基于 PSMA PET 的放射组学特征在中高危前列腺癌患者中进行前列腺内肿瘤的非侵入性鉴别和特征分析——与组织学参考的比较研究。
Radiomic features from PSMA PET for non-invasive intraprostatic tumor discrimination and characterization in patients with intermediate- and high-risk prostate cancer - a comparison study with histology reference.
机构信息
Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine. University of Freiburg, Germany.
German Cancer Consortium (DKTK). Partner Site Freiburg, Germany.
出版信息
Theranostics. 2019 Apr 13;9(9):2595-2605. doi: 10.7150/thno.32376. eCollection 2019.
To evaluate the performance of radiomic features (RF) derived from PSMA PET for intraprostatic tumor discrimination and non-invasive characterization of Gleason score (GS) and pelvic lymph node status. Patients with prostate cancer (PCa) who underwent [Ga]-PSMA-11 PET/CT followed by radical prostatectomy and pelvic lymph node dissection were prospectively enrolled (n=20). Coregistered histopathological gross tumor volume (GTV-Histo) in the prostate served as reference. 133 RF were derived from GTV-Histo and from manually created segmentations of the intraprostatic tumor volume (GTV-Exp). Spearman´s correlation coefficients (ρ) were assessed between RF derived from the different GTVs. We additionally analyzed the differences in RF values for PCa and non-PCa tissues. Furthermore, areas under receiver-operating characteristics curves (AUC) were calculated and uni- and multivariate analyses were performed to evaluate the RF based discrimination of GS 7 and ≥8 disease and of patients with nodal spread (pN1) and non-nodal spread (pN0) in surgical specimen. The results found in the latter analyses were validated by a retrospective cohort of 40 patients. Most RF from GTV-Exp showed strong correlations with RF from GTV-Histo (86% with ρ>0.7). 81% and 76% of RF from GTV-Exp and GTV-Histo significantly discriminated between PCa and non-PCa tissue. The texture feature QSZHGE discriminated between GS 7 and ≥8 considering GTV-Histo (AUC=0.93) and GTV-Exp (prospective cohort: AUC=0.91 / validation cohort: AUC=0.84). QSZHGE also discriminated between pN1 and pN0 disease considering GTV-Histo (AUC=0.85) and GTV-Exp (prospective cohort: AUC=0.87 / validation cohort: AUC=0.85). In uni- and multivariate analyses including patients of both cohorts QSZHGE was a statistically significant (p<0.01) predictor for PCa patients with GS ≥8 tumors and pN1 status. RF derived from PSMA PET discriminated between PCa and non-PCa tissue within the prostate. Additionally, the texture feature QSZHGE discriminated between GS 7 and GS ≥8 tumors and between patients with pN1 and pN0 disease. Our results support the role of RF in PSMA PET as a new tool for non-invasive PCa discrimination and characterization of its biological properties.
为了评估 PSMA PET 衍生的放射组学特征（RF）在前列腺内肿瘤区分和 Gleason 评分（GS）及盆腔淋巴结状态的无创特征中的性能，前瞻性纳入了 20 例接受 [Ga]-PSMA-11 PET/CT 检查后行根治性前列腺切除术和盆腔淋巴结清扫术的前列腺癌（PCa）患者。以前列腺内的大体肿瘤体积（GTV-Histo）配准的组织病理学作为参考。从 GTV-Histo 和手动创建的前列腺内肿瘤体积（GTV-Exp）分割中提取了 133 个 RF。评估了来自不同 GTV 的 RF 之间的斯皮尔曼相关系数（ρ）。我们还分析了 PCa 和非 PCa 组织的 RF 值差异。此外，计算了接收器操作特征曲线（AUC）下的面积，并进行了单变量和多变量分析，以评估基于 RF 的 GS 7 和≥8 疾病以及淋巴结转移（pN1）和无淋巴结转移（pN0）患者的 GS 7 和≥8 疾病和无淋巴结转移（pN0）患者的区分。通过 40 例患者的回顾性队列验证了后者分析中的结果。来自 GTV-Exp 的大多数 RF 与来自 GTV-Histo 的 RF 具有很强的相关性（ρ>0.7 的占 86%）。来自 GTV-Exp 和 GTV-Histo 的 81%和 76%的 RF 可显著区分 PCa 和非 PCa 组织。纹理特征 QSZHGE 考虑到 GTV-Histo（AUC=0.93）和 GTV-Exp（前瞻性队列：AUC=0.91/验证队列：AUC=0.84），可区分 GS 7 和≥8。QSZHGE 还考虑到 GTV-Histo（AUC=0.85）和 GTV-Exp（前瞻性队列：AUC=0.87/验证队列：AUC=0.85），可区分 pN1 和 pN0 疾病。在包括两个队列患者的单变量和多变量分析中，QSZHGE 是 GS≥8 肿瘤和 pN1 状态的 PCa 患者的统计学上显著（p<0.01）的预测因子。来自 PSMA PET 的 RF 可区分前列腺内的 PCa 和非 PCa 组织。此外，纹理特征 QSZHGE 可区分 GS 7 和 GS≥8 肿瘤以及 pN1 和 pN0 疾病患者。我们的结果支持 RF 在 PSMA PET 中的作用，作为一种新的非侵入性 PCa 鉴别和特征分析工具。
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