^68Ga-PSMA PET-CT检查中SUVmax与前列腺癌患者临床病理特点的相关性分析

目的探讨^68Ga-PSMA PET-CT检查中前列腺局部病灶最大标准摄取值(maximum standardized uptake value,SUVmax)与前列腺癌患者临床病理特点的相关性。方法回顾性分析2016年5月至2019年8月北京大学肿瘤医院行^68Ga-PSMA PET-CT检查并行根治性前列腺切除术患者的病例资料。共31例患者。年龄(63.1±4.9)岁。体质指数(24.6±3.0)kg/m^2。血清总PSA(72.71±173.15)ng/ml。14例有基线睾酮数值,基线睾酮(4.72±1.64)ng/ml。穿刺病理Gleason评分按国际泌尿病理学会(International Society of Urological Pathology,ISUP)分级:1级5例,2级7例,3级4例,4级10例,5级5例。术前临床分期:T2a期6例,T2b期2例,T2c期17例,T3a期1例,T3b期4例,T4期1例。所有患者均行^68Ga-PSMA PET-CT检查,由2名核医学专业医生复核SUVmax。原发灶SUVmax(12.49±9.38)。分析SUVmax值与基线PSA、Gleason评分、术后病理情况的关系。结果本研究31例术后ISUP分级:1级3例,2级9例,3级4例,4级6例,5级9例。术后病理分期:T2a期1例,T2c期14例,T3a期6例,T3b期10例。术后病理诊断为切缘阳性19例,阴性12例;脉管癌栓阳性5例,阴性26例;神经侵犯阳性20例,阴性11例。D′Amico危险度分层:低危2例,中危7例,高危22例。按照PSA(≤10 ng/ml或>10 ng/ml)和Gleason评分(≤6分或>6分)分类:低PSA低Gleason评分6例,低PSA高Gleason评分5例,高PSA低Gleason评分9例,高PSA高Gleason评分11例。SUVmax与术后病理ISUP分级具有显著正相关性(r=0.434,P=0.015),与术后病理分期(r=0.232,P=209)、基线PSA(r=0.178,P=0.339)和基线睾酮(r=0.437,P=0.119)无相关性。脉管癌栓阳性组和阴性组的SUVmax分别为14.78±10.^68和8.17±2.81,差异有统计学意义(P=0.005)。病理切缘阳性组和阴性组的SUVmax分别为12.84±7.89和11.79±11.39(P=0.764),神经侵犯阳性组和阴性组的SUVmax分别为22.59±13.72和10.48±6.89(P=0.055),盆腔淋巴结阳性组和阴性组的SUVmax分别为14.50±9.64和12.13±9.32(P=0.639),D′Amico危险度低、中危组和高危组的SUVmax分别为9.39±4.60和13.^68±10.39(P=0.247),差异均无统计学意义。低PSA低Gleason组、低PSA高Gleason组、高PSA低Gleason组、高PSA高Gleason组的SUVmax分别为8.67±4.26、16.70±13.90、9.43±7.75、15.00±9.38,组间差异无统计学意义(P=0.285)。术后病理与穿刺病理ISUP分级相同者19例,SUVmax 11.92±10.61;升级者9例,SUVmax 16.01±5.40;降级者3例,SUVmax 4.98±2.11,3组差异无统计学意义(P=0.287),但升级者SUVmax显著高于降级者(P=0.007)。SUVmax对术后病理ISUP分级的诊断效能受试者工作特征(receiver operating characteristic,ROC)曲线显示,SUVmax对判断术后病理ISUP分级5级的诊断效能最大,曲线下面积0.747(P=0.033);当SUVmax≥11.34时,敏感性可达88.9%,特异性可达77.3%。结论术前^68Ga-PSMA PET-CT中前列腺局部病灶的SUVmax可辅助判断前列腺癌患者是否存在病理预后不良因素,可能具有临床指导意义。

The relationship between SUVmax on preoperative 68Ga-PSMA PET-CT and the clinicopahtological characteristics in patients treated with radical prostatectomy

Objective To investigate the relationship between SUVmax on preoperative^68Ga-PSMA PET-CT and the clinicopathological characteristics of patients treated with radical prostatectomy.Methods The clinicopahtological data of patients evaluated with^68Ga-PSMA PET-CT preoperatively and treated with radical prostatectomy between May 2016 and August 2019 were retrospectively reviewed.31 patients with a mean age(63.1±4.9)and baseline PSA(72.71±173.15)ng/ml were enrolled.Their BMI mean(24.6±3.0)kg/m^2.Baseline testosterone of 14 patients was(4.72±1.64)ng/ml.Based on the Gleason scores related ISUP classification,all patients were classified into grade one in 5 cases,grade 2in 7 cases,grade 3 in 4 cases,grade 4 in 10 cases and grade 5 in 5 cases.The clinical classification included 6 cases in T2a stage,2 cases in T2b stage,17 cases in T2c stage,1 case in T3a stage,4 cases in T3b stage and 1 case in T4 stage.SUVmax was accessed by two independent professional nuclear medicine physicians.SUVmax was 12.49±9.38.SPSS 16.0 software was used to do statistic analysis.Results The post-operative pathological results showed the surgical margin positive in 19 cases,negative in 12 cases,vascular positive in 5 cases,negative in 20 case,positive nerve invasion in 20 cases and negative in 11 cases.2 patients were low risk,7 patients were medium risk and 22 patients were high risk according to D′Amico classification.Based on the basis of PSA(≤10 or>10)and Gleason score(≤6 or>6),6 patients were in group with low PSA and low Gleason score,5 patients were low PSA and high Gleason score,9 patients were high PSA and low Gleason score,11 patients were high PSA and high Gleason score.SUVmax had a significant positive relationship with pathological ISUP(r=0.434,P=0.015)and SUVmax in patients with positive intravascular tumor emboli was significantly higher than those with negative intravascular tumor emboli(14.78±10.^68 vs.8.17±2.81,P=0.005).No significant correlation was found between SUVmax and baseline PSA,testosterone,pathologic T stage,surgical margin,nerve invasion,pelvic lymph node status as well as risk stratification.SUVmax could distinguish pathologic ISUP grade 5 with a maximum AUC 0.747(P=0.033)and the sensitivity was 88.9%.The specificity was 77.3%when SUVmax≥11.34.SUVmax in patients with upgrading ISUP was significantly higher than that in patients with downgrading ISUP(16.01±5.40 vs.4.98±2.11,P=0.007).Conclusions SUVmax measured on preoperative^68Ga-PSMA PET-CT may have a clinical significance in predicting unfavorable pathological factors for patients treated with radical prostatectomy.