68Ga-PSMA-11 PET/CT代谢体积参数在不同风险分层的初诊前列腺癌患者中的差异研究

Study on the differences of metabolic volume parameters of 68Ga-PSMA-11 PET/CT among risk stratified subgroups in patients with newly diagnosed prostate carcinoma

    摘要
  • 摘要:
    目的 探究68Ga-前列腺特异性膜抗原(PSMA)-11 PET/CT代谢体积参数在不同风险分层的初诊前列腺癌（PCa）患者中的差异。
    方法 回顾性分析2019年1月至12月于海军军区大学第一附属医院经前列腺活体组织穿刺检查结果确诊后行68Ga-PSMA-11 PET/CT检查的85例未经治疗的PCa患者的影像及临床资料，患者年龄49~88（69.1±7.7）岁。根据是否发生肿瘤转移和美国国立综合癌症网络指南推荐的风险分层将患者分别分为无转移组和转移组、低中风险组和高风险组；以格里森评分（GS）8分为临界值，将患者分为GS<8分组和GS≥ 8分组；以血清前列腺特异抗原（PSA）20 ng/mL为临界值，将患者分为PSA≤20 ng/mL组和PSA>20 ng/mL组；根据临床分期的不同，将患者分为临床T1~T2期组和临床T3~T4期组。采用三维勾画法在68Ga-PMSA-11 PET/CT图像上自动测量和勾画肿瘤病灶感兴趣区，计算最大标准化摄取值（SUVmax）、原发PSMA肿瘤体积（PSMA-TV原发）、全身PSMA肿瘤体积（PSMA-TV全身）、原发PSMA肿瘤总量（TL-PSMA原发）、全身PSMA肿瘤总量（TL-PSMA全身）。组间代谢体积参数的比较采用两独立样本非参数Mann-Whitney秩和检验。
    结果 85例患者68Ga-PSMA-11 PET/CT显像结果均呈阳性，其中无转移组46例（54.1%）、转移组39例（45.9%）；低中风险组15例（17.6%）、高风险组70例（82.4%）。转移组的SUVmax、PSMA-TV原发、PSMA-TV全身、TL-PSMA原发、TL-PSMA全身的中位数均高于无转移组（16.2对9.8，39.5 cm3对10.8 cm3，58.8 cm3对10.8 cm3，318.4 cm3对37.2 cm3，628.0 cm3对37.2 cm3），且差异均有统计学意义（Z=−6.301~−2.580，均P<0.05）；高风险组的SUVmax、PSMA-TV原发、PSMA-TV全身、TL-PSMA原发、TL-PSMA全身的中位数均高于低中风险组（13.8对4.2，16.5 cm3对8.4 cm3，21.9 cm3对11.4 cm3，146.1 cm3对27.4 cm3，229.6 cm3对28.6 cm3），且差异均有统计学意义（Z=−4.242~−2.438，均P<0.05）；GS≥8分组的SUVmax、PSMA-TV原发、PSMA-TV全身、TL-PSMA原发、TL-PSMA全身的中位数均高于GS<8分组（14.8对9.9，16.5 cm3对12.5 cm3，23.9 cm3对14.3 cm3，146.1 cm3对36.3 cm3，229.6 cm3对36.3 cm3），除PSMA-TV原发外，差异均有统计学意义（Z=−2.850~−2.074，均P<0.05）；PSA>20 ng/mL组的SUVmax、PSMA-TV原发、PSMA-TV全身、TL-PSMA原发、TL-PSMA全身的中位数均高于PSA≤20 ng/mL组（16.2对 6.4，24.7 cm3对8.2 cm3，41.4 cm3对10.2 cm3，253.9 cm3对28.0 cm3，361.5 cm3对29.7 cm3），且差异均有统计学意义（Z=−6.279~−3.948，均P<0.001）；临床T3~T4期组的SUVmax、PSMA-TV原发、PSMA-TV全身、TL-PSMA原发、TL-PSMA全身的中位数均高于临床T1~T2期组（16.6对9.3，34.9 cm3对10.7 cm3，62.3 cm3对14.3 cm3，303.5 cm3对32.6 cm3，482.1 cm3对45.9 cm3），且差异均有统计学意义（Z=−4.889~−3.629，均P<0.001）。
    结论 转移组和高风险组的初诊前列腺癌患者68Ga-PSMA-11 PET/CT的代谢体积参数显著高于无转移组及低中风险组患者。

     

    Abstract:
    Objective To explore significant differences in the metabolic volume parameters of prostate specific membrane antigen labeled with 68Gallium (68Ga-PSMA-11) PET/CT among different risk stratification subgroups in patients with newly diagnosed prostate carcinoma (PCa).
    Methods The images and clinical data of 85 untreated patients with PCa (aged 49–88 (69.1±7.7) years) newly diagnosed by prostate biopsy and examined by 68Ga-PSMA-11 PET/CT in the First Affiliated Hospital of Naval Military Medical University from January 2019 to December 2019 were analyzed retrospectively. In accordance with the occurrence of tumor metastasis and the risk stratification recommended by the guidelines of National Comprehensive Cancer Network, patients were divided into binary subgroups: non-metastasis and metastasis subgroups as well as low-medium- and high-risk subgroups. Taking the Gleason score (GS)=8 as the critical value, patients were divided into GS<8 and GS≥8 subgroups. Taking serum prostate specific antigen (PSA)=20 ng/mL as the critical value, patients were divided into PSA≤20 ng/mL and PSA>20 ng/mL subgroups. In accordance with clinical stage, patients were divided into clinical T1–T2 and T3–T4 subgroups. Three dimensional sketching method was used to automatically measure and sketch the region of interest of tumor lesions on 68Ga-PSMA-11 PET/CT images, and calculate the maximum standardized uptake value (SUVmax), primary PSMA tumor volume (PSMA-TVprimary), whole-body PSMA tumor volume (PSMA-TVwhole body), total number of primary PSMA tumors (TL-PSMAprimary), and total number of whole-body PSMA tumors (TL-PSMAwhole body) separately. The metabolic volume parameters between subgroups were compared by the nonparametric Mann-Whitney U rank sum test of two independent samples.
    Results The results of 68Ga-PSMA-11 PET/CT were positive in all 85 patients, including 46 cases (54.1%) in the non-metastasis subgroup and 39 cases (45.9%) in the metastasis subgroup as well as 15 cases (17.6%) in the low-medium-risk subgroup and 70 cases (82.4%) in the high-risk subgroup. The SUVmax, PSMA-TVprimary, PSMA-TVwhole body, TL-PSMAprimary, and TL-PSMAwhole body in the metastasis subgroup were significantly higher than those in the non-metastasis subgroup (16.2 vs. 9.8, 39.5 cm3 vs. 10.8 cm3, 58.8 cm3 vs. 10.8 cm3, 318.4 cm3 vs. 37.2 cm3, 628.0 cm3 vs. 37.2 cm3; Z=−6.301 to −2.580, all P<0.05). The SUVmax, PSMA-TVprimary, PSMA-TVwhole body, TL-PSMAprimary, and TL-PSMAwhole body in the high-risk subgroup were significantly higher than those in the low-medium-risk subgroup (13.8 vs. 4.2, 16.5 cm3 vs. 8.4 cm3, 21.9 cm3 vs. 11.4 cm3, 146.1 cm3 vs. 27.4 cm3, 229.6 cm3 vs. 28.6 cm3; Z=−4.242 to −2.438, all P<0.05). The SUVmax, PSMA-TVwhole body, TL-PSMAprimary, and TL-PSMAwhole body in the GS≥8 subgroup were significantly higher than those in the GS<8 subgroup (14.8 vs. 9.9, 23.9 cm3 vs. 14.3 cm3, 146.1 cm3 vs. 36.3 cm3, 229.6 cm3 vs. 36.3 cm3; Z=−2.850 to −2.074, all P<0.05), whereas the PSMA-TVprimary was not significantly different between the two subgroups (16.5 cm3 vs. 12.5 cm3, Z=−1.231, P=0.218). The SUVmax, PSMA-TVprimary, PSMA-TVwhole body, TL-PSMAprimary, and TL-PSMAwhole body in the PSA>20 ng/mL subgroup were significantly higher than those in the PSA≤20 ng/mL subgroup (16.2 vs. 6.4, 24.7 cm3 vs. 8.2 cm3, 41.4 cm3 vs. 10.2 cm3, 253.9 cm3 vs. 28.0 cm3, 361.5 cm3 vs. 29.7 cm3; Z=−6.279 to −3.948, all P<0.001). The SUVmax, PSMA-TVprimary, PSMA-TVwhole body, TL-PSMAprimary, and TL-PSMAwhole body in the clinical T3–T4 subgroup were significantly higher than those in the clinical T1–T2 subgroup (16.6 vs. 9.3, 34.9 cm3 vs. 10.7 cm3, 62.3 cm3 vs. 14.3 cm3, 303.5 cm3 vs. 32.6 cm3, 482.1 cm3 vs. 45.9 cm3; Z=−4.889 to −3.629, all P<0.001).
    Conclusion The metabolic volume parameters based on 68Ga-PSMA-11 PET/CT in metastatic and high-risk patients with newly diagnosed PCa were significantly higher than those in non-metastatic and low-medium-risk patients.

     

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