C-胆碱 PET/CT 可预测 PSA<1ng/ml 的前列腺癌患者的生存情况。
C-choline PET/CT predicts survival in prostate cancer patients with PSA < 1 NG/ml.
机构信息
Department of Nuclear Medicine, S. Andrea Hospital, La Spezia, Italy.
University of Milan-Bicocca, Milan, Italy.
出版信息
Eur J Nucl Med Mol Imaging. 2019 Apr;46(4):921-929. doi: 10.1007/s00259-018-4253-3. Epub 2019 Jan 10.
PURPOSE
The main drawback of C-choline PET/CT for restaging prostate cancer (PCa) patients with biochemical failure is the relatively low positive detection rate for prostate specific antigen (PSA) < 1 ng/ml. This study assessed whether C-choline PET/CT predicts survival in PCa patients with PSA < 1 ng/ml.
METHODS
This retrospective study included 210 PCa patients treated with radical prostatectomy who underwent C-choline PET/CT from December 1, 2004 to July 31, 2007 due to biochemical failure. PCa-specific survival was estimated using Kaplan-Meier curves. Cox regression analysis was used to evaluate the association between clinicopathologic variables and PCa-specific survival. PCa-specific survival was computed as the interval from radical prostatectomy to PCa-specific death.
RESULTS
Median follow-up after radical prostatectomy was 6.9 years (95% confidence interval, CI, 2.0-14.5 years). C-choline PET/CT was positive in 20.5% of patients. Median PCa-specific survival was 13.4 years (95% CI, 9.9-16.8 years) in patients with positive C-choline PET/CT, and it was not achieved in patients with negative C-choline PET/CT (log-rank, chi-square = 15.0, P < 0.001). Ten-year survival probabilities for patients with negative C-choline PET/CT and for patients with positive C-choline PET/CT were 86.0% (95% CI: 80.7%-91.3%) and 63.6% (95% CI: 54.5-72.7%). At multivariate analysis, only C-choline PET/CT significantly predicted PCa-specific survival (hazard ratio = 2.54, 95% CI, 1.05-6.13, P = 0.038). Patients with pathological C-choline uptake in the prostatic bed or in pelvic lymph nodes had longer PCa-specific survival in comparison to patients with pathological tracer uptake in the skeleton (log-rank: chi-square = 27.4, P < 0.001).
CONCLUSION
Despite the relatively low positive detection rate for PSA < 1 ng/ml, positive C-choline PET/CT predicts PCa-specific survival in this low PSA range. As long as more sensitive radiotracers, such as Ga-PSMA-11, do not become more widely available, these results might support a broader use of radiolabeled choline in restaging PCa for PSA < 1 ng/ml.
目的
对于生化复发的前列腺癌（PCa）患者，C-胆碱 PET/CT 进行再分期的主要缺点是前列腺特异性抗原（PSA）<1ng/ml 时的阳性检出率相对较低。本研究评估了 C-胆碱 PET/CT 是否可预测 PSA<1ng/ml 的 PCa 患者的生存情况。
方法
本回顾性研究纳入了 210 例因生化复发于 2004 年 12 月 1 日至 2007 年 7 月 31 日接受 C-胆碱 PET/CT 的接受根治性前列腺切除术的 PCa 患者。采用 Kaplan-Meier 曲线估计 PCa 特异性生存情况。Cox 回归分析用于评估临床病理变量与 PCa 特异性生存之间的关联。PCa 特异性生存计算为从根治性前列腺切除术到 PCa 特异性死亡的时间间隔。
结果
根治性前列腺切除术后中位随访时间为 6.9 年（95%置信区间，CI，2.0-14.5 年）。20.5%的患者 C-胆碱 PET/CT 阳性。C-胆碱 PET/CT 阳性患者的 PCa 特异性中位生存时间为 13.4 年（95%CI，9.9-16.8 年），而 C-胆碱 PET/CT 阴性患者未达到中位生存时间（对数秩，卡方=15.0，P<0.001）。C-胆碱 PET/CT 阴性患者和 C-胆碱 PET/CT 阳性患者的 10 年生存率分别为 86.0%（95%CI：80.7%-91.3%）和 63.6%（95%CI：54.5%-72.7%）。多变量分析显示，只有 C-胆碱 PET/CT 显著预测 PCa 特异性生存（风险比=2.54，95%CI，1.05-6.13，P=0.038）。与骨骼中存在病理性示踪剂摄取的患者相比，前列腺床或骨盆淋巴结中存在病理性 C-胆碱摄取的患者具有更长的 PCa 特异性生存（对数秩：卡方=27.4，P<0.001）。
结论
尽管 PSA<1ng/ml 时的阳性检出率相对较低，但 C-胆碱 PET/CT 仍可预测该低 PSA 范围内的 PCa 特异性生存。只要 Ga-PSMA-11 等更敏感的放射性示踪剂不能更广泛地应用，这些结果可能支持在 PSA<1ng/ml 时更广泛地使用放射性标记的胆碱对 PCa 进行再分期。
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