摘要
目的:比较氟18-前列腺特异性膜抗原(18F-PSMA)正电子发射计算机断层扫描(PET/CT)PRIMARY评分与PSMA表达评分对有临床意义前列腺癌(csPCa)的诊断价值。方法:回顾性分析2019年2月1日至2024年2月29日北京医院收治的70例行根治性前列腺切除术的前列腺癌患者的病例资料。所有患者术前均行全身18F-PSMA PET/CT检查。根据病理大切片结果将前列腺病灶分为csPCa组(Gleason评分≥3+4分)和非csPCa组(Gleason评分=6分或良性)。在PSMA PET/CT图像上对前列腺病灶分别进行PRIMARY评分和PSMA表达评分。比较csPCa组和非csPCa组的PRIMARY评分、PSMA表达评分、最大标准化摄取值(SUV_(max))、病灶SUV_(max)/本底SUV_(max)比值(LBR)、摄取形态及病灶分布构成的差异。采用多因素logistic回归模型分析csPCa发生的相关因素。通过绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC),确定各因素诊断csPCa的最佳阈值,采用Delong检验比较不同AUC的差异。定量资料采用M(Q_(1),Q_(3))表示。结果:70例患者年龄70(64,75)岁,共有108个病灶,csPCa组83个病灶(76.9%),非csPCa组25个病灶(23.1%)。csPCa组和非csPCa组的PRIMARY评分[4(3,5)比2(1,4)分]、PSMA表达评分[2(2,2)比1(1,2)分]、SUV_(max)[9.10(5.70,15.80)比5.40(3.35,6.90)]、LBR[2.86(2.09,4.53)比1.96(1.42,2.58)]、局灶性摄取形态比例[74.7%(62/83)比32.0%(8/25)]差异均有统计学意义(均P<0.05),病灶位置差异无统计学意义(P>0.05)。多因素logistic回归分析显示,PRIMARY评分越高,csPCa发生风险越高(OR=1.863,95%CI:1.360~2.552)。PRIMARY评分、PSMA表达评分诊断csPCa的AUC分别为0.751(95%CI:0.659~0.829)及0.697(95%CI:0.601~0.781),差异无统计学意义(Z=1.438,P>0.05),二者诊断csPCa的最佳阈值分别为3分及2分。结论:18F-PSMA PET/CT PRIMARY评分越高,csPCa发生风险越高,PRIMARY评分对csPCa具有较好的诊断效能。
Objective To compare the diagnostic value of fluorine 18-labelled prostate-specific membrane antigen(PSMA)PET/CT PRIMARY score and PSMA expression score for clinically significant prostate cancer(csPCa).Methods The data of 70 patients with prostate cancer who underwent radical prostatectomy at Beijing Hospital from February 1,2019 to February 29,2024 were retrospectively analyzed.All patients underwent whole body ^(18)F-PSMA PET/CT examination before surgery and pathological large sections of prostate specimens were made after surgery.According to the pathological section results,the lesions were divided into csPCa group(Gleason scores≥7)and non-csPCa group(Gleason scores=6 or benign).The PRIMARY score and PSMA expression score were used to evaluate prostatic lesions on PSMA PET/CT images,respectively.The differences in PRIMARY score,PSMA expression score,maximum standardized uptake value(SUV_(max)),lesion-to-background ratios(LBR),PSMA uptake characteristics,and location distribution were compared between csPCa group and non-csPCa group.Multivariate logistic regression analysis was performed to determine the correlation factors for the incidence of csPCa.By plotting the receiver operator characteristic(ROC)curve and calculating the area under the curve(AUC),the optimal diagnostic threshold for csPCa of each factor was determined.The differences in AUC were compared using the Delong test.Quantitative data was represented as M(Q_(1),Q_(3)).Results The 70 patients aged 70(64,75)years with a total of 108 lesions,including 83 lesions(76.9%)in the csPCa group and 25 lesions(23.1%)in the non-csPCa group.There were differences between csPCa group and non-csPCa group in PRIMARY score[4(3,5)vs 2(1,4)],PSMA expression score[2(2,2)vs 1(1,2)],SUV_(max)[9.10(5.70,15.80)vs 5.40(3.35,6.90)],LBR[2.86(2.09,4.53)vs 1.96(1.42,2.58)],and proportion of focal uptake patterns[74.7%(62/83)vs 32.0%(8/25)](all P<0.05).There was no statistically significant difference in the location distribution between the two groups(P>0.05).Multivariate logistic regression analysis indicated the higher the PRIMARY score,the higher the risk of developing csPCa(OR=1.863,95%CI:1.360-2.552).ROC curves revealed that the AUCs of the PRIMARY score and PSMA expression score for csPCa were 0.751(95%CI:0.659-0.829)and 0.697(95%CI:0.601-0.781),respectively,without statistically difference(Z=1.438,P>0.05).The cut-off values for diagnosing csPCa were 3 score for PRIMARY score and 2 score for PSMA expression score,respectively.Conclusions The higher the 18F-PSMA PET/CT PRIMARY score,the higher the risk of developing csPCa.The PRIMARY score has good diagnostic efficacy for csPCa.
作者
朱辉
郭悦
徐文睿
刘龙腾
王淼
侯惠民
李春媚
张伟
刘甫庚
刘明
Zhu Hui;Guo Yue;Xu Wenrui;Liu Longteng;Wang Miao;Hou Huimin;Li Chunmei;Zhang Wei;Liu Fugeng;Liu Ming(Department of Nuclear Medicine,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Radiology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Pathology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Urology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)
出处
《中华医学杂志》
北大核心
2025年第4期291-296,共6页
National Medical Journal of China
基金
中央高水平医院临床科研业务费(BJ-2023-198、BJ-2023-105)。
作者简介
通信作者:刘明,Email:liumingbjh@126.com。
