中国医学装备2024，Vol.21Issue(2) ：79-83.DOI:10.3969/j.issn.1672-8270.2024.02.016

Al18F-PSMA-BCH扫描对生化复发的前列腺癌早期诊断及治疗决策影响的研究

Study on the effect of Al18F-PSMA-BCH scan on early diagnosis and treatment decision of prostate cancer of biochemical recurrence

乔俊巍 梅丽努尔·阿布都热西提 沈荣芳 乃比江·阿布都西库
中国医学装备2024，Vol.21Issue(2) ：79-83.DOI:10.3969/j.issn.1672-8270.2024.02.016
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Al18F-PSMA-BCH扫描对生化复发的前列腺癌早期诊断及治疗决策影响的研究

Study on the effect of Al18F-PSMA-BCH scan on early diagnosis and treatment decision of prostate cancer of biochemical recurrence

乔俊巍 1梅丽努尔·阿布都热西提 1沈荣芳 1乃比江·阿布都西库1
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作者信息

  • 1. 新疆喀什地区第一人民医院核医学中心核医学科 喀什 844000
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摘要

目的:探索Al18F-PSMA-BCH(北京肿瘤医院)标记法正电子发射计算机体层显像(PET/CT)扫描对生化复发的前列腺癌(PCa)早期诊断及治疗决策影响.方法:回顾性分析2021年8月至2022年6月喀什地区第一人民医院收治的80例PCa根治术(RP)患者,依据其是否存在生化复发(BCR)将其分为BCR组(29例)和非BCR组(51例),所有患者均行Al18F-PSMA-BCH PET/CT标记扫描,分析Al18F-PSMA-BCH标记扫描对BCR患者临床局部复发或转移的检出情况,对比复发及转移处的最大标准化摄取值(SUVmax)与患者血清前列腺特异抗原(PSA)及格利森(Gleason)评分的相关性,分析Al18F-PSMA-BCH标记法扫描下SUVmax对不同危险程度BCR患者的检出效能.根据患者的术前PSA、术后病理所得Gleason评分及临床分期将80例患者分为低危、中危及高危分级.结果:Al18F-PSMA-BCH PET/CT标记法扫描下,BCR组中23例患者存在临床复发及转移(占79.31%),其中14例为不同程度的淋巴结转移(占60.87%):包括单纯盆腔淋巴结转移8例(占34.78%),单纯腹膜后淋巴结转移2例(占8.70%),盆腔伴腹膜后淋巴结转移3例(占13.04%),隔上淋巴结转移1例(占4.35%);4例为前列腺术区复发(占17.39%),1例为内脏转移(占4.35%)(脑),15例患者伴有不同程度的骨转移(占65.22%).对于RP术后BCR的PCa患者,Al18F-PSMA-BCH标记法对临床局部复发或转移的检出受试者工作特征(ROC)曲线下面积(AUC)为0.897(95%CI:0.808～0.953,P＜0.001),灵敏度为79.3%,特异度为100.00%.出现骨转移患者的SUVmax为(14.82±24.32),与患者PSA水平及Gleason评分呈明显正相关性(r=0.442、0.372,P＜0.001),出现术区复发的SUVmax为(24.38±26.54),与患者PSA水平及Gleason评分呈明显正相关性(r=0.423、0.338,P＜0.05),出现盆腔淋巴结转移的SUVmax为(45.34±47.04),与患者PSA水平及Gleason评分呈明显正相关性(r=0.423、0.316,P＜0.05).同时,对存在BCR的患者中,Gleason评分≥8分的患者为(12/12,100%)复发或转移的检出率明显高于Gleason评分≤7分的患者(11/17,64.71%),差异有统计学意义(x2=6.502,P＜0.05);0.2 ng/ml≤PSA＜0.5 ng/ml患者(6/10)、0.5 ng/ml≤PSA＜1 ng/ml患者(6/8)、1 ng/ml≤PSA＜2 ng/ml的患者(12/12)以及PSA≥2 ng/ml的患者(9/9)检出率差异有统计学意义(x2=9.041,P＜0.05).SUVmax对低、中及高危BCR患者出现复发或转移的AUC分别为0.708(95%CI:0.543～0.840,P＞0.05)、0.780(95%CI:0.621～0.895,P＜0.05)及0.914(95%CI:0.781～0.979,P＜0.05),其中Al18F-PSMA-BCH对高危BCR患者出现局部复发及转移的诊断效应明显优于对低危BCR患者(x2=8.986,P＜0.05).在23例进行Al18F-PSMA-BCH标记扫描的患者中,15例(占65.22%)患者在原治疗方案基础上增加了局部放疗、全身化疗、内分泌治疗或盆腔淋巴结清扫术,发生了治疗策略上的改变.结论:Al18F-PSMA-BCH标记法扫描对BCR的PCa具有较高的早期诊断价值,会对患者的治疗策略造成一定的影响.

Abstract

Objective:To explore the effect of the labeled positron emission tomography/computed tomography(PET/CT)scan with Al18F-PSMA-BCH(Beijing Cancer Hospital)on early diagnosis and treatment decision of prostate cancer of biochemical recurrence.Methods:A total of 80 patients who underwent radical prostatectomy(RP)for prostate cancer(PCa)in the Kashgar First People's Hospital from August 2021 to June 2022 were retrospectively analyzed.According to the presence of biochemical recurrence(BCR),they were divided into biochemical recurrence group(n=29)and non-biochemical recurrence group(n=51).All patients were scanned with Al18F-PSMA-BCH PET/CT markers.The detection situations of the labeled scan with Al18F-PSMA-BCH on clinically local recurrence or metastasis of patients with BCR were analyzed.The correlations between the maximum standardized uptake value(SUVmax)of recurrence and metastasis,the serum prostate specific antigen(PSA)and Gleason scores were compared.The detection efficiency of SUVmax on BCR patients with different risk levels under labeled scan with Al18F-PSMA-BCH was analyzed.According to the preoperative PSA,Gleason score of obtaining from postoperative pathological results and clinical stage,80 patients were divided into low-risk grade,medium risk grade and high risk grade.Results:Under the labeled scan with Al18F-PSMA-BCH PET/CT,23 patients in biochemical recurrence group occurred clinical recurrence and metastasis(79.31%),of which 14 cases existed various degrees of lymph node metastasis(60.87%),including simple pelvic lymph node metastasis in 8 cases(34.78%),simple retroperitoneal lymph node metastasis in 2 cases(8.70%),pelvic with retroperitoneal lymph node metastasis in 3 cases(13.04%)and 1 case of supraseptal lymph node metastasis(4.35%).There were 4 cases of recurrence in prostatectomy area(17.39%),1 case of visceral metastasis(4.35%)(brain),and 15 cases with various degrees of bone metastasis(65.22%).For PCa patients with BCR after RP,the area under curve(AUC)of the receiver operating characteristic(ROC)curve of the labeled scan with Al18F-PSMA-BCH PET/CT was 0.897(95% CI:0.808-0.953,P<0.001)in detecting patients with clinical local recurrence or metastasis,and the sensitivity and specificity of that were respectively 79.3% and 100.00%.The SUVmax of patients with bone metastasis was(14.82±24.32),which was positively correlated with PSA level and Gleason score(r=0.442,0.372,P<0.001),respectively.The SUVmax of patients with recurrence in operation area was(24.38±26.54),which was positively correlated with PSA level and Gleason score(r=0.423,0.338,P<0.05),respectively.The SUVmax of patients with pelvic lymph node metastasis was(45.34±47.04),which was positively correlated with PSA level and Gleason score(r=0.423,0.316,P<0.05),respectively.At the same time,in these patients with BCR,the detection rate(100%)of recurrence or metastasis in patients with Gleason score≥8 was significantly higher than that in patients with Gleason score≤7(11/17,64.71%),and the difference was statistically significant(x2=6.502,P<0.05).There were significant differences in the detection rates among patients with 0.2 ng/ml≤PSA<0.5 ng/ml(6/10),patients with 0.5 ng/ml≤PSA<1 ng/ml(6/8),patients with 1 ng/ml≤PSA<2 ng/ml(12/12)and patients with PSA≥2 ng/ml(9/9)(x2=9.041,P<0.05).The AUC values of SUVmax for recurrence or metastasis in patients with low,medium and high-risk BCR were 0.708(95% CI:0.543-0.840,P＞0.05),0.780(95% CI:0.621-0.895,P<0.05)and 0.914(95% CI:0.781-0.979,P<0.001),respectively.The diagnostic efficiency of Al18F-PSMA-BCH on local recurrence and metastasis of patients with high-risk BCR was significantly better than that of patients with low-risk BCR(x2=8.986,P<0.05).In the 23 patients who underwent labeled scan with Al18F-PSMA-BCH,15 patients(65.22%)received the added treatment of local radiotherapy,systemic chemotherapy,endocrine therapy or pelvic lymph node dissection on the basis of the original treatment plan,which changed the treatment strategies.Conclusion:The labeled scan with Al18F-PSMA-BCH has higher early diagnostic value for BCR of patients with PCa,which will have a certain influence on the treatment strategy of patients.

关键词

前列腺癌(PCa)/前列腺特异膜抗原(PSA)/生化复发/正电子发射计算机体层显像(PET/CT)

Key words

Prostate cancer/Prostate specific membrane antigen/Biochemical recurrence/Positron emission tomography/computer tomography(PET/CT)

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基金项目

新疆维吾尔自治区自然科学基金(2021D01F16)

出版年

2024
中国医学装备
中国医学装备协会

中国医学装备

CSTPCD
影响因子：0.882
ISSN：1672-8270
参考文献量21
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