Zhang Zeyu, Guo Shiwei, Su Weiwei, Pan Guixia, Wang Yiting, Li Yuchao, Cao Kai, Jiang Hui, Zhang Lu, Cheng Chao, Chen Haojun, Jin Gang, Zuo Changjing
Department of Nuclear Medicine, Changhai Hospital, Naval Medical University, 168 Changhai Road, Yang Pu District, Shanghai, 200433, China.
Department of Hepatobiliary Pancreatic Surgery, Changhai Hospital, Naval Medical University, 168 Changhai Road, Yang Pu District, Shanghai, 200433, China.
Eur J Nucl Med Mol Imaging. 2025 Sep 9. doi: 10.1007/s00259-025-07491-w.
In this retrospective study, whether [Ga]Ga-DOTA-FAPI-04 PET/MR imaging biomarkers can predict the progression-free survival (PFS) and overall survival (OS) of patients with advanced pancreatic cancer was investigated.
Fifty-one patients who underwent [Ga]Ga-DOTA-FAPI-04 PET/MR scans before first-line chemotherapy were recruited. Imaging biomarkers, including the maximum tumor diameter, minimum apparent diffusion coefficient (ADC), maximum and mean standardized uptake values (SUV and SUV), fibroblast activation protein- (FAP-) positive tumor volume (FTV and W-FTV) and total lesion FAP expression (TLF and W-TLF), were recorded for primary and whole-body tumors. A subgroup analysis of 28 patients with obstructive inflammation was performed, and the maximum and mean standardized uptake values (D-SUV and D-SUV), FAP-positive uptake volume (D-FTV), and total FAP expression (D-TLF) in the distal pancreas were assessed. Kaplan-Meier analysis and the Cox proportional hazards model were used to assess the relationships between these imaging biomarkers and PFS/OS.
SUV was negatively correlated with the ADC (r = -0.288, P = 0.041), whereas tumor length was positively correlated with the FTV, TLF, W-FTV, and W-TLF (r = 0.311-0.508, P < 0.05). The median PFS was not reached in patients with a W-TLF ≤ 516.09 but was 91 days in patients with a W-TLF > 516.09 (P < 0.001). Univariate and multivariate Cox regression analyses identified W-TLF as an independent predictor of PFS (P = 0.001, hazard ratio (HR) = 4.949). The TNM stage, tumor length, ADC value, SUV, TLF, W-FTV, and W-TLF were significantly associated with OS (P < 0.05). Multivariate analysis further confirmed that tumor length, ADC, and W-TLF were independent predictors of OS (P < 0.05). A subgroup analysis including 28 patients with obstructive pancreatitis revealed that TNM stage, tumor length, W-FTV, W-TLF, D-FTV, and D-TLF were significantly associated with OS (P < 0.05). The multivariate analysis further identified W-TLF and D-FTV as independent predictors of OS (P < 0.05).
[Ga]Ga-DOTA-FAPI-04 PET/MRI biomarkers are associated with the PFS and OS of pancreatic cancer patients. Both the ADC and W-TLF are independent risk factors for patients with advanced disease. Increased fibroblast activity, driven by cancer-induced inflammation, may influence long-term survival outcomes following adjuvant therapy. These biomarkers have potential for guiding future clinical trials, enabling personalized treatment strategies, and ultimately improving the management and prognosis of patients with pancreatic cancer.
在这项回顾性研究中，探讨[镓]镓 - DOTA - FAPI - 04 PET/MR成像生物标志物能否预测晚期胰腺癌患者的无进展生存期（PFS）和总生存期（OS）。
招募了51例在一线化疗前接受[镓]镓 - DOTA - FAPI - 04 PET/MR扫描的患者。记录了原发性和全身肿瘤的成像生物标志物，包括最大肿瘤直径、最小表观扩散系数（ADC）、最大和平均标准化摄取值（SUV和SUV）、成纤维细胞活化蛋白 - （FAP - ）阳性肿瘤体积（FTV和W - FTV）以及总病变FAP表达（TLF和W - TLF）。对28例伴有梗阻性炎症的患者进行亚组分析，并评估胰腺远端的最大和平均标准化摄取值（D - SUV和D - SUV）、FAP阳性摄取体积（D - FTV）和总FAP表达（D - TLF）。采用Kaplan - Meier分析和Cox比例风险模型评估这些成像生物标志物与PFS/OS之间的关系。
SUV与ADC呈负相关（r = -0.288，P = 0.041），而肿瘤长度与FTV、TLF、W - FTV和W - TLF呈正相关（r = 0.311 - 至0.508，P < 0.05）。W - TLF≤516.09的患者未达到中位PFS，而W - TLF>516.09的患者中位PFS为91天（P < 0.001）。单因素和多因素Cox回归分析确定W - TLF是PFS的独立预测因子（P = 0.001，风险比（HR）= 4.949）。TNM分期、肿瘤长度、ADC值、SUV、TLF、W - FTV和W - TLF与OS显著相关（P < 0.05）。多因素分析进一步证实肿瘤长度、ADC和W - TLF是OS的独立预测因子（P < 0.05）。包括28例梗阻性胰腺炎患者的亚组分析显示，TNM分期、肿瘤长度、W - FTV、W - TLF、D - FTV和D - TLF与OS显著相关（P < 0.05）。多因素分析进一步确定W - TLF和D - FTV是OS的独立预测因子（P < 0.
