用于前列腺癌局部分期的氟-18 前列腺特异性膜抗原-1007 PET/CT 与多参数 MRI。

IF 28.4 1区医学 Q1 Biochemistry, Genetics and Molecular Biology

Jama Oncology Pub Date : 2024-08-01 DOI:10.1001/jamaoncol.2024.3196

Nikhile Mookerji, Tyler Pfanner, Amaris Hui, Guocheng Huang, Patrick Albers, Rohan Mittal, Stacey Broomfield, Lucas Dean, Blair St Martin, Niels-Erik Jacobsen, Howard Evans, Yuan Gao, Ryan Hung, Jonathan Abele, Peter Dromparis, Joema Felipe Lima, Tarek Bismar, Evangelos Michelakis, Gopinath Sutendra, Frank Wuest, Wendy Tu, Benjamin A Adam, Christopher Fung, Alexander Tamm, Adam Kinnaird

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引用次数: 0

摘要

重要性：前列腺特异性膜抗原（PSMA）在前列腺癌中过度表达，并与肿瘤的侵袭性相关。根据目前的研究，PSMA 正电子发射断层扫描（PET）在前列腺癌转移分期方面优于传统成像，但用于局部分期的第二代 PSMA PET 放射性配体的研究还很有限：目的：确定氟-18 PSMA-1007 PET/计算机断层扫描（18F-PSMA-1007 PET/CT）与多参数磁共振成像（MRI）相比，在中危和高危前列腺癌的初次局部分期中的准确性：下一代试验是一项 2 期前瞻性验证配对队列研究，评估 18F-PSMA-1007 PET/CT 和 MRI 在前列腺癌局部分期中的准确性，并以组织病理学检查结果作为参照标准。放射科医生、核医学医生和病理学家对术前临床、病理和成像数据均为盲法。患者在加拿大阿尔伯塔省的两家三级医院接受了所有成像检查和前列腺癌根治术。符合条件的患者包括同意接受前列腺癌根治术的中危或高危前列腺癌男性患者。接受前列腺癌根治术的患者纳入最终分析。患者招募时间为2022年3月至2023年6月，数据分析时间为2023年7月至2023年12月：所有参与者都在根治性前列腺切除术前的两周内接受了18F-PSMA-1007 PET/CT和MRI检查：主要结果和测量指标：主要结果是通过每项成像检测正确识别前列腺癌肿瘤分期。次要结果是正确识别主要结节、侧位、囊外扩展和精囊侵犯：在150名符合条件的前列腺癌男性患者中，134名患者最终接受了根治性前列腺切除术（前列腺切除术时的平均年龄为62.0 [5.7]岁）。在准确确定最终病理肿瘤分期方面，PSMA PET 优于 MRI（61 [45%] vs 38 [28%]；P = .003）。PSMA PET在正确识别优势结节（126 [94%] vs 112 [83%]；P = .01）、侧位（86 [64%] vs 60 [44%]；P = .001）和囊外扩展（100 [75%] vs 84 [63%]；P = .01）方面也优于核磁共振成像，但在精囊受侵（122 [91%] vs 115 [85%]；P = .07）方面则没有优势：在这项二期前瞻性验证性配对队列研究中，18F-PSMA-1007 PET/CT 在前列腺癌的局部分期方面优于 MRI。这些研究结果支持将 PSMA PET 用于中危和高危肿瘤的术前工作流程。

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Fluorine-18 Prostate-Specific Membrane Antigen-1007 PET/CT vs Multiparametric MRI for Locoregional Staging of Prostate Cancer.

Importance: Prostate-specific membrane antigen (PSMA) demonstrates overexpression in prostate cancer and correlates with tumor aggressiveness. PSMA positron emission tomography (PET) is superior to conventional imaging for the metastatic staging of prostate cancer per current research but studies of second-generation PSMA PET radioligands for locoregional staging are limited.

Objective: To determine the accuracy of fluorine-18 PSMA-1007 PET/computed tomography (18F-PSMA-1007 PET/CT) compared to multiparametric magnetic resonance imaging (MRI) in the primary locoregional staging of intermediate-risk and high-risk prostate cancers.

Design, setting, and participants: The Next Generation Trial was a phase 2 prospective validating paired cohort study assessing the accuracy of 18F-PSMA-1007 PET/CT and MRI for locoregional staging of prostate cancer, with results of histopathologic examination as the reference standard comparator. Radiologists, nuclear medicine physicians, and pathologists were blinded to preoperative clinical, pathology, and imaging data. Patients underwent all imaging studies and radical prostatectomies at 2 tertiary care hospitals in Alberta, Canada. Eligible participants included men with intermediate-risk or high-risk prostate cancer who consented to radical prostatectomy. Participants who underwent radical prostatectomy were included in the final analysis. Patients were recruited between March 2022 and June 2023, and data analysis occurred between July 2023 and December 2023.

Exposures: All participants underwent both 18F-PSMA-1007 PET/CT and MRI within 2 weeks of one another and before radical prostatectomy.

Main outcomes and measures: The primary outcome was the correct identification of the prostate cancer tumor stage by each imaging test. The secondary outcomes were correct identification of the dominant nodule, laterality, extracapsular extension, and seminal vesical invasion.

Results: Of 150 eligible men with prostate cancer, 134 patients ultimately underwent radical prostatectomy (mean [SD] age at prostatectomy, 62.0 [5.7] years). PSMA PET was superior to MRI for the accurate identification of the final pathological tumor stage (61 [45%] vs 38 [28%]; P = .003). PSMA PET was also superior to MRI for the correct identification of the dominant nodule (126 [94%] vs 112 [83%]; P = .01), laterality (86 [64%] vs 60 [44%]; P = .001), and extracapsular extension (100 [75%] vs 84 [63%]; P = .01), but not for seminal vesicle invasion (122 [91%] vs 115 [85%]; P = .07).

Conclusions and relevance: In this phase 2 prospective validating paired cohort study, 18F-PSMA-1007 PET/CT was superior to MRI for the locoregional staging of prostate cancer. These findings support PSMA PET in the preoperative workflow of intermediate-risk and high-risk tumors.

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来源期刊

Jama Oncology Medicine-Oncology

CiteScore

37.50

自引率

1.80%

发文量

423

期刊介绍： At JAMA Oncology, our primary goal is to contribute to the advancement of oncology research and enhance patient care. As a leading journal in the field, we strive to publish influential original research, opinions, and reviews that push the boundaries of oncology science. Our mission is to serve as the definitive resource for scientists, clinicians, and trainees in oncology globally. Through our innovative and timely scientific and educational content, we aim to provide a comprehensive understanding of cancer pathogenesis and the latest treatment advancements to our readers. We are dedicated to effectively disseminating the findings of significant clinical research, major scientific breakthroughs, actionable discoveries, and state-of-the-art treatment pathways to the oncology community. Our ultimate objective is to facilitate the translation of new knowledge into tangible clinical benefits for individuals living with and surviving cancer.