文章：

提升前列腺癌分期准确性：68Ga-PSMA PET/CT影像与初治患者组织病理学分级的关联性研究

Enhancing Prostate Cancer Staging: Association of 68Ga-PSMA PET/CT Imaging with Histopathological Grading in Treatment-Naive Patients

原文发布日期：18 October 2024

DOI: 10.3390/cancers16203526

类型: Article

开放获取: 是

英文摘要：

Objective: This study aimed to evaluate the correlation between 68Ga-PSMA uptake in PSMA PET/CT in primary prostate cancer (PC) and its histopathological grading (Gleason score and ISUP grade). Additionally, we compared preoperative biopsy histopathological findings with definitive pathology results in radical prostatectomy (RP) specimens. Methods: We retrospectively analyzed 86 patients who underwent 68Ga-PSMA PET/CT for primary PC staging, of which 40 patients later underwent radical prostatectomy. PET/CT results, including SUVmax values, were correlated with GS and PSA concentrations. Histopathology reports were analyzed and compared between biopsy and final pathology results following RP. Results: A significant positive correlation was observed between SUVmax and ISUP grades (Pearson’s ρ = 0.34,p< 0.001), with higher SUVmax values associated with more advanced grades. A cut-off SUVmax value of 5.64 was determined to predict upstaging in patients, yielding a sensitivity of 76% and a specificity of 60% (AUC = 0.82, 95% CI: 0.70–0.94). Additionally, 57.5% of patients experienced a grade shift following RP, with a 35% upgrade and 22.5% downgrade in ISUP grades. Conclusion: 68Ga-PSMA PET/CT demonstrated high sensitivity in detecting high-risk prostate cancer, particularly in patients with GS > 7 or PSA levels ≥ 10 ng/mL. The findings suggest that this imaging modality may be less effective for the staging of patients with lower GS or PSA values, that is, low-risk PCa. Further prospective studies are necessary to validate these results.

摘要翻译： 

目的：本研究旨在评估原发性前列腺癌（PC）患者68Ga-PSMA PET/CT中PSMA摄取与组织病理学分级（格里森评分及ISUP分级）之间的相关性。同时，我们比较了术前活检组织病理学结果与根治性前列腺切除术（RP）标本的最终病理结果。方法：我们回顾性分析了86例因原发性前列腺癌分期而行68Ga-PSMA PET/CT检查的患者，其中40例后续接受了根治性前列腺切除术。将PET/CT结果（包括SUVmax值）与格里森评分及PSA浓度进行相关性分析。对活检与RP术后最终病理结果的组织病理学报告进行了分析与比较。结果：SUVmax与ISUP分级呈显著正相关（Pearson’s ρ = 0.34, p < 0.001），SUVmax值越高，分级越晚。确定SUVmax截断值为5.64可用于预测患者分级上调，其敏感性为76%，特异性为60%（AUC = 0.82，95% CI：0.70–0.94）。此外，57.5%的患者在RP术后出现分级变化，其中ISUP分级上调占35%，下调占22.5%。结论：68Ga-PSMA PET/CT在检测高危前列腺癌方面表现出高敏感性，尤其适用于格里森评分 > 7 或PSA水平 ≥ 10 ng/mL的患者。研究结果表明，该影像学方法对于格里森评分或PSA值较低（即低危前列腺癌）患者的分期可能效果有限。需进一步开展前瞻性研究以验证这些结果。

原文链接：

Enhancing Prostate Cancer Staging: Association of 68Ga-PSMA PET/CT Imaging with Histopathological Grading in Treatment-Naive Patients