mpMRI联合 99mTc-PSMA SPECT/CT检测前列腺癌新辅助雄激素剥夺治疗后显著残留病灶的价值研究

背景与目的：雄激素剥夺治疗（androgen deprivation therapy,ADT）是前列腺癌患者常用的治疗方法之一,然而对于ADT后病灶的变化,目前仍缺乏直接、精准的评估方法。以术后病理学检查结果作为金标准,初步探讨多参数磁共振成像（multiparametric magnetic resonance imaging,mpMRI）联合 ^99mTc标记前列腺特异性膜抗原（prostate specific membrane antigen,PSMA）小分子抑制剂（HYNIC-Glu-Urea-A,简称 ^99mTc-PSMA）单光子发射计算机体层成像（single photon emission computed tomography,SPECT）/计算机体层成像（computed tomography,CT）评估前列腺癌新辅助ADT后的疗效,即检测显著残留病灶的价值。 方法 回顾并分析2017年3月—2021年7月复旦大学附属肿瘤医院收治的154例接受新辅助ADT后行根治性前列腺切除术的前列腺癌患者的临床资料。所有患者均在术前行mpMRI及 ^99mTc-PSMA SPECT/CT检查,根据术后病理学检查结果分为显著残留组及完全缓解/微残留两组。比较两组的临床病理学特征、mpMRI前列腺局部复发磁共振成像报告评分（Prostate Magnetic Resonance Imaging for Local Recurrence Reporting,PI-RR）分数及 ^99mTc-PSMA SPECT/CT阳性率。采用受试者工作特征（receiver operating characteristic,ROC）曲线及曲线下面积（area under curve,AUC）分析mpMRI、 ^99mTc-PSMA SPECT/CT单独使用及联合使用时的诊断效能差异。 结果 术后病理学检查结果证实显著残留组128例、完全缓解/微残留组26例。患者平均年龄为（66.88±7.79）岁,中位年龄68岁,年龄47~85岁。两组患者年龄、初始PSA、Gleason评分差异无统计学意义（P>0.05）;而新辅助ADT后PSA显著残留组明显高于完全缓解/微残留组,差异有统计学意义（P<0.05）。mpMRI诊断显著残留的AUC值为0.713,以PI-RR评分3为界值时灵敏度为78.13%,特异度为30.77%;以PI-RR评分4为界值时灵敏度为68.75%,特异度为69.23%。 ^99mTc-PSMA SPECT/CT诊断显著残留的AUC值为0.729,与mpMRI相比差异无统计学意义（P>0.05）,灵敏度为76.56%,特异度为69.23%。mpMRI联合 ^99mTc-PSMA SPECT/CT使用时AUC为0.809,显著高于两者单独使用时（P<0.05）。 结论 mpMRI与 ^99mTc-PSMA SPECT/CT均可用于诊断前列腺癌新辅助ADT后显著残留灶,两者联合运用时可以显著提高诊断效能。

The value of mpMRI combined with 99mTc-PSMA SPECT/CT in the detection of significant residual prostate cancer after neoadjuvant androgen deprivation therapy

Background and purpose:Androgen deprivation therapy(ADT)is a key primary treatment for prostate cancer.However,there is still a lack of direct and accurate assessment method for the changes in the lesions after ADT treatment.The aim of this study was to explore the value of multiparametric magnetic resonance imaging(mpMRI)combined with technetium-99m labelled small molecule against prostate specific membrane antigen(PSMA)(HYNIC-Glu-Urea-A,^99mTc-PSMA)single photon emission computed tomography(SPECT)/computed tomography(CT)in the detection of significant residual prostate cancer after neoadjuvant ADT with the reference standard of postoperative pathology.Methods:A retrospective analysis of 154 prostate cancer patients treated in Fudan University Shanghai Cancer Center from March 2017 to July 2021 who underwent radical prostatectomy(RP)after neoadjuvant ADT was performed.All patients underwent preoperative mpMRI and ^99mTc-PSMA SPECT/CT.Patients were divided into two groups according to the postoperative pathology:the significant residual group and complete response or minimum residual disease(CR/MRD)group.The clinical characteristics,the scores of Prostate Magnetic Resonance Imaging for Local Recurrence Reporting(PI-RR)system and the positive rate of ^99mTc-PSMA SPECT/CT of the two groups were compared.The differences among the diagnostic efficacy of mpMRI and ^99mTc-PSMA SPECT/CT alone and in combination were analyzed by the receiver operating characteristic(ROC)curve and the area under curve(AUC).Results:In total,the significant residual group consisted of 128 patients,and the CR/MRD group consisted of 26 patients.The average and median age of the patients were 66.88±7.79(ranged from 47 to 85)years and 68 years,respectively.There was no statistical difference in age,PSA before neoadjuvant ADT and Gleason scores between the two groups,while PSA after neoadjuvant ADT of the significant residual group was significantly higher than that of the CR/MRD group.The AUC of mpMRI was 0.713,the sensitivity and specificity were 78.13%and 30.77%,respectively,with a cut-off of PI-RR score 3,while sensitivity and specificity were 68.75%and 69.23%,respectively,with a cut-off of PI-RR score 4.The AUC of ^99mTc-PSMA SPECT/CT was 0.729,the sensitivity and specificity were 76.56%and 69.23%,respectively.The AUC of mpMRI combined with ^99mTc-PSMA SPECT/CT was 0.809,which was significantly higher compared with the two alone(P<0.05).Conclusion:The combination of mpMRI and ^99mTc-PSMA SPECT/CT can significantly improve the diagnostic efficiency for significant residual prostate cancer after neoadjuvant ADT.