一站式联合全身PSMA PET/CT与局部PET/mpMRI显像优化可疑前列腺癌患者治疗决策的研究

Study on optimizing treatment decisions for patients with suspected prostate cancer using one-stop combined whole-body PSMA PET/CT and local PET/mpMRI imaging

    摘要
  • 摘要:
    目的 评估全身前列腺特异性膜抗原（PSMA）PET/CT联合局部PET/多参数磁共振成像（mpMRI）（简称PSMA联合显像）在引导临床可疑前列腺癌（PCa）患者诊疗决策优化中的价值。
    方法  收集2024年4月至11月于广州医科大学附属第一医院接受PSMA联合显像的110例可疑PCa患者的临床、影像及组织病理学检查资料进行观察性回顾性队列研究，患者年龄（73.0±7.4）岁。经PSMA联合显像排除远处转移的局限性PCa患者接受前列腺癌根治性切除术（RP），并以行RP患者的术后组织病理学检查结果为“金标准”，比较PSMA联合显像与mpMRI在PCa TN分期诊断中的准确率。所有患者均经过前列腺癌多学科诊疗团队集体阅片并提出治疗决策。采用精确McNemar检验比较PSMA联合显像与mpMRI对 PCa分期诊断的准确率。
    结果 110例可疑PCa患者中，4例患者（3.6%）经PSMA联合显像及术前穿刺活检诊断确诊为良性前列腺增生；其余106例（96.4%）为临床显著性前列腺癌（csPCa），其中40例（37.7%，40/106）患者经PSMA联合显像未改变原治疗方案，行RP；其余66例（62.3%，66/106）调整了治疗方案，其中41例（38.7%，41/106）因发现远处转移，转为全身系统性治疗，其余25例（23.6%，25/106）因肿瘤T分期、N分期上调，在RP前行新辅助内分泌治疗。PSMA联合显像对PCa患者T分期的准确率62.5%（25/40）对 45.0%（18/40），χ2=4.000，P=0.020）和N分期的准确率80.0% （32/40）对 67.5%（27/40）均高于mpMRI （χ2=2.286，P=0.131）。
    结论 与mpMRI相比，PSMA联合显像改变了62.3%的PCa患者的临床治疗决策；PSMA联合显像可明显提高临床显著性PCa患者的 T分期和N分期的准确率，为个体化精准诊疗提供依据。

     

    Abstract:
    Objective To evaluate the clinical utility of whole-body prostate-specific membrane antigen (PSMA) PET/CT combined with localized multiparametric magnetic resonance imaging (mpMRI) (termed PSMA-integrated imaging) in optimizing diagnostic and therapeutic decision-making for patients with clinically suspected prostate cancer (PCa).
    Methods The clinical, imaging and histopathological examination data of 110 patients with suspected PCa who underwent PSMA combined imaging at the First Affiliated Hospital of Guangzhou Medical University from April to November 2024 were collected for a retrospective study. The patients were aged (73.0±7.4) years. Patients with localized PCa without distant metastasis who were excluded by PSMA combined imaging underwent radical prostatectomy (RP), and the postoperative histopathological examination results of the patients who underwent RP were used as the "gold standard" to compare the accuracy rates of PSMA combined imaging and mpMRI in the diagnosis of PCa TNM staging. All cases were collectively reviewed and treatment decisions were made by the multidisciplinary prostate cancer treatment team. The accuracy rates of PSMA combined imaging and mpMRI in diagnosing PCa stages were compared using the exact McNemar test.
    Results Among the 110 suspected PCa patients, 4 patients (3.6%) were diagnosed as having benign prostatic hyperplasia based on the results of PSMA combined imaging and postoperative histopathological examination; the remaining 106 cases (96.4%) were clinically significant prostate cancer (csPCa). Among the 106 csPCa patients, 40 patients (37.7%) did not change their original treatment plan and underwent RP after PSMA combined imaging; the remaining 66 patients (62.3%) adjusted their treatment plans, among which 41 patients (62.1%) were transferred to systemic treatment due to the discovery of distant metastasis, and the remaining 25 patients (37.9%) underwent neoadjuvant endocrine therapy before RP due to the elevation of pelvic T stage and N stage. The accuracy rate of PSMA combined imaging for T staging in PCa patients (62.5% vs. 45.0%, χ2=4.000, P=0.020) and the accuracy rate of N staging (80.0% vs. 67.5%) were both higher than those of mpMRI ( χ2=2.286, P=0.131).

     

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