Kerstin Michalski, Aleksander Kosmala, Philipp E Hartrampf, Marieke Heinrich, Sebastian E Serfling, Wiebke Schlötelburg, Andreas K Buck, Alexander Meining, Rudolf A Werner, Alexander Weich
{"title":"[18F]FDG和[68Ga]Ga-FAPI-04引导成像预测高级别神经内分泌肿瘤患者的预后。","authors":"Kerstin Michalski, Aleksander Kosmala, Philipp E Hartrampf, Marieke Heinrich, Sebastian E Serfling, Wiebke Schlötelburg, Andreas K Buck, Alexander Meining, Rudolf A Werner, Alexander Weich","doi":"10.2967/jnumed.124.268288","DOIUrl":null,"url":null,"abstract":"<p><p>We aimed to quantitatively investigate the prognostic value of PET-based biomarkers on [<sup>18</sup>F]FDG and [<sup>68</sup>Ga]Ga-fibroblast activation protein inhibitor (FAPI)-04 PET/CT in patients with highly aggressive neuroendocrine neoplasms (NENs) and to compare the visually assessed differences in uptake on both examinations with progression-free survival (PFS). <b>Methods:</b> In this single-center retrospective analysis, 20 patients with high-grade NENs had undergone [<sup>18</sup>F]FDG and [<sup>68</sup>Ga]Ga-FAPI-04 PET. Both PET scans were visually compared, and the presence of [<sup>18</sup>F]FDG-positive, [<sup>68</sup>Ga]Ga-FAPI-04-negative (FDG+/FAPI-) lesions was noted. In addition, we assessed maximum, peak, and mean SUV; tumor volume (TV); and total lesion uptake (TLU = TV × SUV<sub>mean</sub>) for both radiotracers using a 40% lesion-based threshold. The results of quantitative and visual analysis were correlated with PFS using log-rank analysis or univariate Cox regression. PFS was defined radiographically using RECIST 1.1., clinically using signs of disease progression, or as death. <b>Results:</b> Most primary tumors were located in the gastrointestinal tract (13/20 patients, 65%) or were cancer of unknown primary (5/20 patients, 25%). FDG+/FAPI- lesions were found in 9 of 20 patients (45%). Patients with FDG+/FAPI- lesions had a significantly decreased PFS of 4 mo, compared with 9 mo for patients without FDG+/FAPI- metastases (<i>P</i> = 0.0063 [log-rank test]; hazard ratio [HR], 5.637; 95% CI 1.619-26.16; <i>P</i> = 0.0110 [univariate Cox regression]). On univariate analysis, a significant correlation was also found between PFS and TV for both radiotracers ([<sup>18</sup>F]FDG: mean TV, 258 ± 588 cm<sup>3</sup>; HR, 1.024 [per 10 cm<sup>3</sup>]; 95% CI, 1.007-1.046; <i>P</i> = 0.0204) ([<sup>68</sup>Ga]Ga-FAPI-04: mean TV, 130 ± 192 cm<sup>3</sup>; HR, 1.032 [per 10 cm<sup>3</sup>]; 95% CI, 1.001-1.062; <i>P</i> = 0.0277) and TLU on [<sup>18</sup>F]FDG PET (mean TLU, 1,931 ± 4,248 cm<sup>3</sup>; HR, 1.004 [per 10 cm<sup>3</sup>]; 95% CI, 1.001-1.007; <i>P</i> = 0.0135). <b>Conclusion:</b> The presence of discordant FDG+/FAPI- lesions is associated with a significantly shorter PFS, which might indicate more aggressive disease prone to early progression. Dual-tracer PET/CT of patients with highly aggressive NENs could help guide treatment decisions or identify high-risk lesions for additional local therapeutic approaches.</p>","PeriodicalId":94099,"journal":{"name":"Journal of nuclear medicine : official publication, Society of Nuclear Medicine","volume":" ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"[<sup>18</sup>F]FDG and [<sup>68</sup>Ga]Ga-FAPI-04-Directed Imaging for Outcome Prediction in Patients with High-Grade Neuroendocrine Neoplasms.\",\"authors\":\"Kerstin Michalski, Aleksander Kosmala, Philipp E Hartrampf, Marieke Heinrich, Sebastian E Serfling, Wiebke Schlötelburg, Andreas K Buck, Alexander Meining, Rudolf A Werner, Alexander Weich\",\"doi\":\"10.2967/jnumed.124.268288\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>We aimed to quantitatively investigate the prognostic value of PET-based biomarkers on [<sup>18</sup>F]FDG and [<sup>68</sup>Ga]Ga-fibroblast activation protein inhibitor (FAPI)-04 PET/CT in patients with highly aggressive neuroendocrine neoplasms (NENs) and to compare the visually assessed differences in uptake on both examinations with progression-free survival (PFS). <b>Methods:</b> In this single-center retrospective analysis, 20 patients with high-grade NENs had undergone [<sup>18</sup>F]FDG and [<sup>68</sup>Ga]Ga-FAPI-04 PET. Both PET scans were visually compared, and the presence of [<sup>18</sup>F]FDG-positive, [<sup>68</sup>Ga]Ga-FAPI-04-negative (FDG+/FAPI-) lesions was noted. In addition, we assessed maximum, peak, and mean SUV; tumor volume (TV); and total lesion uptake (TLU = TV × SUV<sub>mean</sub>) for both radiotracers using a 40% lesion-based threshold. The results of quantitative and visual analysis were correlated with PFS using log-rank analysis or univariate Cox regression. PFS was defined radiographically using RECIST 1.1., clinically using signs of disease progression, or as death. <b>Results:</b> Most primary tumors were located in the gastrointestinal tract (13/20 patients, 65%) or were cancer of unknown primary (5/20 patients, 25%). FDG+/FAPI- lesions were found in 9 of 20 patients (45%). Patients with FDG+/FAPI- lesions had a significantly decreased PFS of 4 mo, compared with 9 mo for patients without FDG+/FAPI- metastases (<i>P</i> = 0.0063 [log-rank test]; hazard ratio [HR], 5.637; 95% CI 1.619-26.16; <i>P</i> = 0.0110 [univariate Cox regression]). On univariate analysis, a significant correlation was also found between PFS and TV for both radiotracers ([<sup>18</sup>F]FDG: mean TV, 258 ± 588 cm<sup>3</sup>; HR, 1.024 [per 10 cm<sup>3</sup>]; 95% CI, 1.007-1.046; <i>P</i> = 0.0204) ([<sup>68</sup>Ga]Ga-FAPI-04: mean TV, 130 ± 192 cm<sup>3</sup>; HR, 1.032 [per 10 cm<sup>3</sup>]; 95% CI, 1.001-1.062; <i>P</i> = 0.0277) and TLU on [<sup>18</sup>F]FDG PET (mean TLU, 1,931 ± 4,248 cm<sup>3</sup>; HR, 1.004 [per 10 cm<sup>3</sup>]; 95% CI, 1.001-1.007; <i>P</i> = 0.0135). <b>Conclusion:</b> The presence of discordant FDG+/FAPI- lesions is associated with a significantly shorter PFS, which might indicate more aggressive disease prone to early progression. Dual-tracer PET/CT of patients with highly aggressive NENs could help guide treatment decisions or identify high-risk lesions for additional local therapeutic approaches.</p>\",\"PeriodicalId\":94099,\"journal\":{\"name\":\"Journal of nuclear medicine : official publication, Society of Nuclear Medicine\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-10-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of nuclear medicine : official publication, Society of Nuclear Medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.2967/jnumed.124.268288\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of nuclear medicine : official publication, Society of Nuclear Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2967/jnumed.124.268288","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
[18F]FDG and [68Ga]Ga-FAPI-04-Directed Imaging for Outcome Prediction in Patients with High-Grade Neuroendocrine Neoplasms.
We aimed to quantitatively investigate the prognostic value of PET-based biomarkers on [18F]FDG and [68Ga]Ga-fibroblast activation protein inhibitor (FAPI)-04 PET/CT in patients with highly aggressive neuroendocrine neoplasms (NENs) and to compare the visually assessed differences in uptake on both examinations with progression-free survival (PFS). Methods: In this single-center retrospective analysis, 20 patients with high-grade NENs had undergone [18F]FDG and [68Ga]Ga-FAPI-04 PET. Both PET scans were visually compared, and the presence of [18F]FDG-positive, [68Ga]Ga-FAPI-04-negative (FDG+/FAPI-) lesions was noted. In addition, we assessed maximum, peak, and mean SUV; tumor volume (TV); and total lesion uptake (TLU = TV × SUVmean) for both radiotracers using a 40% lesion-based threshold. The results of quantitative and visual analysis were correlated with PFS using log-rank analysis or univariate Cox regression. PFS was defined radiographically using RECIST 1.1., clinically using signs of disease progression, or as death. Results: Most primary tumors were located in the gastrointestinal tract (13/20 patients, 65%) or were cancer of unknown primary (5/20 patients, 25%). FDG+/FAPI- lesions were found in 9 of 20 patients (45%). Patients with FDG+/FAPI- lesions had a significantly decreased PFS of 4 mo, compared with 9 mo for patients without FDG+/FAPI- metastases (P = 0.0063 [log-rank test]; hazard ratio [HR], 5.637; 95% CI 1.619-26.16; P = 0.0110 [univariate Cox regression]). On univariate analysis, a significant correlation was also found between PFS and TV for both radiotracers ([18F]FDG: mean TV, 258 ± 588 cm3; HR, 1.024 [per 10 cm3]; 95% CI, 1.007-1.046; P = 0.0204) ([68Ga]Ga-FAPI-04: mean TV, 130 ± 192 cm3; HR, 1.032 [per 10 cm3]; 95% CI, 1.001-1.062; P = 0.0277) and TLU on [18F]FDG PET (mean TLU, 1,931 ± 4,248 cm3; HR, 1.004 [per 10 cm3]; 95% CI, 1.001-1.007; P = 0.0135). Conclusion: The presence of discordant FDG+/FAPI- lesions is associated with a significantly shorter PFS, which might indicate more aggressive disease prone to early progression. Dual-tracer PET/CT of patients with highly aggressive NENs could help guide treatment decisions or identify high-risk lesions for additional local therapeutic approaches.
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