Impact of prostate-specific membrane antigen positron emission tomography/computed tomography on initial tumor-node-metastasis staging and treatment strategy for intermediate-and high-risk prostate cancers
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摘要:
目的 评估前列腺特异性膜抗原（prostate-specific membrane antigen，PSMA）正电子发射计算机断层显像（positron emission tomography/computed tomography，PET/CT）对中高危前列腺癌初始临床分期及治疗策略的影响。 方法 回顾性分析2019年10月至2021年11月63例于重庆大学附属肿瘤医院初诊的中高危前列腺癌患者的临床及影像资料。比较PSMA PET/CT和传统影像学对前列腺癌病灶检出率及TNM分期的差异，评估PSMA PET/CT对治疗计划的影响。 结果 PSMA PET/CT对区域外淋巴结和骨转移的检出率分别为23.81%（15/63）和52.38%（33/63），较传统影像学的检出率3.17%（2/63）和25.40%（16/63）高，差异具有统计学意义（均P<0.001）。PSMA PET/CT检查后53.97%（34/63）患者TNM分期发生改变，N、M分期上调（均P<0.05）；22.22%（14/63）患者的治疗计划发生改变。 结论 PSMA PET/CT检查后上调中高危前列腺癌初始TNM分期中的N、M分期，导致超过20%患者临床治疗策略发生改变。PSMA PET/CT可成为精准评估中高危前列腺癌肿瘤负荷的首选影像学检查。 -
关键词:
- 前列腺特异性膜抗原 /
- 前列腺癌 /
- 正电子发射断层显像术
Abstract: Objective : To evaluate the effect of prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) on primary clinical tumor-node-metastasis (TNM) staging and treatment strategies for intermediate-and high-risk prostate cancers. Methods: The clinical and imaging data of 63 patients with intermediate-and high-risk prostate cancers at Chongqing University Cancer Hospital between October 2019 and November 2021 were retrospectively evaluated. The differences between PSMA PET/CT and conventional imaging in lesion detection rate and initial prostate cancer TNM stage were analyzed, and the effect of PSMA PET/CT on treatment strategies was assessed. Results: The detection rates of lymph node and bone metastases using PSMA PET/CT were 23.81% (15/63) and 52.38% (33/63), respectively, 3.17% (2/63) and 25.40% (16/63) more than those determined using traditional imaging, and the differences were significant (all P<0.001). The TNM stage changed for 53.97% (34/63) patients after PSMA PET/CT examination, and the N and M stages were upregulated (all P<0.05). A total of 22.22% (14/63) patients had changes in the treatment plan. Conclusions: The initial N and M stages of intermediate-and high-risk prostate cancers had been upregulated after PSMA PET/CT examination, which led to a change in clinical treatment strategies for more than 20% of patients. PSMA PET/CT may potentially be the first-line imaging modality to accurately assess the whole-body tumor burden in patients with intermediate-and high-risk prostate cancers. -
图 1 68Ga-PSMA-11 PET/CT与传统影像学检查在前列腺癌淋巴结转移中的比较
A：PSMA PET/CT MIP（maximum intensity projection）图显示前列腺癌（黄箭）及多部位淋巴结转移（白箭）；B～D：PSMA PET/CT融合图像显示淋巴结（直径为3～8 mm）转移（白箭）；E～G：对应层面传统影像学检查（增强CT及MRI）显示小淋巴结转移漏诊
图 2 68Ga-PSMA-11 PET/CT与传统影像学检查在前列癌骨转移中的比较
A：PSMA PET/CT MIP图；B～C：PSMA PET/CT融合图像显示脊柱及骨盆多发性转移（白箭）；D：传统影像学检查（骨扫描）显示骨转移（黄箭）和骨盆病灶漏诊
图 3 68Ga-PSMA-11 PET/CT与传统影像学检查在前列腺癌肝脏转移中的比较
A：传统影像学检查(增强CT）显示肝右叶转移可疑（黄箭）；B：PSMA PET/CT融合图像显示病灶无显像剂浓聚（黄箭）并排除肝转移；C：病灶穿刺活检病理图片（H&E×100）显示肝样细胞增生伴纤维血管组织增生
表 1 63例患者行PSMA PET/CT 检查前、后的TNM分期比较
检查项目 T分期（n=63） P N分期（n=63） P M分期（n=63） P Tx T2 T3 T4 Nx N0 N1 Mx M0 M1a M1b M1c 传统影像学检查 4 23 24 12 0.414 0 44 19 0.034 0 43 2 16 2 <0.001 PSMA PET/CT 0 28 24 11 0 39 24 2 26 2 29 4 
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表 2 63例患者临床治疗方案
例（%） 治疗方案 例数（n=63） 合计 前列腺根治性切除术+盆腔淋巴结清扫术 25（39.68） 联合内分泌治疗 8（12.70） 未联合内分泌治疗 17（26.98） 前列腺根治性放疗 6（9.53） 联合内分泌治疗 5（7.94） 未联合内分泌治疗 1（1.59） 系统治疗为主 32（50.79） 内分泌治疗 25（39.69） 内分泌治疗联合化疗 2（3.17） 内分泌治疗联合盆腔放疗 2（3.17） 内分泌治疗联合前列腺局部切除 2（3.17） 内分泌治疗联合化疗及骨转移灶减症放疗 1（1.59）
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