Zhang Shunyu, Su Minggang, Li Qianrui, Hu Qiancheng, Liu Xijiao, Chen Xiaolong, Gou Hongfeng
Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, Sichuan, 610041, China.
Gastric Cancer Center, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, Sichuan, 610041, China.
J Cancer Res Clin Oncol. 2025 Jan 16;151(1):35. doi: 10.1007/s00432-024-06075-9.
To evaluate the added value of additional Ga-FAPI PET/CT following CT for primary staging, detection of postoperative recurrence, and management of gastric cancer patients.
We retrospectively included patients with gastric cancers who underwent contrast-enhanced computed tomography (ceCT), followed by Ga-FAPI PET/CT within 30 days. Ga-FAPI PET/CT was performed for initial staging or detection of postoperative recurrence. Two nuclear medicine physicians and a radiologist independently decided on imaging-based staging. Pre-Ga-FAPI PET/CT treatment decisions were made by a simulated tumor board and post-Ga-FAPI PET/CT decisions were extracted from medical records. We evaluated the impact of Ga-FAPI PET/CT with inconsistent new findings based on the initial findings from ceCT and the resulting changes in treatment strategies.
We included 112 patients, 84 for initial staging and 28 for detection of postoperative recurrence. Compared to CT, 29 new findings in 24 patients were diagnosed as, or ruled out, cancer involvement on Ga-FAPI PET/CT. Among the 112 patients, 21 patients (18.8%) experienced changes in stage or postoperative recurrence. Among patients for initial staging, 14 had stage changes, with 10 being upstaged and 4 being downstaged. Among patients for detection of postoperative recurrence, 7 more patients were diagnosed with tumor recurrence. New findings of Ga-FAPI PET/CT led to treatment change in 20/112 (17.9%) patients, which was deemed of major change in 19 patients and minor change in 1 patient.
Ga-FAPI PET/CT is valuable for precise staging and detection of postoperative recurrence of gastric cancers, and has the potential to influence management.
评估在CT之后加做镓标记的成纤维细胞活化蛋白抑制剂（Ga-FAPI）PET/CT对胃癌患者进行初始分期、检测术后复发及治疗管理的附加价值。
我们回顾性纳入了接受增强计算机断层扫描（ceCT），并在30天内接受Ga-FAPI PET/CT检查的胃癌患者。Ga-FAPI PET/CT用于初始分期或检测术后复发。两名核医学医师和一名放射科医师独立进行基于影像的分期。Ga-FAPI PET/CT检查前的治疗决策由模拟肿瘤专家委员会做出，Ga-FAPI PET/CT检查后的决策从病历中提取。我们根据ceCT的初始检查结果以及由此导致的治疗策略变化，评估了具有不一致新发现的Ga-FAPI PET/CT的影响。
我们纳入了112例患者，其中84例用于初始分期，28例用于检测术后复发。与CT相比，24例患者中的29个新发现被Ga-FAPI PET/CT诊断为癌症累及或排除癌症累及。在112例患者中，21例（18.8%）的分期或术后复发情况发生了变化。在初始分期的患者中，14例分期发生了变化，其中10例分期上调，4例分期下调。在检测术后复发的患者中，又有7例被诊断为肿瘤复发。Ga-FAPI PET/CT的新发现导致20/112（17.9%）的患者治疗方案发生改变，其中19例被认为是重大改变，1例是轻微改变。
Ga-FAPI PET/CT对胃癌的精确分期和术后复发检测有价值，并且有可能影响治疗管理。
