Zschaeck Sebastian, Andela Stephanie Bela, Amthauer Holger, Furth Christian, Rogasch Julian M, Beck Marcus, Hofheinz Frank, Huang Kai
Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
BIH Charité Clinician Scientist Program, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Berlin, Germany.
Front Oncol. 2022 Apr 22;12:879089. doi: 10.3389/fonc.2022.879089. eCollection 2022.
PSMA PET is frequently used for staging of prostate cancer patients. Furthermore, there is increasing interest to use PET information for personalized local treatment approaches in surgery and radiotherapy, especially for focal treatment strategies. However, it is not well established which quantitative imaging parameters show highest correlation with clinical and histological tumor aggressiveness.
This is a retrospective analysis of 135 consecutive patients with non-metastatic prostate cancer and PSMA PET before any treatment. Clinical risk parameters (PSA values, Gleason score and D'Amico risk group) were correlated with quantitative PET parameters maximum standardized uptake value (SUV), mean SUV (SUV), tumor asphericity (ASP) and PSMA tumor volume (PSMA-TV).
Most of the investigated imaging parameters were highly correlated with each other (correlation coefficients between 0.20 and 0.95). A low to moderate, however significant, correlation of imaging parameters with PSA values (0.19 to 0.45) and with Gleason scores (0.17 to 0.31) was observed for all parameters except ASP which did not show a significant correlation with Gleason score. Receiver operating characteristics for the detection of D'Amico high-risk patients showed poor to fair sensitivity and specificity for all investigated quantitative PSMA PET parameters (Areas under the curve (AUC) between 0.63 and 0.73). Comparison of AUC between quantitative PET parameters by DeLong test showed significant superiority of SUV compared to SUV for the detection of high-risk patients. None of the investigated imaging parameters significantly outperformed SUV.
Our data confirm prior publications with lower number of patients that reported moderate correlations of PSMA PET parameters with clinical risk factors. With the important limitation that Gleason scores were only biopsy-derived in this study, there is no indication that the investigated additional parameters deliver superior information compared to SUV.
PSMA PET常用于前列腺癌患者的分期。此外，人们越来越有兴趣将PET信息用于手术和放疗中的个性化局部治疗方法，特别是对于局部治疗策略。然而，尚未明确哪些定量成像参数与临床和组织学肿瘤侵袭性具有最高的相关性。
这是一项对135例未经治疗的非转移性前列腺癌患者及PSMA PET进行的回顾性分析。临床风险参数（PSA值、Gleason评分和D'Amico风险组）与PET定量参数最大标准化摄取值（SUV）、平均SUV（SUV）、肿瘤非球形度（ASP）和PSMA肿瘤体积（PSMA-TV）相关。
大多数研究的成像参数之间高度相关（相关系数在0.20至0.95之间）。除ASP外，所有参数与PSA值（0.19至0.45）和Gleason评分（0.17至0.31）之间均观察到低至中度但显著的相关性，ASP与Gleason评分无显著相关性。检测D'Amico高危患者的受试者工作特征曲线显示，所有研究的定量PSMA PET参数的敏感性和特异性均较差至中等（曲线下面积（AUC）在0.63至0.73之间）。通过DeLong检验比较定量PET参数之间的AUC，结果显示在检测高危患者方面，SUV显著优于SUV。没有一个研究的成像参数明显优于SUV。
我们的数据证实了之前患者数量较少的研究报告，即PSMA PET参数与临床风险因素存在中度相关性。鉴于本研究中Gleason评分仅来源于活检这一重要局限性，没有迹象表明所研究的其他参数比SUV能提供更优的信息。
