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, No. 1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, China.
Department of General Surgery, PUMC Hospital, Chinese Academy of Medical Sciences and PUMC, No. 1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, China.
Eur J Nucl Med Mol Imaging. 2023 Nov;50(13):4036-4050. doi: 10.1007/s00259-023-06297-y. Epub 2023 Jul 26.
Anatomical and molecular staging strategies are needed for the personalized treatment of localized pancreatic ductal adenocarcinoma (PDAC). This study evaluated the performance of [ Ga]Ga-FAPI-04 and [F]F-FDG PET/CT on the disease staging and prognostic value of patients with localized PDAC on contrast-enhanced (CE)-CT images.
Patients with suspected localized PDAC on CE-CT were recruited for static [ Ga]Ga-FAPI-04 and [F]F-FDG and PET/CT, and select patients underwent simultaneous 60-min dynamic Ga-FAPI-04 PET/CT. The diagnostic and staging performances of the static PET/CT results were evaluated by delineating regions of interest in the primary tumor, whole pancreas, and distal pancreas in both types of scans and then evaluating correlations between the PET/CT findings and clinicopathological characteristics. Furthermore, Kaplan-Meier and hazard ratio (log-rank) methods were used to evaluate the prognostic value of the combined dynamic [ Ga]Ga-FAPI-04 and static [F]F-FDG PET/CT method.
We included 49 patients with histologically confirmed PDAC adenocarcinomas; 32 underwent 60-min dynamic [ Ga]Ga-FAPI-04 PET/CT imaging simultaneously. The static [ Ga]Ga-FAPI-04 method had significantly higher accuracy and uptake values than the static [F]F-FDG method for primary PDAC lesions, metastatic lymph nodes, and distal metastases. Furthermore, 18.4% and 10.2% of the patients' stages changed after using the [ Ga]Ga-FAPI-04 and [F]F-FDG PET/CT methodologies, respectively, compared to the CE-CT-designated stage. The Ki values obtained from dynamic [ Ga]Ga-FAPI-04 PET/CT did not differ between PDAC and distal obstructive pancreatitis lesions. Pathologically enlarged tumor size, poor differentiation, and perineural invasion were associated with increased [ Ga]Ga-FAPI-04 uptake but not with [F]F-FDG uptake. The preoperative prognostic performance of [ Ga]Ga-FAPI-04 was better than that of [F]F-FDG. Interestingly, combined [ Ga]Ga-FAPI-04 and [F]F-FDG uptake results in the whole pancreas could further stratify patients based on their postoperative prognosis.
[ Ga]Ga-FAPI-04 PET/CT was more sensitive and accurate than [F]F-FDG PET/CT for tumor, node, and metastasis staging of PDAC identified on CE-CT. Additionally, [ Ga]Ga-FAPI-04 uptake was significantly associated with pathologically aggressive tumor features. Combined [ Ga]Ga-FAPI-04 and [F]F-FDG PET/CT findings improved the prognostic value, potentially providing a non-invasive guide for clinical management. Finally, increased fibroblast activity in PDAC-induced obstructive pancreatitis may be associated with poor patient survival rates.
为了实现局部胰腺导管腺癌(PDAC)的个体化治疗,需要采用解剖学和分子分期策略。本研究评估了[68Ga]Ga-FAPI-04 和 [18F]F-FDG PET/CT 对增强 CT 图像上局部 PDAC 患者疾病分期和预后价值的影响。
招募疑似局部 PDAC 的患者进行静态[68Ga]Ga-FAPI-04 和 [18F]F-FDG PET/CT 检查,部分患者同时进行 60 分钟的动态[68Ga]Ga-FAPI-04 PET/CT 检查。通过在两种扫描中勾画原发性肿瘤、整个胰腺和远端胰腺的感兴趣区域,并评估 PET/CT 结果与临床病理特征之间的相关性,评估静态 PET/CT 结果的诊断和分期性能。此外,使用 Kaplan-Meier 和风险比(对数秩)方法评估联合动态[68Ga]Ga-FAPI-04 和静态[18F]F-FDG PET/CT 方法的预后价值。
本研究共纳入 49 例经组织学证实的 PDAC 腺癌患者;其中 32 例同时进行了 60 分钟的动态[68Ga]Ga-FAPI-04 PET/CT 成像。与静态[18F]F-FDG 方法相比,静态[68Ga]Ga-FAPI-04 方法对原发性 PDAC 病变、转移性淋巴结和远端转移的准确性和摄取值更高。此外,与增强 CT 确定的分期相比,使用[68Ga]Ga-FAPI-04 和[18F]F-FDG PET/CT 方法后,分别有 18.4%和 10.2%的患者分期发生改变。从动态[68Ga]Ga-FAPI-04 PET/CT 获得的 Ki 值在 PDAC 和远端梗阻性胰腺炎病变之间没有差异。病理性增大的肿瘤大小、低分化和神经周围侵犯与[68Ga]Ga-FAPI-04 摄取增加相关,但与[18F]F-FDG 摄取无关。术前[68Ga]Ga-FAPI-04 的预后性能优于[18F]F-FDG。有趣的是,整个胰腺中[68Ga]Ga-FAPI-04 和[18F]F-FDG 摄取结果的联合可进一步根据患者的术后预后进行分层。
与增强 CT 确定的 PDAC 相比,[68Ga]Ga-FAPI-04 PET/CT 对肿瘤、淋巴结和转移的分期更敏感和准确。此外,[68Ga]Ga-FAPI-04 摄取与病理性侵袭性肿瘤特征显著相关。联合[68Ga]Ga-FAPI-04 和[18F]F-FDG PET/CT 检查结果提高了预后价值,可能为临床管理提供一种非侵入性指导。最后,PDAC 引起的梗阻性胰腺炎中增加的成纤维细胞活性可能与患者生存率降低有关。