18F-前列腺特异性膜抗原PET/CT在tPSA≤20ng/mL前列腺癌患者转移灶检出的应用价值及预测因素
The application value and predictors of 18 F-PSMA PET/CT on the metastatic lesions of prostate cancer with tPSA≤20 ng/mL
郑安琪 1王卓楠 1董伟璇 1李运轩 1李磊 2贺大林 2吴开杰 2段小艺1
作者信息
- 1. 西安交通大学第一附属医院PET-CT室,陕西西安 710061
- 2. 西安交通大学第一附属医院泌尿外科,陕西西安 710061
- 折叠
摘要
目的 探索18F-前列腺特异性膜抗原(PSMA)PET/CT 对血清总前列腺特异性抗原(tPSA)≤20 ng/mL 前列腺癌患者转移灶检出的应用价值以及影响成像结果的临床预测变量,并建立PET/CT阳性预测列线图.方法 回顾性收集 2020 年 1 月—2021 年 10 月于西安交通大学第一附属医院泌尿外科行前列腺穿刺活检病理证实为前列腺癌、并行18 F-PSMA PET/CT 成像的175 例患者的影像、病理、血清学指标等临床资料.依据PET/CT成像结果分为转移组和非转移组,计算阳性检出率.采用单因素和多因素logistic回归分析确定18 F-PSMA PET/CT成像对tPSA≤20 ng/mL前列腺癌转移灶阳性检出的独立影响因素,并建立预测列线图.结果 175 例 tPSA≤20 ng/mL的前列腺癌患者中,18 F-PSMA PET/CT 检测出转移灶 78 例,未检出转移灶 97例,阳性率为 44.6%(78/175);有无尿路系统症状、PET/CT检查同期有无行雄激素剥夺(ADT)治疗及 Gleason(GS)评分危险程度在转移组和未转移组间差异有统计学意义(P<0.05).单因素 logistic 回归显示,尿路系统症状(OR=3.64,P<0.001)、GS评分危险程度(OR=3.96,P<0.001)及同期行 ADT治疗(OR=3.71,P<0.001)与转移灶阳性检出率有关;多因素 logistic 回归亦显示尿路系统症状(OR=3.19,P=0.002)、GS评分高危组(OR=2.95,P=0.005)以及同期行 ADT 治疗(OR=3.27,P= 0.001)是影响PET/CT阳性检出率的独立预测因子.成功建立PET/CT列线图.结论 血清 tPSA≤20 ng/mL初诊前列腺癌患者发生转移的几率仍较高,18 F-PSMA PET/CT对于转移灶的早期检出有较高价值;尿路系统症状、GS评分高危组以及同期行 ADT治疗是影响转移灶检出的独立预测因子,结合预测列线图可以协助临床优化影像学检查路径.
Abstract
Objective To explore the application value of 18 F-PSMA PET/CT on the detection of metastatic lesions of prostate cancer with serum total prostate specific antigen(tPSA)≤20 ng/mL and the predictive variables affecting the imaging results,and to establish a predictive nomogram for the metastasis of prostate cancer.Methods The imaging,pathological,serum and clinical data of 175 pathologically confirmed prostate cancer patients who underwent 18 F-PSMA PET/CT examination during Jan.2020 and Oct.2021 were retrospectively collected.The patients were divided into metastatic group and non-metastatic group according to PET/CT imaging results,and the positive detection rate of metastatic lesions was calculated.The independent influencing factors of 18 F-PSMA PET/CT in the positive detection of metastatic lesions were determined with univariate and multivariate logistic regression analyses.The predictive nomogram was established.Results Of the 175 patients,metastatic lesions were detected in 78 cases and not detected in 97 cases,with a detection rate of 44.6%(78/175).There were statistically significant differences between the metastatic group and the non-metastatic group in urinary tract symptoms,androgen deprivation treatment(ADT)at the time of PET/CT examination and the risk level of Gleason score(GS)(P<0.05).Univariate logistic regression showed that urinary tract symptoms(OR=3.64,P<0.001),GS risk(OR=3.96,P<0.001)and concurrent ADT treatment(OR=3.71,P<0.001)were associated with the positive detection rate of metastatic lesions.Multivariate Logistic regression showed that urinary tract symptoms(OR=3.19,P=0.002),GS high-risk group(OR= 2.95,P=0.005)and concurrent ADT treatment(OR=3.27,P=0.001)were independent predictors of positive detection rate.Conclusion The probability of metastasis in newly diagnosed prostate cancer patients with tPSA≤20 ng/mL is high.18 F-PSMA PET/CT is of high value for the early detection of metastasis.Urinary tract symptoms,GS high-risk group and concurrent ADT treatment are independent predictors of metastatic lesions.The predictive nomogram can help assist clinical optimization of imaging examination path.
关键词
前列腺癌/总前列腺特异性抗原/转移/独立预测因子/预测列线图/前列腺特异性膜抗原Key words
prostate cancer/tPSA/metastasis/independent predictor/predictive nomogram/prostate specific membrane antigen引用本文复制引用
基金项目
西安交通大学第一附属医院临床研究项目(2020)(XJTU1AF-CRF-2020-008)
出版年
2024
NETL
NSTL
万方数据