F-FAPI-42 PET/CT提高结直肠癌腹膜转移的诊断效能并指导治疗决策：一项原创性回顾性研究
F-FAPI-42 PET/CT enhances the diagnostic efficacy for peritoneal metastasis of colorectal cancer and guides treatment decisions: an original retrospective study.
作者信息
Zhang Xuneng, Zhang Rongqin, Zheng Qingyang, He Zichuan, Lan Bing, Zhong Yun, Huang Zhichao, Fan Wei, Wang Hui, Yang Keli, Zhang Zhanwen, Wang Huaiming
机构信息
Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.
Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.
出版信息
Gastroenterol Rep (Oxf). 2024 Dec 13;12:goae104. doi: 10.1093/gastro/goae104. eCollection 2024.
BACKGROUND
Colorectal cancer is the third-most common type of cancer. When peritoneal metastasis (PM) develops, diagnosing metastatic lesions is difficult and the prognosis is poor. This study aimed to compare the value of fluorine-18 fibroblast activation protein-specific inhibitor (F-FAPI-42) and fluorine-18 fluorodeoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT) for detecting PM of colorectal cancer and to guide clinical decision-making.
METHODS
Forty-eight patients with PM who underwent both F-FAPI-42 and F-FDG PET/CT examinations were studied. The maximum standardized uptake value (SUV max), tumor-to-background ratios (TBRs) and peritoneal cancer index (PCI) of the PM were compared between the two imaging techniques. The intraclass correlation coefficient (ICC) was used to compare the consistency between the PET/CT PCI score and the intraoperative PCI. A receiver-operating characteristic curve was used to predict the accuracy of CC-0 cytoreduction (complete cytoreduction with no visible disease).
RESULTS
The sensitivity and accuracy of F-FAPI-42 PET/CT for detecting PM were higher than those of F-FDG PET/CT (82.1% vs 61.1%, <0.01; 84.6% vs 74.5%, <0.01). The median SUV max and TBR of PM was greater in F-FAPI-42 than in F-FDG PET/CT [4.8 (1.9-20.1) vs 4.7 (1.0-11.0), =0.02; 4.3 (1.4-14.6) vs 2.9 (0.6-8.0), <0.01, respectively]. The median PCI of PM based on F-FAPI-42 PET/CT was greater than that based on F-FDG PET/CT (15 vs 9, <0.01). The ICC for F-FAPI-42 PCI was greater than that for F-FDG PCI (0.915 vs 0.724, <0.01). The cut-off values of the PCI of the PM for F-FAPI-42 and F-FDG PET/CT to predict CC-0 were <18 and <10, with areas under the curve of 0.80 and 0.79, respectively.
CONCLUSIONS
F-FAPI-42 PET/CT has superior diagnostic efficacy for PM, particularly in the right upper epigastrium and small intestine. The PCI score of F-FAPI-42 PET/CT is very close to the intraoperative PCI score and has a high value for predicting CC-0. The individualized management of PM based on the F-FAPI-42 PET/CT PCI score is pivotal.
背景
结直肠癌是第三大常见癌症类型。当发生腹膜转移（PM）时，诊断转移灶困难且预后较差。本研究旨在比较氟 - 18成纤维细胞活化蛋白特异性抑制剂（F - FAPI - 42）和氟 - 18氟脱氧葡萄糖（F - FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）在检测结直肠癌腹膜转移方面的价值，并指导临床决策。
方法
对48例接受了F - FAPI - 42和F - FDG PET/CT检查的腹膜转移患者进行研究。比较两种成像技术下PM的最大标准化摄取值（SUV max）、肿瘤与背景比值（TBRs）和腹膜癌指数（PCI）。组内相关系数（ICC）用于比较PET/CT PCI评分与术中PCI之间的一致性。采用受试者工作特征曲线预测CC - 0细胞减灭术（无可见疾病的完全细胞减灭术）的准确性。
结果
F - FAPI - 42 PET/CT检测PM的敏感性和准确性高于F - FDG PET/CT（82.1%对61.1%，<0.01；84.6%对74.5%，<0.01）。F - FAPI - 42检查中PM的SUV max和TBR中位数大于F - FDG PET/CT [4.8（1.9 - 20.1）对4.7（1.0 - 11.0），P = 0.02；4.3（1.4 - 14.6）对2.9（0.6 - 8.0），<0.01，分别]。基于F - FAPI - 42 PET/CT的PM的PCI中位数大于基于F - FDG PET/CT的（15对9，<0.01）。F - FAPI - 42 PCI的ICC大于F - FDG PCI的（0.915对0.724，<0.01）。F - FAPI - 42和F - FDG PET/CT预测CC - 0的PM的PCI截断值分别<18和<10，曲线下面积分别为0.80和0.79。
结论
F - FAPI - 42 PET/CT对PM具有卓越的诊断效能，尤其在上腹右上象限和小肠。F - FAPI - 42 PET/CT的PCI评分与术中PCI评分非常接近，对预测CC - 0具有很高价值。基于F - FAPI - 42 PET/CT PCI评分对PM进行个体化管理至关重要。
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