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中华腔镜泌尿外科杂志(电子版) ›› 2025, Vol. 19 ›› Issue (04) : 441 -446. doi: 10.3877/cma.j.issn.1674-3253.2025.04.008

临床研究

18F-PSMA-1007 PET/CT对ISUP 1~2级前列腺癌患者术后病理升级的预测价值
李阳1, 罗量1, 常儒玺1, 董伟璇1, 王博1, 吴开杰2, 段小艺1,†()   
  1. 1710061　陕西，西安交通大学第一附属医院PET/CT室
    2710061　陕西，西安交通大学第一附属医院泌尿外科
  • 收稿日期:2024-08-13 出版日期:2025-08-01
  • 通信作者: 段小艺
  • 基金资助:
    陕西省自然科学基础研究计划(2020JZ-38)

Predictive value of 18F-PSMA-1007 PET/CT for postoperative pathologic upgrading in patients with biopsy ISUP grade 1-2 prostate cancer

Yang Li1, Liang Luo1, Ruxi Chang1, Weixuan Dong1, Bo Wang1, Kaijie Wu2, Xiaoyi Duan1,†()   

  1. 1Department of PET/CT Room, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
    2Department of Urology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
  • Received:2024-08-13 Published:2025-08-01
  • Corresponding author: Xiaoyi Duan
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引用本文：

李阳, 罗量, 常儒玺, 董伟璇, 王博, 吴开杰, 段小艺. 18F-PSMA-1007 PET/CT对ISUP 1~2级前列腺癌患者术后病理升级的预测价值[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(04): 441-446.

Yang Li, Liang Luo, Ruxi Chang, Weixuan Dong, Bo Wang, Kaijie Wu, Xiaoyi Duan. Predictive value of 18F-PSMA-1007 PET/CT for postoperative pathologic upgrading in patients with biopsy ISUP grade 1-2 prostate cancer[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2025, 19(04): 441-446.

目的

探讨18F-前列腺特异膜抗原（PSMA）-1007 PET/CT对穿刺病理国际泌尿病理学会（ISUP）1~2级的前列腺癌患者术后病理升级的诊断价值。

方法

回顾性收集2020年10月至2023年8月在西安交通大学第一附属医院经穿刺病理证实为ISUP 1~2级且行根治性前列腺切除术（RP）的73例患者临床和病理信息。比较ISUP升级组和ISUP未升级组间18F-PSMA-1007 PET/CT和临床参数的差异。采用单因素和多因素Logistic回归分析筛选18F-PSMA-1007 PET/CT和临床参数中影响术后病理升级的因素。构建诊断预测列线图，并绘制受试者工作特征（ROC）曲线和决策曲线评估模型的预测性能和临床效益。

结果

73例前列腺癌患者中，44例（60.3%）发生ISUP升级。ISUP升级组的前列腺特异抗原（PSA）水平，最大标准化摄取值（SUVmax）和平均标准化摄取值（SUVmean）均显著高于ISUP未升级组（均P<0.05）。而年龄、肿瘤代谢体积（MTV）和病灶总摄取值（TLU）在两组间差异均无统计学意义（均P>0.05）。单因素Logistic回归分析结果显示，PSA水平、穿刺ISUP分级分组和SUVmean可影响术后ISUP升级。多因素Logistic回归分析结果表明穿刺ISUP分级分组和SUVmean是术后前列腺癌ISUP升级的预测因素。穿刺ISUP升级与SUVmean联合模型对预测术后ISUP升级的AUC高于穿刺ISUP分级分组和SUVmean（0.851 vs 0.623，0.728，P=0.008，P=0.210），但后者差异无统计学意义。决策曲线分析表明当阈值概率>47%时，穿刺ISUP分级分组与SUVmean构成的联合模型在临床应用中获益较高。

结论

18F-PSMA-1007 PET/CT在诊断穿刺ISUP 1~2级前列腺癌患者术后病理升级方面具有一定价值。

关键词: 前列腺肿瘤, 前列腺特异膜抗原, 正电子发射断层显像术, 病理升级, 国际泌尿病理学会
Objective

To investigate the diagnostic value of 18F-prostate-specific membrane antigen (PSMA)-1007 PET/CT for postoperative upgrading in patients with biopsy International Society of Urological Pathology (ISUP) grade 1-2 prostate cancer.

Method

Clinical and pathologic information were retrospectively collected from October 2020 to August 2023 for 73 patients with biopsy ISUP grade 1-2 prostate cancer who underwent radical prostatectomy (RP) at the First Affiliated Hospital of Xi'an Jiaotong University. Differences in 18F-PSMA-1007 PET/CT and clinical parameters were compared between the ISUP upgrading and ISUP non-upgrading groups. Univariate and multivariate logistic regression analyses were used to select the predictors of 18F-PSMA-1007 PET/CT and clinical parameters for predicting postoperative pathologic upgrading. A diagnostic prediction nomogram was constructed. Receiver operating characteristic (ROC) curve and decision curve were plotted to evaluate the predictive performance and clinical benefit of the model.

Results

Among 73 included prostate cancer patients, ISUP upgrading occurred in 44(60.3%) cases. Serum prostate-specific antigen (PSA) level, the maximum standardized uptake values (SUVmax) and mean standardized uptake values (SUVmean) were significantly higher in the ISUP upgrading group than those in the ISUP non-upgrading group (all P<0.05). Age, metabolic tumor volume (MTV), and total lesion uptake (TLU) had no statistically significant differences between the two groups (all P>0.05). The univariate logistic regression analysis showed that PSA level, biopsy ISUP grade group, and SUVmean could influence the postoperative upgrading. And the multivariate logistic regression analysis indicated that biopsy ISUP grade group and SUVmean were independent predictors of ISUP upgrading in postoperative prostate cancer. The combined model for predicting postoperative ISUP upgrading was higher than that of biopsy ISUP grading group and SUVmean (0.851 vs 0.623, 0.728, P=0.008, P=0.210), but there was no significantly statistical difference in the latter. Decision curve analysis showed that when the threshold probability was greater than 47%, the combined model was beneficial in clinical application.

Conclusion

18F-PSMA-1007 PET/CT is promising for diagnosing postoperative pathologic upgrading in patients with biopsy ISUP grade 1-2 prostate cancer.

Key words: Prostate cancer, Prostate-specific membrane antigen, Positron-emission tomography, Pathological upgrading, International Society of Urological Pathology (ISUP)
表1 73例前列腺癌患者的临床资料
项目 指标
年龄[岁，(±s)] 68±6
PSA [ng/mL，M(Q)] 16.2（10.2~27.7）
SUVmax[M(Q)] 13.8（9.4~20.6）
SUVmean[M(Q)] 5.8（4.4~7.7）
MTV[cm3，M(Q)] 17.8（10.4~27.4）
TLU[cm3，M(Q)] 105.4（56.1~168.4）
ISUP升级情况[例(%)]  
升级组 44（60.3%）
未升级组 29（39.7%）
表2 44例术后ISUP升级前列腺癌患者穿刺病理与术后病理对照表
    穿刺病理
ISUP 1级 ISUP 2级
术后病理 ISUP 1级 8 -
ISUP 2级 12 21
ISUP 3级 8 15
ISUP 4级 2 4
ISUP 5级 1 2
表3 ISUP升级组和未升级组前列腺癌患者的一般资料比较
组别 例数 年龄[岁，(±s)] PSA[ng/mL，M(Q)] SUVmax [M(Q)] SUVmean [M(Q)] MTV[cm3，M(Q)] TLU[cm3，M(Q)]
ISUP升级组 44 68±6 18.8(10.7，32.4) 15.9(12.2，22.6) 6.4(5.1，8.0) 17.5(10.1，25.5) 121.4(58.5，185.8)
ISUP未升级组 29 70±6 13.3(8.0，21.9) 11.4(6.3，15.9) 4.4(3.7，6.6) 19.3(10.4，35.5) 96.4(49.5，155.1)
统计值   t=1.267 Z=-2.119 Z=-2.689 Z=-3.281 Z=-0.614 -0.891
P值   0.209 0.034 0.007 0.001 0.539 0.373
图1 穿刺ISUP分级分组和SUVmean构建的联合模型预测前列腺癌患者术后ISUP升级的列线图注：举例，对于穿刺ISUP 1级的患者在行18F-PSMA-1007 PET/CT后测量SUVmean为10，对应得分分别为18和55分，总分为73分，根据该列线图，该患者出现术后ISUP升级的概率为95%
图2 不同参数和联合模型对前列腺癌患者术后ISUP升级预测的ROC曲线
图3 穿刺ISUP分级分组与SUVmean构成联合模型的临床决策曲线
表4 Logistic回归分析不同因素对ISUP升级的影响
因素 单因素回归 多因素回归
OR(95%CI) P值 OR(95%CI) P值
年龄(岁) 0.95(0.88~1.03) 0.209 - -
PSA(ng/mL) 1.04(1.01~1.08) 0.047 1.04(0.99~1.09) 0.087
穿刺ISUP分级分组 0.35(0.13~0.95) 0.040 0.13(0.04~0.47) 0.002
SUVmax 1.05(1.00~1.11) 0.065 - -
SUVmean 1.50(1.14~1.98) 0.004 1.61(1.17~2.21) 0.003
MTV(cm3) 0.98(0.95~1.01) 0.274 - -
TLU(cm3) 1.00(1.00~1.01) 0.290 - -
表5 Logistic回归分析穿刺ISUP 1级患者中不同因素对ISUP升级的影响
因素 单因素回归 多因素回归
OR(95%CI) P值 OR(95%CI) P值
年龄(岁) 0.92(0.80~1.05) 0.226 - -
PSA(ng/mL) 1.02(0.95~1.09) 0.551 - -
SUVmax 1.53(1.09~2.13) 0.013 - -
SUVmean 3.95(1.37~11.37) 0.011 3.70(1.25~10.94) 0.018
MTV(cm3) 0.94(0.89~1.00) 0.048 0.98(0.92~1.04) 0.503
TLU(cm3) 1.00(0.99~1.01) 0.758 - -
表6 Logistic回归分析穿刺ISUP 2级患者中不同因素对ISUP升级的影响
因素 单因素回归 多因素回归
OR(95%CI) P值 OR(95%CI) P值
年龄(岁) 0.97(0.87~1.09) 0.653 - -
PSA(ng/mL) 1.08(1.01~1.15) 0.016 1.06(1.01~1.13） 0.047
SUVmax 1.04(0.99~1.09) 0.142 - -
SUVmean 1.38(1.01~1.87) 0.041 1.24(0.93~1.65） 0.147
MTV(cm3) 1.00(0.96~1.05) 0.839 - -
TLU(cm3) 1.00(0.99~1.01) 0.169 - -
表7 不同因素对ISUP升级的诊断效能
  AUC(95%CI) 截断值 灵敏度(%) 特异度(%)
穿刺ISUP分级分组 0.623(0.502~0.734) 1 72.4 52.3
SUVmean 0.728(0.611~0.826) 4.45 90.9 55.2
联合模型 0.851(0.748~0.924) 0.47 68.2 96.6
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