Wang Zhuonan, Zheng Anqi, Li Yunxuan, Dong Weixuan, Liu Xiang, Yuan Wang, Gao Fan, Duan Xiaoyi
PET/CT Unit, Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Front Oncol. 2021 Oct 28;11:759053. doi: 10.3389/fonc.2021.759053. eCollection 2021.
To evaluate the prediction performance of F-PSMA-1007 PET/CT and clinicopathologic characteristics on prostate cancer (PCa) risk stratification and distant metastatic prediction.
A retrospective analysis was performed on 101 consecutively patients with biopsy or radical prostatectomy proved PCa who underwent F-PSMA-1007 PET/CT. The semi-quantitative analysis provided minimum, maximum and mean standardized uptake (SUVmin, SUVmax and SUVmean) of PCa. Association between clinicopathologic characteristics (total prostate-specific antigen, tPSA and Gleason Score, GS) and PET/CT indexes were analyzed. The diagnostic performance of distant metastatic on PET/CT parameters, tPSA and GS was evaluated using logistic regression analyses. A path analysis was conducted to evaluate the mediating effect of tPSA level on the relation between semi-quantitative parameters of primary tumors and metastatic lesions.
The PET/CT parameters were all higher in high risk stratification subgroups (tPSA>20 ng/mL, GS ≥ 8, and tPSA>20 ng/mL and/or GS ≥ 8, respectively) with high sensitivity (86.89%, 90.16% and 83.61%, respectively). The SUVmax, tPSA and GS could effectively predict distant metastatic with high sensitivity of SUVmax (90.50%) compared with tPSA (57.14%) and GS (55.61%). With a cutoff value of 29.01ng/mL for tPSA, the detection rate of distant metastasis between low and high prediction tPSA group had statistical differences (50.00% vs. 76.60%, respectively; P = 0.006) which was not found on guideline tPSA level (P>0.05). 6/15 (40%) patients tPSA between 20ng/mL to 29.01ng/mL without distant metastases may change the risk stratification. Finally, tPSA had a partial mediating effect on SUVmax of primary tumors and metastases lesions.
The F-PSMA-1007 PET/CT SUVmax has a higher sensitivity and can be an "imaging biomarker" for primary PCa risk stratification. The prediction tPSA level (29.01 ng/mL) is more conducive to the assessment of distant metastasis and avoid unnecessary biopsy.
评估F-PSMA-1007 PET/CT及临床病理特征对前列腺癌（PCa）风险分层和远处转移预测的性能。
对101例经活检或根治性前列腺切除术证实为PCa且接受F-PSMA-1007 PET/CT检查的患者进行回顾性分析。半定量分析给出了PCa的最小、最大和平均标准化摄取值（SUVmin、SUVmax和SUVmean）。分析临床病理特征（总前列腺特异性抗原，tPSA和Gleason评分，GS）与PET/CT指标之间的相关性。使用逻辑回归分析评估PET/CT参数、tPSA和GS对远处转移的诊断性能。进行路径分析以评估tPSA水平在原发性肿瘤和转移灶半定量参数关系中的中介作用。
在高风险分层亚组（分别为tPSA>20 ng/mL、GS≥8以及tPSA>20 ng/mL和/或GS≥8）中，PET/CT参数均较高，敏感性较高（分别为86.89%、90.16%和83.61%）。与tPSA（57.14%）和GS（55.61%）相比，SUVmax对远处转移的预测敏感性较高（90.50%）。以tPSA的截断值29.01ng/mL划分，低预测tPSA组和高预测tPSA组的远处转移检出率有统计学差异（分别为50.00%和76.60%；P = 0.006），而在指南规定的tPSA水平上未发现差异（P>0.05）。15例tPSA在20ng/mL至29.01ng/mL之间且无远处转移的患者中有6例（40%）可能改变风险分层。最后，tPSA在原发性肿瘤和转移灶的SUVmax之间具有部分中介作用。
F-PSMA-1007 PET/CT的SUVmax具有较高的敏感性，可作为原发性PCa风险分层的“影像生物标志物”。预测tPSA水平（29.01 ng/mL）更有利于评估远处转移并避免不必要的活检。
