Department of Nuclear Medicine, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine and State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Science and PUMC, Beijing, China.
Department of General Surgery, PUMC Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing, China.
Eur J Nucl Med Mol Imaging. 2023 May;50(6):1780-1791. doi: 10.1007/s00259-022-06100-4. Epub 2023 Jan 25.
Our aim was to assess the prognostic value of [ Ga]Ga-FAPI-04 positron emission tomography (PET) uptake in PDAC and to evaluate the correlation between in vivo lesional radioactivity with pathological characteristics of pancreatic ductal adenocarcinoma (PDAC).
We retrospectively analyzed treatment-naïve PDAC patients who underwent preoperative [ Ga]Ga-FAPI-04 PET/CT followed by pancreatectomy. The tracer uptake was determined as maximum tumor standardized uptake value (SUV), FAPI-avid tumor volume (FTV), total lesion FAP expression (TLF) as well total pancreatic uptake (TSUV), total FAPI-avid pancreatic volume (FPV), and total pancreatic FAP expression (TPF). Spearman's correlation analysis was performed to evaluate the association between [ Ga]Ga-FAPI-04 PET/CT imaging and ex vivo immunohistological FAP expression and pathological characteristics of surgical specimens (differentiation, size, vascularity, perineural invasion, and lymph node metastases). Kaplan-Meier and hazard ratio (HR, log-rank) methods were used to evaluate the prognostic value of [ Ga]Ga-FAPI-04 PET/CT and clinicopathological factors.
Thirty-seven surgical PDAC patients were included. The ex vivo expression of FAP was significantly associated with the tumor SUV and TLF. FAP expression was more abundant in poorly differentiated PDAC than in well- to moderately differentiated neoplasms. Tumor SUV or TLF and pancreatic TSUV or TPF were significantly correlated with tumor size, differentiation, and perineural invasion, respectively. SUV had a significant independent prognostic value for recurrence-free survival (HR = 2.46, P < 0.05), while [ Ga]Ga-FAPI-04 TPF predicted overall survival (HR = 12.82, P < 0.05).
The in vivo [ Ga]Ga-FAPI-04 uptake in localized PDAC showed a significant correlation with ex vivo FAP expression and aggressive pathological characteristics. [ Ga]Ga-FAPI-04 PET/CT also presented a potential for postoperative prognostication of PDAC. Elevated fibroblast activity induced by obstructive pancreatitis might be associated with the patient's survival.
我们旨在评估[Ga]Ga-FAPI-04 正电子发射断层扫描（PET）摄取在胰腺导管腺癌（PDAC）中的预后价值，并评估活体病变放射性与胰腺导管腺癌（PDAC）病理特征之间的相关性。
我们回顾性分析了接受术前[Ga]Ga-FAPI-04 PET/CT 检查后行胰腺切除术的未经治疗的 PDAC 患者。将示踪剂摄取确定为最大肿瘤标准化摄取值（SUV）、FAPI 阳性肿瘤体积（FTV）、总病变 FAP 表达（TLF）、总胰腺摄取（TSUV）、总 FAPI 阳性胰腺体积（FPV）和总胰腺 FAP 表达（TPF）。采用 Spearman 相关分析评估[Ga]Ga-FAPI-04 PET/CT 成像与手术标本中体外免疫组织化学 FAP 表达和病理特征（分化程度、大小、血管生成、神经周围侵犯和淋巴结转移）之间的相关性。Kaplan-Meier 和危险比（HR，对数秩）方法用于评估[Ga]Ga-FAPI-04 PET/CT 和临床病理因素的预后价值。
共纳入 37 例接受手术的 PDAC 患者。FAP 的体外表达与肿瘤 SUV 和 TLF 显著相关。在低分化 PDAC 中，FAP 的表达比在中高分化肿瘤中更为丰富。肿瘤 SUV 或 TLF 与胰腺 TSUV 或 TPF 分别与肿瘤大小、分化程度和神经周围侵犯显著相关。SUV 对无复发生存率有显著的独立预后价值（HR=2.46，P<0.05），而[Ga]Ga-FAPI-04 TPF 预测总生存率（HR=12.82，P<0.05）。
局部 PDAC 中的体内[Ga]Ga-FAPI-04 摄取与体外 FAP 表达和侵袭性病理特征显著相关。[Ga]Ga-FAPI-04 PET/CT 也有可能对 PDAC 进行术后预后预测。阻塞性胰腺炎引起的成纤维细胞活性升高可能与患者的生存有关。
