南方医科大学学报

南方医科大学学报 ›› 2022, Vol. 42 ›› Issue (8): 1143-1148.doi: 10.12122/j.issn.1673-4254.2022.08.05

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68Ga-PSMA-I&T PET/CT评估初诊前列腺癌原发灶的肿瘤负荷

谢 彦，李 澄，张露露，俞 飞，臧士明，王书奎，王 峰   

  1. 南京医科大学附属南京医院//南京市第一医院核医学科，检验科，江苏 南京 210006；东南大学附属中大医院核医学科，江苏 南京 210009
  • 出版日期:2022-08-20 发布日期:2022-09-05

68Ga-PSMA-I&T PET/CT for assessment of tumor burden in primary lesions of treatment-naïve prostate cancer

XIE Yan, LI Cheng, ZHANG Lulu, ZANG Shiming, YU Fei, WANG Shukui, WANG Feng   

  1. Department of Nuclear Medicine, Department of Laboratory Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China; Department of Nuclear Medicine, Zhongda Hospital, Southeast University, Nanjing 210009, China
  • Online:2022-08-20 Published:2022-09-05

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摘要： 目的 探讨68Ga标记的前列腺特异性膜抗原（PSMA）PET/CT原发灶肿瘤负荷在预测初诊前列腺癌（PCa）危险分层和转移风险中的价值。方法 回顾性纳入2018年6月~2019年7月行68Ga-PSMA-I&T PET/CT检查的36 例初诊PCa患者，年龄56~89岁，平均年龄71.3±8.6 岁。测量出PCa患者原发病灶最大标准化摄取值（SUVmax）和平均标准化摄取值，分析病灶组织对68Ga-PSMA-I&T的摄取程度。采用三维体积分割技术自动测量出所有PCa患者原发病灶PSMA肿瘤体积（PSMA-TV）并计算出病灶PSMA代谢（TL-PSMA），分析原发灶SUVmax、PSMA-TV、TL-PSMA与血清前列腺特异性抗原(PSA)、Gleason评分(GS)的相关性。所有患者分别根据PSA水平、GS、是否转移和危险程度进行分组，包括PSA≤20 ng/mL组（22例）和PSA>20 ng/mL组 （14例），GS≤7组（18例）和GS≥8（18例），非转移组（23例）和转移组（13例）、低-中危组（16例）和高危组（20例），比较不同亚组间PCa的原发病灶SUVmax、PSMA-TV、TL-PSMA之间的差异。用spearman等级相关分析不符合正态分布的定量数据之间的相关性，用Pearson相关系数分析正态分布的定量数据之间的相关性。结果 PCa原发灶SUVmax、PSMA-TV和TL-PSMA和PSA都有相关性（r分别为 0.463，0.550和0.638，P均<0.05），SUVmax、PSMA-TV和TL-PSMA和GS都有相关性（r分别为 0.467， 0.437，0.540，P均<0.05）。PCa亚组分析显示：PSA>20 ng/mL组的SUVmax、PSMA-TV和TL-PSMA均显著高于PSA≤20 ng/mL组（z分别为 -3.606，-4.035和 -4.265，P均<0.001）。GS≥8组的SUVmax、PSMA-TV和TL-PSMA均显著高于GS≤7组（z分别为 -3.512，-4.145和 -3.987，P均<0.001）。转移组的PSMA-TV和TL-PSMA均显著高于非转移组（z分别为 -2.734，-2.421，P均<0.001），而非转移组和转移组SUVmax的差异无统计学意义。高风险组的SUVmax、PSMA-TV和TL-PSMA均高于低-中风险组，差异有统计学意义（z分别为-3.273，-4.155和 -4.298，P分别为0.002，<0.001，<0.001）。结论 68Ga-PSMA-I&T PET/CT肿瘤负荷体积参数PSMA-TV和TL-PSMA在预测初诊PCa危险分层和转移风险中具有一定的潜在优势。

关键词: 68Ga-PSMA-I&T；前列腺癌; 肿瘤负荷；危险分层；前列腺特异性膜抗原

Abstract: Objective To investigate the value of 68Ga-labeled prostate specific membrane antigen (PSMA) PET/CT for assessing tumor load in primary lesions for risk stratification and predicting metastasis of newly diagnosed prostate cancer (PCa). Methods We retrospectively analyzed the data of 36 patients (mean age 71.3 ± 8.6 years, range 56 to 89 years) with newly diagnosed PCa undergoing 68Ga-PSMA-I&T PET/CT from June 2018 to July 2019. SUVmax and SUVmean of the primary lesions were measured, and the primary PSMA tumor volume (PSMA-TV) and total lesion PSMA (TL-PSMA) were automatically measured and calculated in all the patients. The correlations of primary SUVmax, PSMA-TV, and TL-PSMA with PSA and Gleason score (GS) were analyzed, and SUVmax, PSMA-TV and TL-PSMA of the primary lesions were compared among different PCa subgroups. Results SUVmax, PSMA-TV and TL-PSMA of the primary lesions were all correlated with PSA and GS (P<0.05). PCa subgroup analysis showed that SUVmax, PSMA-TV and TL-PSMA were all significantly higher in patients with PSA >20 ng/mL than in those with PSA ≤20 ng/mL (P<0.001), and were higher in patients with a GS ≥8 than in those with a GS ≤7 (P<0.001). PSMA-TV and TL-PSMA were significantly higher in patients with tumor metastasis than in those without metastasis (P<0.001), while SUVmax did not differ significantly with tumor metastasis. SUVmax (P=0.002), PSMA-TV (P<0.001), and TL-PSMA (P<0.001) were all significantly higher in high-risk group than in low-to moderate-risk group. Conclusion PSMA-TV and TL-PSMA of 68Ga-PSMA-I&T PET/CT have potential value in predicting risk stratification and metastasis of newly diagnosed PCa.

Key words: 68Ga-PSMA-I&T; prostate cancer; tumor load; risk stratification; metastasis risk; prostate specific membrane antigen