Nectin‑4靶向探针68Ga‑N188在胰腺癌诊断中的应用价值

Application value of Nectin‐4 targeting radiotracer 68Ga-N188 in the diagnosis of pancreatic cancer

目的探讨Nectin‑4靶向探针68Ga‑N188在胰腺癌诊断中的应用价值。方法采用前瞻性研究方法。选取2022年8—12月北京大学第一医院收治的16例经增强CT检查诊断为胰腺癌患者的临床病理资料;男9例,女7例;年龄为(62±8)岁。患者均行18氟‑脱氧葡萄糖(18F‑FDG)和68Ga‑N188正电子发射断层显像(PET)/CT检查。观察指标:(1)68Ga‑N188在患者不同组织和肿瘤原发灶中的分布。(2)胰腺肿瘤中Nectin‑4的表达和68Ga‑N188的摄取。(3)68Ga‑N188与18F‑FDG的PET/CT检查结果比较。正态分布的计量资料以x±s表示,组间比较采用独立样本t检验。计数资料以绝对数或百分率表示。结果(1)68Ga‑N188在患者不同组织和肿瘤原发灶中的分布。PET/CT检查结果显示:注射后1 h,68Ga‑N188在16例患者脂肪、肌肉、皮肤、脑组织中的最大标准摄取值(SUVmax)和平均标准摄取值(SUVmean)分别为0.40±0.16和0.25±0.09、0.68±0.20和0.44±0.12、0.39±0.14和0.28±0.11、0.09±0.04和0.05±0.02;在食管、肝脏、脾脏、胰腺组织中,上述指标分别为1.53±0.48和1.16±0.31、1.49±0.45和0.91±0.30、1.40±0.30和1.02±0.24、1.24±0.31和0.96±0.25;在肿瘤原发灶中,上述指标分别为3.28±1.02和2.14±0.62,与胰腺组织比较,差异均有统计学意义(t=8.03,6.75,P<0.05)。肿瘤原发灶中,基于SUVmax的肿瘤背景比为1.82±0.58。(2)胰腺肿瘤中Nectin‑4的表达和68Ga‑N188的摄取。免疫组织化学染色结果显示:16例患者中,Nectin‑4高表达7例,低表达9例。PET/CT检查结果显示:7例Nectin‑4高表达和9例低表达患者肿瘤原发灶中,68Ga‑N188的SUVmax分别为3.77±1.10和2.64±0.68,两者比较,差异有统计学意义(t=2.64,P<0.05)。18F‑FDG在7例Nectin‑4高表达和9例低表达患者肿瘤原发灶中的SUVmax分别为6.73±3.24和6.43±3.45,两者比较,差异无统计学意义(t=0.17,P>0.05)。(3)68Ga‑N188与18F‑FDG的PET/CT检查结果比较。16例患者中,14例经术后组织病理学检查诊断为胰腺癌患者肿瘤原发灶68Ga‑N188和18F‑FDG PET/CT检查阳性分别为14例和11例;其中3例经化疗后评估疗效胰腺癌患者肿瘤原发灶68Ga‑N188和18F‑FDG PET/CT检查阳性分别为3例和1例。3例接受化疗和11例未接受化疗胰腺癌患者肿瘤原发灶18F‑FDG的SUVmax分别为2.80±0.69和6.97±2.11,两者比较,差异有统计学意义(t=3.29,P<0.05),68Ga‑N188的SUVmax分别为3.38±1.12和2.93±0.50,两者比较,差异无统计学意义(t=0.66,P>0.05)。6例经术后组织病理学检查诊断有淋巴结转移胰腺癌患者淋巴结转移灶68Ga‑N188和18F‑FDG PET/CT检查阳性分别为6例和4例,转移灶中68Ga‑N188和18F‑FDG的SUVmax分别为2.25±1.12和4.02±1.27。结论68Ga‑N188 PET/CT检查可用于胰腺癌原发灶和淋巴结转移灶影像学诊断。

Objective To investigate the application value of nectin‐4 targeting radiotracer 68Ga‐N188 in the diagnosis of pancreatic cancer.Methods The prospective study was conducted.The clinicopathologic data of 16 patients diagnosed as pancreatic cancer on enhanced computed tomography(CT)who were admitted to the Peking University First Hospital from August to December 2022 were collected.There were 9 males and 7 females,aged(62±8)years.All patients underwent 18F‐flurodeoxyglucose(18F‐FDG)and 68Ga‐N188 positron emission tomography(PET)/CT examina‐tion.Observation indicators:(1)distribution of 68Ga‐N188 in different tissues and tumor primary lesion of patients;(2)expression of Nectin‐4 and uptake of 68Ga‐N188 in pancreatic cancer;(3)com‐parison of examination results between 68Ga‐N188 and 18F‐FDG PET/CT.Measurement data with nor‐mal distribution were represented as Mean±SD,and comparison between groups was conducted using the independent sample t test.Count data were described as absolute numbers or percentages.Results(1)Distribution of 68Ga‐N188 in different tissues and tumor primary lesion of patients.Results of PET/CT examination showed that in 1 hour after injection,the maximum standard uptake value(SUVmax)and mean standard uptake value(SUVmean)of 68Ga‐N188 in fat,muscle,skin,and brain tissues of 16 patients were 0.40±0.16 and 0.25±0.09,0.68±0.20 and 0.44±0.12,0.39±0.14 and 0.28±0.11,0.09±0.04 and 0.05±0.02,respectively.In the tissues of the esophagus,liver,spleen,and pancreas,the above indicators were 1.53±0.48 and 1.16±0.31,1.49±0.45 and 0.91±0.30,1.40±0.30 and 1.02±0.24,1.24±0.31 and 0.96±0.25,respectively.In tumor primary lesion,the above indicators were 3.28±1.02 and 2.14±0.62,respectively,showing significant differences in SUVmax and SUVmean compared with pancreatic tissue(t=8.03,6.75,P<0.05).The tumor background ratio in tumor pri‐mary lesion based on SUVmax was 1.82±0.58.(2)Expression of Nectin‐4 and uptake of 68Ga‐N188 in pancreatic cancer.Results of immunohistochemical staining in 16 patients showed that there were 7 patients with high Nectin‐4 expression and 9 patients with low Nectin‐4 expression.Results of PET/CT examination showed that the SUVmax of 68Ga‐N188 in tumor primary lesion of the 7 patients with high Nectin‐4 expression and 9 patients with low Nectin‐4 expression were 3.77±1.10 and 2.64±0.68,showing a significant difference between them(t=2.64,P<0.05).The SUVmax of 18F‐FDG in tumor primary lesion of the 7 patients with high Nectin‐4 expression and 9 patients with low Nectin‐4 expression were 6.73±3.24 and 6.43±3.45,showing no significant difference between them(t=0.17,P>0.05).(3)Comparison of examination results between 68Ga‐N188 and 18F‐FDG PET/CT.Of the 16 patients,cases with positive results of tumor primary lesion on 68Ga‐N188 and 18F‐FDG PET/CT were 14 and 11,respectively,for the 14 pancreatic cancer patients diagnosed by postoperative histo‐pathology.Among them,cases with positive results of tumor primary lesion on 68Ga‐N188 and 18F‐FDG PET/CT were 3 and 1 for the 3 pancreatic cancer patients receiving evaluation for chemotherapy.The SUVmax of 18F‐FDG in tumor primary lesion of the 3 patients with chemotherapy and the 11 patients without chemotherapy were 2.80±0.69 and 6.97±2.11,showing a significant difference between them(t=3.29,P<0.05).The SUVmax of 68Ga‐N188 in tumor primary lesion of the 3 patients with chemo‐therapy and the 11 patients without chemotherapy were 3.38±1.12 and 2.93±0.50,showing no sig‐nificant difference between them(t=0.66,P>0.05).Cases with positive results of lymph node metas‐tases in 68Ga‐N188 and 18F‐FDG PET/CT were 6 and 4,respectively,for the 6 pancreatic cancer patients diagnosed with lymph node metastases by postoperative histopathology,and the SUVmax of 68Ga‐N188 and 18F‐FDG in lymph node metastases were 2.25±1.12 and 4.02±1.27.Conclusion 68Ga‐N188 PET/CT can be used for imaging diagnosis of tumor primary lesion and lymph node metastases of pancreatic cancer.