Prostat kanserli olgularda ölçülen adc ve suvmax değerlerinin histopatolojik evre, perinöral invazyon ve kemik metastazı ile ilişkisinin araştırılması ve karşılaştırılması
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Tarih
2021
Yazarlar
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Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmada, prostat kanseri evrelemesinde kullanılan Ga-68 PSMA PET/BT ve Multiparametrik Prostat MRG incelemeleri olan prostat kanserli olgularda, görüntüleme yöntemlerinden elde edilen kantitatif değerlerin, histopatolojik evre, perinöral invazyon ve kemik metastazı ile ilişkisi araştırılarak, hastalığın agresifliğini öngörme düzeyinin tespit edilmesi amaçlanmıştır. Gereç ve Yöntem: Bu çalışmada; Eylül 2018 – Aralık 2020 tarihleri arasında histopatolojik tanısı kesinleşmiş, tedavi öncesi evreleme için PET/BT ve MRG çekilmiş prostat kanserli 81 olguda, elde edilen kantitatif değerler, hastalığın seyrini belirleyen diğer faktörler ile karşılaştırılmıştır. Elde edilen ADC ve SUVmax değerlerini kullanarak; hastaların histopatolojik evresi, perinöral invazyon, kemik metastazı bulgularını karşılaştırarak, bu kantitatif değerlerin, hastalar için prognostik açıdan prediktif değerinin olup olmadığı araştırılmıştır. Bulgular: Çalışmaya dahil edilen 81 erkek hastaların Gleason ISUP evreleri sırasıyla, %7.41'i (n=6) evre 1, hastaların %14.81'i (n=12) evre 2, hastaların %14.81'i (n=12) evre 3, hastaların %13.58'i (n=11) evre 4, hastaların %49.38'i (n=40) evre 5 prostat kanserine sahiptir. Hastalardan 51'inde (%62.9) perinöral invazyon var iken, 30'unda (%37) perinöral invazyon yoktur. Hastalardan 50'sinde (%61.7) kemik metastazı yok iken 31 hastada (%38.2) kemik metastazı tespit edilmiştir. Hastalardan yapılan ölçümlerde; ortalama ADC 0.49±0.11 mm²/sn, ortanca SUVmax değeri 11.47 (4.8-89.76), ortanca SUVmax/ADC oranı 24.08 (7.15-280.5), ortanca prostat volümü 53 (16-150) ml, ortanca serum PSA düzeyleri 33.64 (0.44-860.9) ng/ml, ortanca serbest PSA düzeyleri 4.56 (0.02-50) ng/ml, ortanca PSA dansitesi 0.56 (0.01-53.8) olarak hesaplanmıştır. ADC dışındaki parametreler normal dağılıma uymamaktadır. ADC ölçümleri arasında gözlemci içi uyum için sınıf içi korelasyon katsayısı (ICC) 0.816, gözlemciler arası uyum için ICC 0.879 bulunmuştur (iyi derecede güvenilir). ADC, SUVmax, SUVmax/ADC parametreleri ISUP evrelemesine göre karşılaştırıldığında istatistiksel anlamlı farklılık bulunmadığından (p>0.05), hastalar evre 1-2 (erken evre), evre 3-4-5 (ileri evre) şeklinde gruplandırılmıştır. Erken ve ileri evre grupları arasında ADC değerleri için istatistiksel anlamlı farklılık saptanmadı (p=0.1854). SUVmax, SUVmax/ADC, PSA, serbest PSA, PSA dansite değerleri için istatistiksel olarak anlamlı fark saptanmıştır (p=0.000132, p=0.0002717, p<0.0001, p<0.0001, p=0.000154). Erken ve ileri evre grupları arasındaki cut-off değerleri SUVmax için 8.09, SUVmax/ADC için 16.29, PSA için 25.32, serbest PSA için 2.93, PSA dansitesi için 0.495 olarak belirlenmiştir (Sırasıyla AUC=0.797, 0.783, 0.825, 0.864, 0.794). Perinöral invazyon varlığının parametrelerin tümüyle arasında istatistiksel anlamlı bir ilişki bulunmamaktadır (p>0.05). Kemik metastazı varlığının ADC, SUVmax, SUVmax/ADC oranı için yapılan karşılaştırmalı analizde anlamlı istatistiksel fark bulunmamıştır (p>0.05). Kemik metastazının varlığı ile PSA ve serbest PSA değerleri arasında istatistiksel olarak anlamlı farklılık saptanmıştır (p=0.0036, p=0.001554). Kemik metastazı için cut-off PSA değeri 27.97, serbest PSA değeri 3.85 olarak saptanmıştır (AUC=0.693, 0.710). ISUP evre 2 ve evre 3 olan hastalar için ADC, PSA, serbest PSA, PSA dansite değerleri arasında anlamlı farklılık saptanmadı (p>0.05). Evre 2 ve 3 hastaların SUVmax ve SUVmax/ADC değerleri arasında istatistiksel anlamlı fark saptanmıştır (p=0.02726, p=0.01706). Evre 2 ve 3 arasında cut-off değerleri SUVmax için 12.91, SUVmax/ADC için 24.4 olarak belirlenmiştir (AUC=0.774, 0.778). Orta ve yüksek riskli hastalar için ADC, SUVmax, SUVmax/ADC ölçümleri arasında istatistiksel olarak anlamlı fark saptanmıştır (p=0.03311, p=0.00652, p=0.002199) Orta ve yüksek risk grupları arasında cut-off değerleri ADC için 0.55, SUVmax için 8.09, SUVmax/ADC için 16.29 olarak belirlenmiştir (AUC=0.673, 0.721, 0.749). Sonuçlar: Çalışmamızın sonucunda, hastaların evrelemesi için yapılan Ga-68 PSMA PET/BT ve multiparametrik prostat MRG tetkiklerinden elde edilen kantitatif ölçümlerin, prognoz açısından kullanılabileceği sonucuna ulaşılmıştır. Tüm parametreler arasında PSA ve serbest PSA değerleri, hastalığın evresi ve kemik metastazını belirleme açısından halen kullanılan en önemli parametredir. Prostat kanseri odaklarının tespitinde en duyarlı görüntüleme yöntemi PSMA PET uygulamaları ile korele edildiğinde mpMRG'de indeks lezyonun ayırt edilmesi daha kolay hale gelmektedir. Yüksek riskli olguları belirlemede cut-off değeri ADC için 0.55, SUVmax için 8.09, SUVmax/ADC oranı için 16.29 olarak tespit edilmiştir (AUC=0.673, 0.721, 0.749). SUVmax ve SUVmax/ADC ölçümlerinin prostat kanserinin erken ve ileri evresini ayırabilmede PSA ve serbest PSA değerleri kadar duyarlı olduğu anlaşılmaktadır. SUVmax ve SUVmax/ADC oranının aynı zamanda ISUP evre 2 ve evre 3 olan hastaları ayırmada da başarılı olduğu ortaya konmuştur. Bu olguların ayrı evre ve ayrı risk grubunda değerlendirilmesinin gerekliliğini göstermektedir. Bu çalışmada, perinöral invazyon varlığının tüm parametrelerden bağımsız bir prognostik faktör olduğu gösterilmiştir. ADC ve SUVmax ölçümlerinin yanında, SUVmax/ADC oranı da prostat kanserinin biyolojik davranışını gösterme açısından prognostik faktör olarak gelecek için ümit vaat etmektedir. Anahtar kelimeler: Prostat kanseri, manyetik rezonans görüntüleme, pozitron emisyon tomografi
In this study, the quantitative values obtained from imaging methods in prostate cancer patients with Ga-68 PSMA PET/CT and Multiparametric Prostate MRI examinations used in prostate cancer staging were investigated with the histopathological stage, perineural invasion and bone metastasis, and the level of predicting the aggressiveness of the disease was investigated. Materials and Methods: In this study; between September 2018 and December 2020, the quantitative values obtained in 81 patients with prostate cancer whose histopathological diagnosis was proven and whose pre-treatment staging was performed with PET / CT and MRI were compared with other factors determining the prognosis of the disease. Using the measured ADC and SUVmax values; the significance of these quantitative values for the prognosis of the disease was investigated by comparing the histopathological stage of the patients, perineural invasion and bone metastasis findings. Results: Gleason ISUP stages of 81 male patients included in the study, 7.41% (n = 6) stage 1, 14.81% (n = 12) stage 2, 14.81% (n = 12) stage 3 of the patients, 13.58% (n = 11) of the patients had stage 4, and 49.38% (n = 40) of the patients had stage 5 prostate cancer. While 51 (62.9%) of the patients had perineural invasion, 30 (37%) had no perineural invasion. Bone metastasis was detected in 31 patients (38.2%) while there was no bone metastasis in 50 of the patients (61.7%). In the measurements made from the patients; mean ADC 0.49 ± 0.11 mm² / s, median SUVmax value 11.47 (4.8-89.76), median SUVmax/ADC ratio 24.08 (7.15-280.5), median prostate volume 53 (16-150) ml, median serum PSA levels 33.64 (0.44- 860.9) ng / ml, median free PSA levels were 4.56 (0.02-50) ng / ml, and median PSA density was 0.56 (0.01-53.8). Parameters other than ADC do not show normal distribution. Intra-observer agreement between ADC measurements was found to be 0.816 for intraobserver agreement, and for interobserver agreement ICC 0.879 (highly reliable). Since there was no statistically significant difference when the ADC, SUVmax, SUVmax/ADC parameters were compared according to ISUP staging (p> 0.05), the patients were grouped as stage 1-2 (early stage), stage 3-4-5 (advanced stage). There was no statistically significant difference for ADC values between early and advanced stage groups (p = 0.1854). A statistically significant difference was found for SUVmax, SUVmax/ADC, PSA, free PSA, PSA density values (p = 0.000132, p = 0.0002717, p <0.0001, p <0.0001, p = 0.000154). The cut-off values between the early and advanced stage groups were determined as 8.09 for SUVmax, 16.29 for SUVmax/ADC, 25.32 for PSA, 2.93 for free PSA, and 0.495 for PSA density (AUC = 0.797, 0.783, 0.825, 0.864, 0.794, respectively). There is no statistically significant relationship between the presence of perineural invasion and all of the parameters (p> 0.05). In the comparative analysis for the presence of bone metastasis ADC, SUVmax, SUVmax/ADC ratio, no statistically significant difference was found (p> 0.05). A statistically significant difference was found between the presence of bone metastasis and PSA and free PSA values (p = 0.0036, p = 0.001554). The cut-off PSA value for bone metastasis was 27.97, and the free PSA value was 3.85 (AUC = 0.693, 0.710). There was no significant difference between ADC, PSA, free PSA, PSA density values for patients with ISUP stage 2 and stage 3 (p> 0.05). A statistically significant difference was found between the SUVmax and SUVmax/ADC values of stage 2 and 3 patients (p = 0.02726, p = 0.01706). The cut-off values between stage 2 and 3 were determined as 12.91 for SUVmax and 24.4 for SUVmax/ADC (AUC = 0.774, 0.778). A statistically significant difference was found between ADC, SUVmax, SUVmax/ADC measurements for intermediate and high risk patients (p = 0.03311, p = 0.00652, p = 0.002199) The cut-off values between the intermediate and high risk groups were determined as 0.55 for ADC, 8.09 for SUVmax, 16.29 for SUVmax/ADC (AUC = 0.673, 0.721, 0.749). Conclusions: As a result of our study, it was concluded that the quantitative measurements obtained from Ga-68 PSMA PET/CT and multiparametric prostate MRI examinations performed for staging the patients can be used in terms of prognosis. Among all parameters, PSA and free PSA values are still the most important parameter in determining the stage of the disease and bone metastasis. When the most sensitive imaging method in detecting prostate cancer foci is correlated with PSMA PET applications, it becomes easier to distinguish the index lesion in mpMRI. The cut-off value was determined as 0.55 for ADC, 8.09 for SUVmax and 16.29 for SUVmax/ADC ratio in determining high risk cases (AUC = 0.673, 0.721, 0.749). It is understood that SUVmax and SUVmax/ADC ratio are as sensitive as PSA and free PSA values in distinguishing the early and advanced stages of prostate cancer. The SUVmax and SUVmax/ADC ratio has also been shown to be successful in separating patients with ISUP stage 2 and stage 3. This indicates the necessity of evaluating these cases in a separate stage and in a separate risk group. In this study, it has been shown that the presence of perineural invasion is a prognostic factor independent of all parameters. In addition to ADC and SUVmax measurements, the SUVmax/ADC ratio also holds promise for the future as a prognostic factor in demonstrating the biological behavior of prostate cancer. Keywords: Prostate cancer, magnetic resonance imaging, positron emission tomography
In this study, the quantitative values obtained from imaging methods in prostate cancer patients with Ga-68 PSMA PET/CT and Multiparametric Prostate MRI examinations used in prostate cancer staging were investigated with the histopathological stage, perineural invasion and bone metastasis, and the level of predicting the aggressiveness of the disease was investigated. Materials and Methods: In this study; between September 2018 and December 2020, the quantitative values obtained in 81 patients with prostate cancer whose histopathological diagnosis was proven and whose pre-treatment staging was performed with PET / CT and MRI were compared with other factors determining the prognosis of the disease. Using the measured ADC and SUVmax values; the significance of these quantitative values for the prognosis of the disease was investigated by comparing the histopathological stage of the patients, perineural invasion and bone metastasis findings. Results: Gleason ISUP stages of 81 male patients included in the study, 7.41% (n = 6) stage 1, 14.81% (n = 12) stage 2, 14.81% (n = 12) stage 3 of the patients, 13.58% (n = 11) of the patients had stage 4, and 49.38% (n = 40) of the patients had stage 5 prostate cancer. While 51 (62.9%) of the patients had perineural invasion, 30 (37%) had no perineural invasion. Bone metastasis was detected in 31 patients (38.2%) while there was no bone metastasis in 50 of the patients (61.7%). In the measurements made from the patients; mean ADC 0.49 ± 0.11 mm² / s, median SUVmax value 11.47 (4.8-89.76), median SUVmax/ADC ratio 24.08 (7.15-280.5), median prostate volume 53 (16-150) ml, median serum PSA levels 33.64 (0.44- 860.9) ng / ml, median free PSA levels were 4.56 (0.02-50) ng / ml, and median PSA density was 0.56 (0.01-53.8). Parameters other than ADC do not show normal distribution. Intra-observer agreement between ADC measurements was found to be 0.816 for intraobserver agreement, and for interobserver agreement ICC 0.879 (highly reliable). Since there was no statistically significant difference when the ADC, SUVmax, SUVmax/ADC parameters were compared according to ISUP staging (p> 0.05), the patients were grouped as stage 1-2 (early stage), stage 3-4-5 (advanced stage). There was no statistically significant difference for ADC values between early and advanced stage groups (p = 0.1854). A statistically significant difference was found for SUVmax, SUVmax/ADC, PSA, free PSA, PSA density values (p = 0.000132, p = 0.0002717, p <0.0001, p <0.0001, p = 0.000154). The cut-off values between the early and advanced stage groups were determined as 8.09 for SUVmax, 16.29 for SUVmax/ADC, 25.32 for PSA, 2.93 for free PSA, and 0.495 for PSA density (AUC = 0.797, 0.783, 0.825, 0.864, 0.794, respectively). There is no statistically significant relationship between the presence of perineural invasion and all of the parameters (p> 0.05). In the comparative analysis for the presence of bone metastasis ADC, SUVmax, SUVmax/ADC ratio, no statistically significant difference was found (p> 0.05). A statistically significant difference was found between the presence of bone metastasis and PSA and free PSA values (p = 0.0036, p = 0.001554). The cut-off PSA value for bone metastasis was 27.97, and the free PSA value was 3.85 (AUC = 0.693, 0.710). There was no significant difference between ADC, PSA, free PSA, PSA density values for patients with ISUP stage 2 and stage 3 (p> 0.05). A statistically significant difference was found between the SUVmax and SUVmax/ADC values of stage 2 and 3 patients (p = 0.02726, p = 0.01706). The cut-off values between stage 2 and 3 were determined as 12.91 for SUVmax and 24.4 for SUVmax/ADC (AUC = 0.774, 0.778). A statistically significant difference was found between ADC, SUVmax, SUVmax/ADC measurements for intermediate and high risk patients (p = 0.03311, p = 0.00652, p = 0.002199) The cut-off values between the intermediate and high risk groups were determined as 0.55 for ADC, 8.09 for SUVmax, 16.29 for SUVmax/ADC (AUC = 0.673, 0.721, 0.749). Conclusions: As a result of our study, it was concluded that the quantitative measurements obtained from Ga-68 PSMA PET/CT and multiparametric prostate MRI examinations performed for staging the patients can be used in terms of prognosis. Among all parameters, PSA and free PSA values are still the most important parameter in determining the stage of the disease and bone metastasis. When the most sensitive imaging method in detecting prostate cancer foci is correlated with PSMA PET applications, it becomes easier to distinguish the index lesion in mpMRI. The cut-off value was determined as 0.55 for ADC, 8.09 for SUVmax and 16.29 for SUVmax/ADC ratio in determining high risk cases (AUC = 0.673, 0.721, 0.749). It is understood that SUVmax and SUVmax/ADC ratio are as sensitive as PSA and free PSA values in distinguishing the early and advanced stages of prostate cancer. The SUVmax and SUVmax/ADC ratio has also been shown to be successful in separating patients with ISUP stage 2 and stage 3. This indicates the necessity of evaluating these cases in a separate stage and in a separate risk group. In this study, it has been shown that the presence of perineural invasion is a prognostic factor independent of all parameters. In addition to ADC and SUVmax measurements, the SUVmax/ADC ratio also holds promise for the future as a prognostic factor in demonstrating the biological behavior of prostate cancer. Keywords: Prostate cancer, magnetic resonance imaging, positron emission tomography
Açıklama
Anahtar Kelimeler
Prostat kanseri, Manyetik rezonans görüntüleme, Pozitron emisyon tomografi, Prostate cancer, Magnetic resonance imaging, Positron emission tomography
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Ataş, A. E. (2021). Prostat kanserli olgularda ölçülen adc ve suvmax değerlerinin histopatolojik evre, perinöral invazyon ve kemik metastazı ile ilişkisinin araştırılması ve karşılaştırılması. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Radyoloji Anabilim Dalı, Konya.
