FAPI PET 成像在胃癌中的评估：系统评价和荟萃分析。

Evaluation of FAPI PET imaging in gastric cancer: a systematic review and meta-analysis.

机构信息

Department of Nuclear Medicine and Minnan PET Center, Xiamen Key Laboratory of Radiopharmaceuticals, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.

The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350004, China.

出版信息

Theranostics. 2023 Aug 21;13(13):4694-4710. doi: 10.7150/thno.88335. eCollection 2023.

DOI:10.7150/thno.88335

PMID:37649615

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10465231/

Abstract

Recent studies suggest that Ga-FAPI PET/CT demonstrated superiority over F-FDG PET/CT in the evaluation of various cancer types, especially in gastric cancer (GC). By comprehensively reviewing and analysing the differences between Ga-FAPI and F-FDG in GC, some evidence is provided to foster the broader clinical application of FAPI PET imaging. In this review, studies published up to July 3, 2023, that employed radionuclide labelled FAPI as a diagnostic radiotracer for PET in GC were analysed. These studies were sourced from both the PubMed and Web of Science databases. Our statistical analysis involved a bivariate meta-analysis of the diagnostic data and a meta-analysis of the quantitative metrics. These were performed using R language. The meta-analysis included 14 studies, with 527 patients, of which 358 were diagnosed with GC. Overall, Ga-FAPI showed higher pooled sensitivity (0.84 [95% CI 0.67-0.94] 0.46 [95% CI 0.32-0.60]), specificity (0.91 [95% CI 0.76-0.98] 0.88 [95% CI 0.74-0.96]) and area under the curve (AUC) (0.92 [95% CI 0.77-0.98] 0.52 [95% CI 0.38-0.86]) than F-FDG. The evidence showed superior pooled sensitivities of Ga-FAPI PET over F-FDG for primary tumours, local recurrence, lymph node metastases, distant metastases, and peritoneal metastases. Furthermore, Ga-FAPI PET provided higher maximum standardized uptake value (SUVmax) and tumour-to-background ratios (TBR). For bone metastases, while Ga-FAPI PET demonstrated slightly lower patient-based pooled sensitivity (0.93 1.00), it significantly outperformed F-FDG in the lesion-based analysis (0.95 0.65). However, SUVmax (mean difference [MD] 1.79 [95% CI -3.87-7.45]) and TBR (MD 5.01 [95% CI -0.78-10.80]) of bone metastases showed no significant difference between Ga-FAPI PET/CT and F-FDG PET/CT. Compared with F-FDG, Ga-FAPI PET imaging showed improved diagnostic accuracy in the evaluation of GC. It can be effectively applied to the early diagnosis, initial staging, and detection of recurrence/metastases of GC. Ga-FAPI may have the potential of replacing F-FDG in GC in future applications.

摘要

最近的研究表明，镓-FAPI PET/CT 在评估各种癌症类型方面优于 F-FDG PET/CT，尤其是在胃癌（GC）中。通过综合回顾和分析 GC 中 Ga-FAPI 和 F-FDG 的差异，为促进 FAPI PET 成像的更广泛临床应用提供了一些证据。在本综述中，分析了截至 2023 年 7 月 3 日发表的使用放射性核素标记的 FAPI 作为 GC 中 PET 诊断示踪剂的研究。这些研究来自 PubMed 和 Web of Science 数据库。我们的统计分析包括对诊断数据的双变量荟萃分析和对定量指标的荟萃分析。这些都是使用 R 语言进行的。荟萃分析包括 14 项研究，涉及 527 名患者，其中 358 名被诊断为 GC。总体而言，Ga-FAPI 显示出更高的汇总敏感性（0.84 [95%CI 0.67-0.94] vs. 0.46 [95%CI 0.32-0.60]）、特异性（0.91 [95%CI 0.76-0.98] vs. 0.88 [95%CI 0.74-0.96]）和曲线下面积（AUC）（0.92 [95%CI 0.77-0.98] vs. 0.52 [95%CI 0.38-0.86]）高于 F-FDG。证据表明，Ga-FAPI PET 对原发性肿瘤、局部复发、淋巴结转移、远处转移和腹膜转移的总体敏感性均优于 F-FDG。此外，Ga-FAPI PET 提供了更高的最大标准化摄取值（SUVmax）和肿瘤与背景比值（TBR）。对于骨转移，虽然 Ga-FAPI PET 对患者的总体敏感性略低（0.93 vs. 1.00），但在病变基础分析中，它明显优于 F-FDG（0.95 vs. 0.65）。然而，骨转移的 SUVmax（平均差值[MD] 1.79 [95%CI -3.87-7.45]）和 TBR（MD 5.01 [95%CI -0.78-10.80]）在 Ga-FAPI PET/CT 和 F-FDG PET/CT 之间没有显著差异。与 F-FDG 相比，Ga-FAPI PET 成像在评估 GC 方面显示出更高的诊断准确性。它可以有效地应用于 GC 的早期诊断、初始分期以及复发/转移的检测。Ga-FAPI 有可能在未来的应用中取代 F-FDG 在 GC 中的应用。