Journal of Nuclear Medicine:美国单中心研究发现黑人前列腺癌68Ga-PSMA-11PET成像使用机会少

2021-05-12 MedSci原创 MedSci原创

68Ga-PSMA-11已成为更优的示踪剂,具有更高的敏感性。在美国单一高等医疗中心接受前列腺癌分子影像学检查的患者中,黑人患者获得68Ga-PSMA-11 PET的机会明显受限。

前列腺癌是美国男性最常见的癌症,也是导致癌症死亡的第二大原因。2020年,美国确诊的前列腺癌新病例估计为191930例,有33330名男性死于该疾病。2016年5月,美国食品和药物管理局(FDA)批准使用18F-fluciclovine PET/CT显像评估可疑生物化学复发或持续性前列腺癌患者的疾病负担;这种分子显像剂从2017年开始在医疗保险患者中覆盖。18F-fluciclovine是一种合成氨基酸,不代谢或并入蛋白质。它以跨膜氨基酸转运体ACST2和LAT1为靶点,这些转运体被前列腺癌细胞过表达。它比常规成像(腹部和盆腔CT、盆腔MRI和用99mTc标记的亚甲基二膦酸盐进行骨显像)或胆碱PET/CT更能检测转移性疾病。

前列腺特异性膜抗原(PSMA)在前列腺癌细胞上过表达,靶向该抗原的放射性示踪剂越来越多地用于评估前列腺癌患者的疾病程度。最常用的靶向PSMA的放射性示踪剂是68Ga -前列腺特异性膜抗原(68Ga-PSMA-11)。重要的是,最近的研究表明,68Ga-PSMA-11与18F-fluciclovine相比,检出率显著提高。然而,68Ga-PSMA-11尚未获得FDA批准,在美国只能通过成本回收机制进行临床试验。

不同种族/民族的前列腺癌患者的健康差异是很明显的。非洲裔男性的前列腺癌发病率和死亡率明显高于美国、加勒比、联合王国和南美洲部分地区其他人口群体的男性。人们注意到许多相互关联的因素是造成这种情况的原因,包括社会经济贫困社区的社会经济地位和生活方式的不同、获得保健的机会、种族和族裔歧视、语言和文化障碍以及疾病诊断的延迟。

为了查明在提供保健服务的中间步骤中获得最新保健服务方面的潜在差异,这种差异可能会导致前列腺癌健康结果的差异。Matthew D. Bucknor评估了在一个高等医疗中心接受18F-fluciclovine PET/CT显像的患者与接受68Ga-PSMA-11 PET/CT显像的前列腺癌患者之间的人口统计学差异。

该研究回顾2015年10月至2020年1月在旧金山加利福尼亚大学进行的所有18F -fluciclovine 68Ga-PSMA-11 PET研究。年龄、种族/民族、主要语言、身体质量指数、保险类型和家庭住址通过电子病历获得。采用logistic回归模型对预测变量进行评价。

研究共纳入1,756例患者,其中1,502例患者接受了68Ga -PSMA-11治疗,254例患者接受了18F-fluciclovine。非西班牙裔白人患者占整个研究人数的78.8%(1,383/1,756),少数族裔患者占21.2% (383/1,756);66.6%的患者来自邻里社会经济地位(nSES)的最高分位数(998/ 1498),其次是中等分位数(24.7%,370/ 1498)和最低分位数(8.7%,130/ 1498)。在种族/民族与nSES的交叉方面,黑人患者在nSES最高的三分位数中所占百分比最低(40.0%,16/40),在nSES最低的三分位数中所占百分比最高(27.5%,11/40)(表2)。西班牙裔患者在nSES最高的三分位数中所占百分比第二低(51.0%,11/40)。26/51),其次是最低的三分之一(13/51,25.5%)。

接受18F-fluciclovine (平均69.8±7.9岁)和68Ga-PSMA-11(平均69.6±7.7岁)治疗的患者年龄相似,两组间BMI也相似。在这项研究中,相对较少的患者没有将英语作为首选语言,非英语使用者在18F-fluciclovine组中占3.1%(8/254),在68Ga-PSMA-11组中占1.9%(28/1,502)。

黑人患者接受18F-fluciclovine显像的概率大约是68Ga -PSMA-11的4倍(OR, 3.88;95%可信区间,1.90 - -7.91)。两组间其他统计学数据无显著差异。与68Ga -PSMA-11相比,亚裔美国人或夏威夷本地人/其他太平洋岛民的18F-fluciclovine显像的概率有增加的趋势(优势比,1.64;95%置信区间,0.95 - -2.85;P = 0.073)。有政府保险和年龄增长的患者也显示出18F-fluciclovine显像使用几率增加的趋势,但差异的幅度相对较小。

该研究发现不同种族/民族的分子成像模式有不同的使用模式。虽然18F-fluciclovine68Ga-PSMA-11都显著提高了评估前列腺癌患者总体疾病负担的能力,但68Ga-PSMA-11已成为更优的示踪剂,具有更高的敏感性。目前的研究表明,在美国单一高等医疗中心接受前列腺癌分子影像学检查的患者中,通过临床试验,与非西班牙裔白人患者相比,黑人患者获得68Ga-PSMA-11 PET的机会明显受限,接近4倍。在获得研究试验方面的差异以及对成本回收机制的潜在财政负担的担忧可能导致了成像率的差异。更多的研究评估与已知的健康社会决定因素有关的成像技术使用方面的潜在差异,对于建立公平的保健提供系统至关重要。

原文出处:

Disparities in PET Imaging for Prostate Cancer at a Tertiary Academic Medical Center,Matthew D. Bucknor, Daphne Y. Lichtensztajn, Tracy K. Lin, Hala T. Borno, Scarlett L. Gomez, Thomas A. Hope,Journal of Nuclear Medicine May 2021, 62 (5) 695-699; DOI: 10.2967/jnumed.120.251751

 

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target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Fri May 14 13:34:28 CST 2021, time=2021-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1041008, encodeId=52bd104100880, content=前列腺癌相关研究,学习了,谢谢梅斯, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Thu May 13 01:34:28 CST 2021, time=2021-05-13, status=1, ipAttribution=)]
    2022-03-01 jeanqiuqiu
  4. 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  5. 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target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Fri May 14 13:34:28 CST 2021, time=2021-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1041008, encodeId=52bd104100880, content=前列腺癌相关研究,学习了,谢谢梅斯, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Thu May 13 01:34:28 CST 2021, time=2021-05-13, status=1, ipAttribution=)]
    2021-10-12 kalseyzl
  6. 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target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Fri May 14 13:34:28 CST 2021, time=2021-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1041008, encodeId=52bd104100880, content=前列腺癌相关研究,学习了,谢谢梅斯, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Thu May 13 01:34:28 CST 2021, time=2021-05-13, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=1753587, encodeId=510c1e5358741, content=<a href='/topic/show?id=6a57e33772b' target=_blank style='color:#2F92EE;'>#研究发现#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73377, encryptionId=6a57e33772b, topicName=研究发现)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7e1736602208, createdName=hanhaisha2020, createdTime=Fri Apr 15 01:34:28 CST 2022, time=2022-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1728943, encodeId=65561e2894386, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, 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target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Fri May 14 13:34:28 CST 2021, time=2021-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1041008, encodeId=52bd104100880, content=前列腺癌相关研究,学习了,谢谢梅斯, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Thu May 13 01:34:28 CST 2021, time=2021-05-13, status=1, ipAttribution=)]
    2021-05-14 江川靖瑶
  8. 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  9. 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target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Fri May 14 13:34:28 CST 2021, time=2021-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1041008, encodeId=52bd104100880, content=前列腺癌相关研究,学习了,谢谢梅斯, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Thu May 13 01:34:28 CST 2021, time=2021-05-13, status=1, ipAttribution=)]
    2021-05-14 智慧医人
  10. 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    2021-05-13 misszhang

    前列腺癌相关研究,学习了,谢谢梅斯

    0

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