^(18)F-PSMA-1007 PET/CT与mpMRI在前列腺癌局部分期的诊断效能比较  

Comparison of Diagnostic Performance between^(18)F-PSMA-1007 PET/CT and mpMRI in Local Staging of Prostate Cancer

作　　者：刘骏锋 李曾[2] 周术奎 陈勇吉 沈镇岗 李云龙 杨盛柯 廖洪[2] Liu Junfeng;Li Zeng;Zhou Shukui;Chen Yongji;Shen Zhengang;Li Yunlong;Yang Shengke;Liao Hong(Department of Urology,the Third Affiliated Hospital of Chengdu Medical College(i.e.People's Hospital of Pidu District,Chengdu),Chengdu 611730,Sichuan,China;Department of Urology,Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,University of Electronic Science and Technology of China,Chengdu 610041,Sichuan,China)

机构地区：[1]成都医学院第三附属医院·成都市郸都区人民医院泌尿外科,成都611730 [2]四川省肿瘤医院·研究所,四川省肿瘤临床医学研究中心,四川省癌症防治中心,电子科技大学附属肿瘤医院泌尿外科,成都610041

出　　处：《肿瘤预防与治疗》2025年第3期201-209,共9页Journal of Cancer Control And Treatment

基　　金：四川省科技厅重点研发项目(编号:2020YFS0421);四川省卫生健康委员会医学科技项目(编号:23LCYJ004)。

摘　　要：目的:比较^(18)F-前列腺特异性膜抗原(prostate-specific membrane antigen,PSMA)-1007 PET/CT与多参数磁共振成像(multiparameter MRI,mpMRI)在前列腺癌(prostate cancer,PCa)局部分期中的效能,明确^(18)F-PSMA-1007在临床实践中的应用价值。方法:回顾性分析2018年11月至2023年1月于四川省肿瘤医院接受治疗,符合纳排标准的经穿刺活检确诊为PCa患者的临床资料。所有患者均行PCa根治术(radical prostatectomy,RP)+扩大盆腔淋巴结清扫术(extended pelvic lymph node dissection,ePLND),术前均完成^(18)F-PSMA-1007 PET/CT和mpMRI检查。以术后组织病理学结果作为金标准,比较^(18)F-PSMA-1007 PET/CT和mpMRI分别对PCa包膜外侵犯(extracapsular extension,ECE)、精囊侵犯(seminal vesicle invasion,SVI)和盆腔淋巴结转移(lymph node metastases,LNM)的诊断性能。计算两类方法的灵敏度、特异度、阳性预测值、阴性预测值、准确率,并采用Kappa检验分析两种成像方式与金标准的一致性。结果:共纳入41例患者,平均年龄(68.5±6.1)岁;血清PSA中位值35.5(15.9,85.2)ng/mL,其中PSA<10 ng/mL 4例、10~20 ng/mL 8例、20~100 ng/mL 20例、>100 ng/mL 9例;国际泌尿病理协会分级分组:1组3例、2组6例、3组7例、4组10例、5组15例;行腹腔镜前列腺癌根治术+ePLND 35例,机器人辅助前列腺根治术+ePLND 6例。根据风险分级(D-Amico量表),高危39例(95.1%),中危2例(4.9%),低危0例。术后病理结果提示有ECE 21例、SVI 7例、盆腔LNM15例。在检测ECE方面,^(18)F-PSMA-1007 PET/CT和mpMRI均检出8例,误诊2例,漏诊13例,显示出相同的诊断效能,诊断灵敏度为38.1%,特异度为90.0%,准确率为63.4%,Kappa值为0.277。在检测SVI方面,两种成像方式均检出4例阳性,在SVI诊断中,两种方法的灵敏度均为57.1%(4/7),^(18)F-PSMA-1007 PET/CT的诊断特异度(88.2%vs 85.3%)和准确率(82.9%vs 80.5%)高于mpMRI,但差异均无统计学意义(P>0.05)。对于盆腔LNM的检测,^(18)F-PSMA-1007 PET/CT的诊断�Objective:To compare the efficacy of^(18)F-prostate-specific membrane antigen(PSMA)-1007 PET/CT and multiparametric magnetic resonance imaging(mpMRI)in the local staging of prostate cancer(PCa),and to clarify the clinical application value of^(18)F-PSMA-1007.Methods:A retrospective analysis was conducted on clinical data from patients diagnosed with PCa via prostate biopsy at Sichuan Cancer Hospital between November 2018 and January 2023.All patients underwent radical prostatectomy(RP)with extended pelvic lymph node dissection(ePLND),and preoperative^(18)F-PSMA-1007 PET/CT and mpMRI examinations were completed for each patient.Using postoperative histopathological results as the gold standard,the diagnostic performance of^(18)F-PSMA-1007 PET/CT and mpMRI was compared for detecting extracapsular extension(ECE),seminal vesicle invasion(SVI),and pelvic lymph node metastases(LNM)in PCa.The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of the two methods were calculated.Additionally,the agreement between the two imaging modalities and the gold standard was analyzed using the Kappa test.Results:A total of 41 patients were included,with a mean age of(68.5±6.1)years.The median serum PSA level was 35.5(range:15.9~85.2)ng/mL,with 4 cases having PSA<10 ng/mL,8 cases with PSA 10~20 ng/mL,20 cases with PSA 20~100 ng/mL,and 9 cases with PSA>100 ng/mL.According to the International Society of Urological Pathology grading system,the cases were distributed as follows:Grade Group 1(3 cases),Grade Group 2(6 cases),Grade Group 3(7 cases),Grade Group 4(10 cases),and Grade Group 5(15 cases).Thirty-five patients underwent laparoscopic radical prostatectomy with ePLND,while 6 patients underwent robot-assisted radical prostatectomy with ePLND.Based on the D'Amico risk classification,39 patients(95.1%)were classified as high-risk,2 patients(4.9%)as intermediate-risk,and none as low-risk.Postoperative pathology confirmed ECE in 21 cases,SVI in 7 cases,and pelvic LNM in 15 cases.In the detection o

关 键 词：前列腺癌 前列腺特异性膜抗原 正电子发射断层显像术 多参数磁共振成像 诊断效能 

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