^(99m)Tc标记PSMA小分子抑制剂靶向前列腺癌分子影像初步临床研究  

Preliminary clinical study of ^(99m)Tc-labelled small molecules against PSMA for prostate cancer imaging

作　　者：胡四龙[1,2,3,4] 许晓平[1,2,3,4] 朱耀[5] 宿恒川[5] 叶定伟[5] 姚之丰[1,2,3,4] 潘禾戎[1,2,3,4] 郭小毛[3,4,6] 章英剑[1,2,3,4] 

机构地区：[1]复旦大学附属肿瘤医院核医学科复旦大学上海医学院肿瘤学系,上海200032 [2]复旦大学生物医学影像研究中心,上海200032 [3]上海分子影像探针工程技术研究中心(筹),上海200032 [4]复旦大学附属肿瘤医院质子重离子中心,上海201315 [5]复旦大学附属肿瘤医院泌尿外科复旦大学上海医学院肿瘤学系,上海200032 [6]复旦大学附属肿瘤医院放疗科复旦大学上海医学院肿瘤学系,上海200032

出　　处：《中国癌症杂志》2016年第7期608-615,共8页China Oncology

基　　金：上海市科委项目(14DZ2251400);上海市卫生和计划生育委员会项目(20124189)

摘　　要：背景与目的:前列腺特异性膜抗原(prostate-specific membrane antigen,PSMA)在前列腺癌细胞表面特异性高表达,是前列腺癌诊断和治疗的极具有吸引力的靶点。放射性核素标记的PSMA小分子抑制剂能够高效、特异性探测前列腺癌病灶并进行分期。本研究初步探讨^(99m)Tc标记PSMA小分子抑制剂(HYNIC-GluUrea-A,简称^(99m)Tc-PSMA)SPECT/CT显像诊断前列腺原发灶和转移灶的价值。方法:24例前列腺癌和1例前列腺增生患者静脉注射^(99m)Tc-PSMA 2 h后行全身平面扫描和腹盆部SPECT/CT断层显像,采用感兴趣区技术计算肿瘤和肌肉摄取^(99m)Tc-PSMA比值(T/N)进行半定量分析,评价全身平面显像结合断层显像检测前列腺癌原发灶和(或)转移灶的灵敏度和特异度,分析^(99m)Tc-PSMA阳性率与前列腺癌特异性抗原(prostate-specific antigen,PSA)水平和Gleason评分的关系。结果:以患者为单位,^(99m)Tc-PSMA SPECT/CT对前列腺癌原发灶或转移灶检测的灵敏度为72.7%(16/22)、特异度为100%(3/3)。^(99m)Tc-PSMA阳性患者,(中位数17.31 ng/m L,范围2.26~3 239.00 ng/m L)水平明显高于^(99m)Tc-PSMA阴性患者PSA(中位数0.49 ng/m L,范围0.07~9.28 ng/m L)(Z=-3.51,P<0.001);在初诊和PSA大于2 ng/m L的复发患者中,^(99m)Tc-PSMA阳性率明显提高,灵敏度达94.1%(16/17);^(99m)Tc-PSMA的阳性率与Gleason评分高低无关(Z=-0.69,P=0.52)。结论:^(99m)Tc-PSMA全身平面显像结合局部SPECT/CT断层显像对前列腺癌原发灶和转移灶的探测有较高应用价值,灵敏度及特异度均较高。Background and purpose： Prostate-specific membrane antigen （PSMA）, a cell surface protein with high expression in prostate carcinoma （PC） cells, is an attractive target for PC imaging and therapy. Small-molecule radiopharmaceuticals targeting PSMA can detect the location and extent of disease with high sensitivity and specificity. The aim of this study was to evaluate the value of technetium-99m-labelled small molecule against PSMA （HYNIC- Glu-Urea-A, 99mTc-PSMA） for the detection of primary and metastatic prostate cancers. Methods： Twenty-four prostate cancer patients and I patient with benign prostate hyperplasia received whole-body scan followed by abdominopelvic SPECT/CT 2 h after intravenous injection of 99mTc-PSMA. Tumor to muscle uptake ratio of 99mTc-PSMA was calcu- lated using region of interest （ROI） technology. The sensitivity and specificity of 99mTc-PSMA were evaluated. The relationships between positive 99mTc-PSMA and prostate specific antigen （PSA） level and Gleason Score were analyzed. Results： Based on per patient, the sensitivity and specificity of 99mTc-PSMA were 72.7% （16/22） and 100% （3/3）, re- spectively. The level of PSA in patients with positive 99mTc-PSMA imaging was significantly higher than that in patients with negative 99mTc-PSMA imaging [（PSA median 17.31 ng/mL, range： 2.26-3 239.0 ng/mL） vs （PSA median 0.49 ng/ mL, range： 0.07-9.28 ng/mL）] （Z=-3.51, P〈0.001）. Among newly diagnosed patients and recurrent patients with PSA more than 2.0 nm/mL, it was apparent that 99raTc-PSMA imaging was able to detect lesions with improved sensitivity of 94.1% （16/17）. Gleason Scores between positive 99mTc-PSMA patients and negative 99mTc-PSMA patients were not significantly different （Z=-0.69, P=0.52）. Conclusion： With the combination of whole-body scan and tomography, 99mTc-PSMA SPECT/CT can be an excellent and specific molecular imaging strategy to detect prostate cancer and its metastases.

关 键 词：前列腺癌 前列腺特异性膜抗原 前列腺特异性抗原 GLEASON评分 99mTc-PSMA显像 

分 类 号：R737.25[医药卫生—肿瘤]