^(68)Ga-PSMA-NYM032 PET/CT显像在前列腺癌初诊患者中的临床应用  

Clinical application of ^(68)Ga-PSMA-NYM032 PET/CT imaging in patients diagnosed initially with prostate cancer

作　　者：王艳娟 付海田 贺慧慧 糜远源 吴玉伟 葛东升 郁春景[1] Wang Yanjuan;Fu Haitian;He Huihui;Mi Yuanyuan;Wu Yuwei;Ge Dongsheng;Yu Chunjing(Department of Nuclear Medicine,Affiliated Hospital of Jiangnan University,Wuxi 214000,China;Department of Urology,Affiliated Hospital of Jiangnan University,Wuxi 214000,China)

机构地区：[1]江南大学附属医院核医学科,无锡214000 [2]江南大学附属医院泌尿外科,无锡214000

出　　处：《中华核医学与分子影像杂志》2023年第12期724-729,共6页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的评价靶向前列腺特异膜抗原(PSMA)的新型分子探针^(68)Ga-PSMA-NYM032 PET/CT显像在前列腺癌初诊患者中的临床应用价值。方法前瞻性纳入2022年3月至2023年1月在江南大学附属医院接受^(68)Ga-PSMA-NYM032 PET/CT显像的疑诊前列腺癌患者63例[年龄(68.7±8.7)岁],以患者为中心评价^(68)Ga-PSMA-NYM032的诊断效能,并采用视觉分析、勾画ROI行半定量分析得到SUV_(max),利用ROC曲线获得SUV_(max)诊断阈值。采用Spearman秩相关分析原发灶SUV_(max)与总前列腺特异抗原(tPSA)之间、原发灶SUV_(max)与Gleason评分(GS)之间的相关性。根据D′Amico前列腺癌危险度评估标准对患者进行分层[前列腺特异膜抗原(PSA)>20μg/L与≤20μg/L;GS>7分与≤7分],用Fisher确切概率法分析^(68)Ga-PSMA-NYM032 PET/CT显像对不同分层的前列腺癌患者转移灶的检出率,并用Mann-WhitneyU检验分析不同分层患者转移灶SUV_(max)的差异。结果^(68)Ga-PSMA-NYM032 PET/CT显像检查准确性为92.06%(58/63),灵敏度为96.55%(28/29),特异性为88.24%(30/34),阳性预测值为87.50%(28/32),阴性预测值为96.77%(30/31),SUV_(max)的最佳诊断阈值为6.9。^(68)Ga-PSMA-NYM032在前列腺癌原发灶中呈不同程度的高摄取,SUV_(max)与tPSA水平、GS均呈正相关(rs值:0.657、0.592,P值:<0.001、0.001)。分层分析结果显示,仅GS>7分与≤7分组的^(68)Ga-PSMA-NYM032 PET/CT对骨转移的检出率差异有统计学意义(9/17与1/12;P=0.019),而对PSA水平分层中的骨转移灶、GS或PSA分层中的淋巴结转移灶的检出率差异均无统计学意义(均P>0.05)。另外,GS或PSA分层的前列腺癌患者转移灶的SUV_(max)差异均不具有统计学意义(z值:-1.57~-0.50,均P>0.05)。结论^(68)Ga-PSMA-NYM032 PET/CT显像对前列腺癌具有良好的诊断效能,可为前列腺癌精准化诊疗提供新的策略;GS分层会影响^(68)Ga-PSMA-NYM032 PET/CT对于骨转移的检出率。Objective To evaluate the clinical application potential of a novel prostate specific membrane antigen(PSMA)targeted PET tracer ^(68)Ga-PSMA-NYM032 in patients diagnosed initially with prostate cancer.Methods A total of 63 patients(age(68.7±8.7)years)with suspected prostate cancers who received ^(68)Ga-PSMA-NYM032 PET/CT imaging in Affiliated Hospital of Jiangnan University between March 2022 and January 2023 were enrolled prospectively.The diagnostic efficiency of ^(68)Ga-PSMA-NYM032 PET/CT imaging was evaluated in a patient-centered manner.The ROI was drawn to obtain SUV_(max) by semi-quantitative analysis with visual analysis,and the diagnostic threshold of SUV_(max) was obtained by ROC curve analysis.The correlations of SUV_(max) in primary foci with total prostate specific antigen(tPSA)and Gleason score(GS)were analyzed by Spearman rank correlation analysis.Based on the D′Amico risk stratification(prostate specific antigen(PSA)>20μg/L and≤20μg/L,GS>7 and≤7),the detection rates of metastases by ^(68)Ga-PSMA-NYM032 PET/CT imaging in different stratifications were analyzed by Fisher exact test,and the differences between SUV_(max) of metastases in different stratifications were determined by Mann-Whitney U test.Results The accuracy of ^(68)Ga-PSMA-NYM032 PET/CT imaging was 92.06%(58/63),the sensitivity was 96.55%(28/29),the specificity was 88.24%(30/34),the positive predictive value was 87.50%(28/32),the negative predictive value was 96.77%(30/31),and the optimal SUV_(max) threshold was 6.9.^(68)Ga-PSMA-NYM032 showed varying degrees of high uptake in the primary foci of prostate cancer,and SUV_(max) were positively correlated with tPSA and GS(rs values:0.657,0.592,P values:<0.001,0.001).Stratified analysis showed a statistically significant difference in the detection rate of bone metastases by ^(68)Ga-PSMA-NYM032 PET/CT between the GS>7 and GS≤7 subgroups(9/17 vs 1/12;P=0.019),while no statistical significances were observed in the detection rates of bone metastases or lymph node metastases of anoth

关 键 词：前列腺肿瘤 前列腺特异膜抗原 镓放射性同位素 正电子发射断层显像术 体层摄影术 X线计算机 

分 类 号：R737.25[医药卫生—肿瘤] R730.44[医药卫生—临床医学]