首页|18F-PSMA-1007 PET/CT在前列腺癌诊断评估与治疗决策中的应用价值探索

18F-PSMA-1007 PET/CT在前列腺癌诊断评估与治疗决策中的应用价值探索

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目的 探讨18F标记的前列腺特异性膜抗原(PSMA)-1007显影剂PET/CT(18F-PSMA-1007 PET/CT)检查应用于前列腺癌(PCa)初诊及根治性前列腺切除术(RP)后随访中对诊断评估与治疗决策的价值。方法 采用回顾性观察性研究方法,分析2022年9月至2023年10月在该院接受18F-PSMA-1007 PET/CT检查的患者共68例,其中初诊患者36例、RP后随访生化失败的患者32例。共收集临床资料30项,包括基本临床特征8项、病理学相关特征7项和影像学特征15项。分别对初诊PCa和RP术后生化失败患者的临床特征进行描述性分析,采用Fisher确切概率法分析初诊PCa患者中不同临床亚组[诊断时不同总前列腺特异性抗原(tPSA)水平、不同mi-T分期、不同穿刺Gleason评分和不同病理类型]原发病灶的最大标准化摄取值(SUVmax)差异性,以及RP后生化失败患者中不同临床亚组(18F-PSMA-1007 PET/CT检查时不同tPSA、不同病理T分期、不同术后病理淋巴结侵犯情况和不同病理Gleason评分)复发病灶检出率的差异性,采用Spearman相关性检验分析阳性病灶的影像特征与tPSA的相关性。结果 初诊PCa患者中,1例前列腺增生、35例PCa,35例PCa患者确诊时不同tPSA水平(P=0。81)、不同mi-T分期(P=0。70)、不同穿刺时Gleason评分(P=0。20)和不同病理类型(P=0。71)中原发病灶SUVmax比较,差异无统计学意义。且确诊时tPSA与18F-PSMA-1007 PET/CT检出的转移灶个数呈正相关(r=0。410,P=0。01)。根据检查结果改变了 11例(31。43%)患者的临床治疗决策;在9例RP联合淋巴结清扫的患者中发现18F-PSMA-1007 PET/CT与MRI在淋巴结检出率的准确率、一致率均为100%。RP后生化失败患者中,整体复发病灶检出率71。88%(23/32),以术区原位复发11例(34。38%)和骨转移11例(34。38%)最常见。18F-PSMA-1007 PET/CT检查时不同tPSA水平(P=0。08)、不同病理T分期(P=0。10)、不同术后病理淋巴结侵犯情况(P=0。68)和不同病理Gleason评分(P=0。08)中18 F-PSMA-1007 PET/CT复发病灶检出率差异均无统计学意义。RP后生化失败18 F-PSMA-1007 PET/CT检查时复发病灶的tPSA与18F-PSMA-1007 PET/CT检出的复发病灶数目(r=0。48,P=0。01)、复发病灶SUVmax值(r=0。46,P=0。01)和复发病灶平均标准化摄取值(SUVmean)值(r=0。38,P=0。03)均呈正相关。根据检查结果改变中18例(56。25%)患者的临床治疗决策。结论 18F-PSMA-1007 PET/CT对初诊PCa的原发灶和转移灶、RP后生化失败的复发灶均具有很好的诊断价值和诊断效能。
Exploration on application value of 18F-PSMA-1007 PET/CT in diagnostic evaluation and treatment decision of prostate cancer
Objective To investigate the value of 18F labeled prostate-specific membrane antigen(18F-PSMA)-1007 developing agent PET/CT(18F-PSMA-1007PET/CT)examination in the diagnostic evaluation and therapeutic decision of the newly diagnosed prostate cancer(PCa)and follow up after radical prostatecto-my(RP).Methods This study adopted the retrospective observational study method.A total of 68 patients receiving 18 F-PSMA-1007 PET/CT examination in this hospital from September 2022 to October 2023 were analyzed,including 36 cases of newly diagnosed PCa and 32 cases of biochemistry follow up failure after RP.A total of 30 items of clinical data were collected,including 8 items of basic clinical characteristics,7 items of pa-thology-related characteristics and 15 items of imaging characteristics.The patients clinical characteristics in the newly diagnosed PCa and biochemical failure after RP conducted the descriptive analysis.The Fisher exact probability method was used to analyze the differentiation of the SUVmax of primary lesions in different clini-cal subgroups[different tPSA levels at diagnosis,different mi-T stages,different Gleason scores at postopera-tive pathological puncture and different pathological types]in the newly diagnosed PCa group and the differ-entiation of recurrent lesion detection rates in different clinical subgroups(different tPSA in 18F-PSMA-1007 PET/CT examination,different pathological T stages,different lymph node invasion and different pathological Gleason scores in the biochemical failure after RP group.The Spearman correlation was adopted to test and analyze the correlation between the imaging features of positive lesions and tPSA.Results In the newly diag-nosed PCa group,there were 1 case of prostatic hyperplasia and 35 cases of PCa.SUVmax had no statistical differences among the primary lesions with different tPSA levels(P=0.81),different mi-T stages(P=0.70),different puncture Glleasonscores(P=0.20)and different pathological types(P=0.71).Moreover the tPSA value at diagnosis was positively correlated with the number of metastatic lesions(r=0.410,P=0.01).The clinical treatment decisions in 11 cases(31.43%)were changed according to the examination re-sults.In 9 cases of RP combined with lymph node dissection,the accuracy rate and concordance rate of 18F-PS-MA-1007 PET/CT and MRI in the lymph node detection rate all were 100%.I n the biochemical failure after RP group,the overall recurrent lesion detection rate was 71.88%(23/32),the operative area in situ recurrence(11 cases,34.38%)and bone metastasis(11 cases,34.38%)were most common.The differences of 18F-PS-MA-1007 PET/CT recurrent lesions detection rates had no statistical differences among the patients with dif-ferent tPSA levels(P=0.08),different pathological T stages(P=0.10),different postoperative pathological lymph node invasions(P=0.68)and different pathologic Gleason score in the 18F-PSMA-1007 PET/CT ex-amination.In the 18 F-PSMA-1007 PET/CT examination in the biochemical failure after RP,the tPSA value in the recurrent lesion was positively correlated with the number of recurrent lesions(r=0.48,P=0.01),SUVmax value in the recurrent lesion(r=0.46,P=0.01)and the SUVmean value(r=0.38,P=0.03).The clinical treatment decision in 18 cases(56.25%)was changed according to the examination results.Conclusion 18 F-PSMA-1007 PET/CT has good diagnostic value and efficiency for primary lesion and metastasis lesion of new-ly diagnosed PCa and recurrent foci of biochemical failure after RP.

prostate cancerprostate-specific membrane antigenPET/CTdiagnosistreatment

陈剑、陈启铭、陈晓、夏仁祥、汪泽、金俊豪、严旭芝、刘秋礼、舒泽华、张尧、张军、王洛夫、兰卫华、江军

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陆军特色医学中心泌尿外科,重庆 400042

陆军特色医学中心核医学科,重庆 400042

前列腺癌 前列腺特异性膜抗原 PET/CT 诊断 治疗

2024

重庆医学
重庆市卫生信息中心,重庆市医学会

重庆医学

CSTPCD
影响因子:1.797
ISSN:1671-8348
年,卷(期):2024.53(22)