_(min)比值预测病理升级的价值更高。

Objective To investigate the application value of the maximum standardized uptake value(SUV_(max))of ^(18)F prostate-specific membrane antigen(PSMA)PET/CT combined with the minimum apparent diffusion coefficient(ADC_(min))of biparametric magnetic resonance imaging(bpMRI)in predicting pathological upgrading after radical prostatectomy(RP)for prostate cancer.Methods The data of 89 patients with localized prostate cancer treated at Beijing Hospital from April 2019 to October 2023 were retrospectively analysed.The average age of patients was(68.4±7.0)years old,with prostate-specific antigen(PSA)level of 7.7(5.4,12.9)ng/ml,prostate volume of 34.6(26.9,47.1)ml,tumor diameter of 1.3(1.0,1.8)cm,prostate imaging reporting and data system(PI-RADS)score of 5 in 29 cases(32.6%),clinical stage≥T,in 13 cases(14.6%).There were 31 cases(34.8%)in group 1 of targeted biopsy International Society of Urological Pathology(ISUP)grading groups,36 cases(40.4%)in group 2,11 cases(12.4%)in group 3,and 11 cases(12.4%)in group 4.All patients underwent ^(18)F-PSMA PET/CT and bpMRI examinations before RP.The index lesion,identified as the highest Gleason score in pathological whole-mount sections,were outlined.SUV_(max) and ADC_(min) values were calculated from the images'region of interest.Pathological upgrading was defined as the post-RP grade group higher than the targeted-biopsy grade group.Clinical data of patients with and without pathological upgrading were compared.Spearman correlation coefficient analysis was used to assess the correlation between SUV_(max) and ADC_(min).Multivariate logistic regression analysis was conducted to evaluate the factors influencing pathological upgrading.Receiver operating characteristic(ROC)curve analysis was employed to assess the predictive value of each indicator for pathological upgrading.Results Among the 89 cases,31 cases(34.8%)experienced pathological upgrading.Compared with the patients without pathological upgrading,the SUV_(max)[11.3(8.1,16.4)vs.6.7(4.6,9.2)],SUV_(max)/ADC_(min) ratio[3.1(2.0,4.6)vs.1.4(0.9,2.1)],PSA[9.8(6.3,15.6)ng/ml vs.7.1(5.1,10.5)ng/ml],PSA density[0.3(0.2,0.5)ng/ml vs.0.2(0.1,0.3)ng/m^(2)],and post-RP ISUP grade group[≥3 group 17 cases(54.8%)vs.13 cases(22.4%)Jwere higher in patients with pathological upgrading,while ADC_(min)[3.8(3.0,5.3)×10^(-4)mm^(2)/s vs.5.2(3.6,6.1)×10^(-4)mm^(2)/s]and targeted biopsy ISUP grade group[≤2 group 27 cases(87.1%)vs.40 cases(69.0%)J were lower(all P<0.05).Spearman analysis showed a negative correlation between SUV_(max) and ADC_(min)(R=-0.227,P=0.032).Multivariate logistic regression analysis revealed that SUV_(max)(OR=1.108,95%CI1.020-1.238),ADC_(min)(OR=0.607,95%CI 0.390-0.874),and SUV_(max)/ADC_(min) ratio(OR=1.815,95%CI 1.282-2.949)independently predicted pathological upgrading.The AUC of the SUV_(max)/ADC_(min) ratio for predicting pathological upgrading(AUC=0.817)was higher than that of SUV_(max)(AUC=0.774)and ADC_(min)(AUC=0.686),indicating a higher predictive efficiency.Conclusions SUV_(max),ADC_(min),and SUV_(max)/ADC_(min) ratio can independently predict pathological upgrading in targeted biopsy of prostate cancer.The SUV_(max)/ADC_(min) ratio has a stronger predictive value for pathological upgrading.