Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Institute of Urology, Nanjing University, 321 Zhongshan Rd, Nanjing, Jiangsu, China.
Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, 321 Zhongshan Rd, Nanjing, 210008, Jiangsu, China.
Eur Radiol. 2022 Sep;32(9):6545-6553. doi: 10.1007/s00330-022-08738-y. Epub 2022 Mar 31.
OBJECTIVE: To evaluate the efficacy of parameters derived from [Ga]Ga-PSMA-11 PET/CT images in predicting pathological HIF-2α expression in primary tumors among patients with renal cell carcinoma (RCC). METHODS: Fifty-three RCC patients with preoperative [Ga]Ga-PSMA-11 PET/CT scans and complete surgical specimens were retrospectively enrolled in this study. Radiographic parameters were obtained from PET/CT images, and immunohistochemistry was used to measure the expression of HIF-2α and PSMA. Continuous variables and categorical variables were analyzed by the Mann-Whitney U test and chi-square test, respectively. ROC analysis was used to test the efficacy of several preoperative parameters in identifying pathological HIF-2α expression. Univariable logistic regression analyses were performed for significant parameters to predict pathological HIF-2α expression in RCC. RESULTS: Of the 53 tumors, 29 (54.7%) had high expression of HIF-2α. The SUV was significantly different in the HIF-2α expression subgroups (p < 0.001). SUV emerged as the most significant parameter to differentiate HIF-2α expression subgroups (high vs. low), with the AUC of 0.93 (95% CI 0.85-1.00, p < 0.001), sensitivity of 90%, and specificity of 88%. Furthermore, SUV was confirmed as the most significant predictor of HIF-2α expression level by univariable logistic regression model analysis (odds ratio 1.39, 95% CI 1.17-1.65, p < 0.001). Consistent with the radiographic results of [Ga]Ga-PSMA-11 PET/CT, the staining intensity of pathological PSMA was significantly higher in HIF-2α-high-expressing tumors (p = 0.003). CONCLUSIONS: [Ga]Ga-PSMA-11 PET/CT was superior in identifying pathological HIF-2α expression in primary tumors of RCC patients, demonstrating its potential application in predicting responses to HIF-2α antagonists. KEY POINTS: • [Ga]Ga-PSMA-11 PET/CT could potentially predict the HIF-2α expression of primary tumors among patients with RCC. • SUVof [Ga]Ga-PSMA-11 PET/CT was the most significant predictor of HIF-2α expression level. • This probability could help predict the therapeutic response of patients with RCC to HIF-2α antagonists.
目的：评估[Ga]Ga-PSMA-11 PET/CT 图像参数在预测肾细胞癌（RCC）患者原发肿瘤中病理 HIF-2α表达中的疗效。
方法：回顾性纳入 53 例接受术前[Ga]Ga-PSMA-11 PET/CT 扫描和完整手术标本的 RCC 患者。从 PET/CT 图像中获得影像学参数，并通过免疫组织化学检测 HIF-2α和 PSMA 的表达。连续变量和分类变量分别采用 Mann-Whitney U 检验和卡方检验进行分析。ROC 分析用于测试几种术前参数在识别病理 HIF-2α表达方面的效果。单变量逻辑回归分析用于对显著参数进行分析，以预测 RCC 中病理 HIF-2α的表达。
结果：53 个肿瘤中，有 29 个（54.7%）HIF-2α高表达。HIF-2α 表达亚组之间 SUV 差异有统计学意义（p<0.001）。SUV 是区分 HIF-2α 表达亚组的最显著参数，AUC 为 0.93（95%CI 0.85-1.00，p<0.001），敏感性为 90%，特异性为 88%。此外，SUV 通过单变量逻辑回归模型分析被证实为 HIF-2α 表达水平的最显著预测因子（优势比 1.39，95%CI 1.17-1.65，p<0.001）。与[Ga]Ga-PSMA-11 PET/CT 的影像学结果一致，HIF-2α 高表达肿瘤的 PSMA 病理染色强度明显更高（p=0.003）。
结论：[Ga]Ga-PSMA-11 PET/CT 可用于识别 RCC 患者原发肿瘤中病理 HIF-2α 的表达，表明其在预测 HIF-2α 拮抗剂治疗反应方面具有潜在应用价值。
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