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中华腔镜泌尿外科杂志(电子版)

中华腔镜泌尿外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (03) : 214 -218. doi: 10.3877/cma.j.issn.1674-3253.2023.03.003

临床研究

68Ga-PSMA-PET/CT对前列腺癌盆腔淋巴结转移诊断价值的研究
单兴利1, 王栋2,†(), 邢念增2, 肖泽均2, 李亚健2   
  1. 1. 100122　北京市朝阳区桓兴肿瘤医院泌尿外科
    2. 100021　北京，国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院泌尿外科
  • 收稿日期:2022-02-28 出版日期:2023-06-01
  • 通信作者: 王栋
  • 基金资助:
    北京市朝阳区科技计划项目(CYSF1918)

Diagnostic value of 68Ga-PSMA-PET /CT in pelvic lymph node metastasis of prostate cancer

Xingli Shan1, Dong Wang2,†(), Nianzeng Xing2, Zejun Xiao2, Yajian Li2   

  1. 1. Department of Urology, Cancer Hospital of Huanxing, ChaoYang District, Beijng 100122, China
    2. Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
  • Received:2022-02-28 Published:2023-06-01
  • Corresponding author: Dong Wang
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单兴利, 王栋, 邢念增, 肖泽均, 李亚健. 68Ga-PSMA-PET/CT对前列腺癌盆腔淋巴结转移诊断价值的研究[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(03): 214-218.

Xingli Shan, Dong Wang, Nianzeng Xing, Zejun Xiao, Yajian Li. Diagnostic value of 68Ga-PSMA-PET /CT in pelvic lymph node metastasis of prostate cancer[J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(03): 214-218.

目的

分析68Ga-PSMA-PET/CT诊断前列腺癌盆腔淋巴结转移（LNM）与手术病理的一致性程度，用以指导临床。

方法

回顾性分析44例术前完成68Ga-PSMA-PET/CT的前列腺癌3D腹腔镜下根治性切除术+盆腔淋巴结清扫术患者的病历资料，观察68Ga-PSMA-PET/CT对于盆腔淋巴结转移的诊断价值。

结果

患者中位年龄66（60，69）岁，初始PSA 17（11，30）ng/ml。68Ga-PSMA-PET/CT淋巴结情况被描述为三种类型：Ⅰ、未见淋巴结转移；Ⅱ、可能淋巴结转移；Ⅲ、考虑淋巴结转移。将类型Ⅰ、Ⅱ定义为阴性，类型Ⅲ定义为阳性。68Ga-PSMA-PET/CT的LNM阳性率为25.00%（11/44），病理LNM阳性率为13.64%（6/44），6例病理LNM阳性患者全部为高危组，ISUP分级分别为G3（1/6）及G5（5/6）。总体68Ga-PSMA-PET/CT诊断LNM的灵敏度为83.33%（5/6），特异度为84.21%（32/38），诊断符合率为84.09%（37/44），阴性预测值为96.97%（32/33），阳性预测值为45.45%（5/11）。Kappa系数一致性检验显示其与病理诊断LNM存在较强程度的一致性，Kappa=0.601，P<0.05（Z=4.109，P<0.001，SEM=0.159，95%CI：0.291~0.912）。

结论

68Ga-PSMA-PET/CT用于前列腺癌患者诊断盆腔淋巴结转移与手术病理存在较强的一致性，其表现出的高阴性预测值临床应用价值很高，但不能取代盆腔淋巴结清扫术的地位。

关键词: 前列腺肿瘤, 68Ga-PSMA-PET/CT, 3D，腹腔镜, 前列腺切除术, 淋巴结转移
Objective

To analyze the consistency between the application of 68Ga-PSMA-PET/CT in the diagnosis of pelvic lymph node metastasis (LNM) of prostate cancer and surgical pathology, so as to guide the clinical practice.

Methods

The medical records of 44 patients with prostate cancer who completed 68Ga-PSMA-PET/CT preoperative 3D laparoscopic radical resection and pelvic lymph node dissection were analyzed retrospectively, and the diagnostic value of 68Ga-PSMA-PET/CT for pelvic lymph node metastasis was observed.

Results

The patients median age was 66(60, 69) years, and the initial PSA was 17(11, 30) ng/ml. 68Ga-PSMA-PET/CT lymph node was described as 3 types: I, no lymph node metastasis; II, possible lymph node metastasis; III, considering lymph node metastasis. Types I and II were defined as negative, and type III was defined as positive. The LNM positive rate of 68Ga-PSMA-PET/CT was 25.00%(11/44), and the pathological LNM positive rate was 13.64%(6/44), of which G3(1/6) and G5(5/6). The overall sensitivity of 68Ga-PSMA-PET/CT in the diagnosis of LNM was 83.33%(5/6), specificity was 84.21%(32/38), diagnostic coincidence rate was 84.09%(37/44), negative predictive value was 96.97%(32/33), positive predictive value was 45.45%(5/11). The Kappa coefficient consistency test showed that it had a strong degree of consistency with the pathological diagnosis of LNM, Kappa=0.601, P<0.05 (Z=4.109, P<0.001, SEM=0.159, 95%CI: 0.291-0.912).

Conclusions

The application of 68Ga-PSMA-PET/CT in the diagnosis of pelvic lymph node metastasis in prostate cancer patients has a strong degree of consistency with the surgical pathology, and its high negative predictive value is of high clinical application value, but it can not replace the status of pelvic lymph node dissection.

Key words: Prostate cancer, 68Ga-PSMA-PET/CT, 3D, laparoscopic prostatectomy, Lymph node metastasis
表1 44例前列腺癌患者的临床资料
项目 组别 例数 占比(%)
年龄(岁) 45~59 9 20.45
60~74 32 72.73
75~82 3 6.82
初始PSA(ng/ml) <10 8 18.18
10≤PSA<20 17 38.64
20≤PSA<100 17 38.64
≥100 2 4.55
ISUP分级(G1-5)(n=43，1例信息缺失) G1 2 4.65
G2 11 25.58
G3 10 23.26
G4 6 13.95
G5 14 32.56
危险因素分组 低危组 1 2.27
中位组 6 13.64
高危组 37 84.09
有无骨转移 无 40 90.91
有 4 9.09
淋巴结手术方式 标准淋巴结清扫 23 52.27
扩大淋巴结清扫 21 47.73
病理LNM 阳性 6 13.64
阴性 38 86.36
68Ga-PSMA-PET淋巴结情况 Ⅰ未见淋巴结转移 25 56.82
Ⅱ可能淋巴结转移 8 18.18
Ⅲ考虑淋巴结转移 11 25.00
合计   44 100.0
表2 总体68Ga-PSMA-PET/CT与病理诊断效能的比较(例)
68Ga-PSMA-PET/CT LNM情况 病理LNM(金标准) 总计
阳性 阴性
阳性 5 6 11
阴性 1 32 33
总计 6 38 44
表3 高危组68Ga-PSMA-PET/CT与病理诊断效能的比较(例)
68Ga-PSMA-PET/CT LNM情况 病理LNM(金标准) 总计
阳性 阴性
阳性 5 6 11
阴性 1 25 26
总计 6 31 37
表4 ISUP G3-G5组68Ga-PSMA-PET/CT与病理诊断效能的比较(例)
68Ga-PSMA-PET/CT LNM情况 病理LNM(金标准) 总计
阳性 阴性
阳性 5 10 15
阴性 1 14 15
总计 6 24 30
[1]
Siegel RL, Miller KD, Fuchs HE. Cancer statistics, 2021[J]. CA Cancer J Clin, 2021, 71(1): 7-33.
[2]
郑荣寿, 孙可欣, 张思维, 等. 2015年中国恶性肿瘤流行情况分析[J]. 中华肿瘤杂志, 2019, 41(1): 19-28。
[3]
Mottet N, Cornford P，van den Bergh RCN, et al. EAU-ESTRO-ESUR-SIOG guidelines on prostate cancer[EB/OL]. [2021-11-27].

URL    
[4]
Afshar-Oromieh A, Malcher A, Eder M, et al. PET imaging with a [68Ga]gallium-labelled PSMA ligand for the diagnosis of prostate cancer: biodistribution in humans and first evaluation of tumour lesions [J]. Eur J Nucl Med Mol Imaging, 2013, 40(4): 486-495.
[5]
Fendler WP, Schmidt DF, Wenter V, et al. 68Ga-PSMA PET/CT detects the location and extent of primary prostate cancer[J]. J Nucl Med, 2016, 57(11): 1720-1725.
[6]
Tulsyan S, Das CJ, Tripathi M, et al. Comparison of 68Ga-PSMA PET/CT and multiparametric MRI for staging of high-risk prostate cancer68Ga-PSMA PET and MRI in prostate cancer[J]. Nucl Med Commun, 2017, 38(12): 1094-1102.
[7]
Gultekin MH, Demirci E, Turegun FA, et al. The Role of 68GA-PSMA PET/CT scan in patients with prostate adenocarcinoma who underwent radical prostatectomy[J]. Urol J, 2020, 18(1): 58-65.
[8]
The SPSSAU project (2021). SPSSAU. (Version 21.0) [CP/OL]. [2021-12-01]

URL    
[9]
Soydal C, Urun Y, Suer E, et al. Predictor of 68Ga PSMA PET/CT positivity in patients with prostate cancer[J]. Q J Nucl Med Mol Imaging, 2020, 64(2): 226-230.
[10]
Wu H, Xu T, Wang X, et al. Diagnostic performance of 68gallium labelled prostate-specifific membrane antigen positron emission tomography/computed tomography and magnetic resonance imaging for staging the prostate cancer with intermediate or high risk prior to radical prostatectomy: a systematic review and metaanalysis[J]. World J Mens Health, 2020, 38(2): 208-219.
[11]
Rahman LA, Rutagengwa D, Lin P, et al. High negative predictive value of 68Ga PSMA PET-CT for local lymph node metastases in high risk primary prostate cancer with histopathological correlation[J]. Cancer Imaging, 2019, 19(1): 86.
[12]
Hofman MS, Lawrentschuk N, Francis RJ, et al. Prostate-specifific membrane antigenPET-CT inpatientswithhigh-risk prostate cancerbefore curative-intent surgery or radiotherapy (proPSMA): a prospective, randomisedmulti-centre study[J]. Lancet, 2020, 395 (10231):1208-1216.
[13]
Franklin A, Yaxley WJ, Raveenthiran S, et al. Histological comparison between predictive value of preoperative 3-T multiparametric MRI and 68Ga-PSMA PET/CT scan for pathological outcomes at radical prostatectomy and pelvic lymph node dissection for prostate cancer[J]. BJU Int, 2021, 127(1): 71-79.
[14]
Tulsyan S, Das CJ, Tripathi M, et al. Comparison of 68Ga-PSMA PET/CT and multiparametric MRI for staging of high-risk prostate cancer68Ga-PSMA PET and MRI in prostate cancer[J]. Nucl Med Commun, 2017, 38(12): 1094-1102.
[15]
Giovacchini G, Giovannini E, Riondato M, et al. PET/CT with 68Ga-PSMA in prostate cancer: radiopharmaceutical background and clinical implications[J]. Curr Radiopharm, 2018, 11(1):4-13.
[16]
Arslan A, Karaarslan E, Güner AL, et al. Comparison of MRI, PSMA PET/CT, and fusion PSMA PET/MRI for detection of clinically significant prostate cancer[J]. J Comput Assist Tomogr, 2021, 45(2):210-217.
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