Yafei Zhang, Mimi Xu, Yu Wang, Fang Yu, Xinxin Chen, Guangfa Wang, Kui Zhao, Hong Yang, Xinhui Su
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PET/CT parameters were evaluated for their association with TRG, recurrence-free survival (RFS) and overall survival (OS) after NCT, including the maximum standardized uptake value (SUV<sub>max</sub>), FAPI-avid tumor volume (FTV), total lesion FAP expression (TLF) of primary tumor, total FAPI-avid pancreatic volume (FPV) and total pancreatic FAP expression (TPF) of total pancreas.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Of 34 patients with LAPDAC, 14 patients had a pathologic good response (PGR, Evans III-IV), and 20 patients had a pathologic poor response (PPR, Evans I-II). Both the primary tumor SUV<sub>max</sub>, FTV and TLF, and total pancreas FPV and TPF in the PGR groups were significantly lower than those in the PPR groups. Furthermore, SUV<sub>max</sub> and TLF were higher in poorly differentiated LAPDAC than in well-moderately differentiated neoplasms. The FTV, TLF, FPV and TPF were closely associated with RFS and OS. On multivariate analysis, patients with FTV > 54.21 and TLF > 290.21 had a worse RFS and OS, respectively (HR = 3.24, <i>P</i> = 0.014 and HR = 3.35, <i>P</i> = 0.019) and OS (HR = 7.35, <i>P</i> = 0.002 and HR = 7.09, <i>P</i> = 0.004) in LAPDAC after NCT.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>The parameters of [<sup>18</sup>F]AlF-NOTA-FAPI-04 PET/CT had the excellent performance for predicting pathologic TRG after NCT in LAPDAC. 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After 4–6 cycles of NCT, these patients underwent radical resection. Pathological response to NCT was assessed by pathological tumor regression grades (TRG) based on the Evans system. PET/CT parameters were evaluated for their association with TRG, recurrence-free survival (RFS) and overall survival (OS) after NCT, including the maximum standardized uptake value (SUV<sub>max</sub>), FAPI-avid tumor volume (FTV), total lesion FAP expression (TLF) of primary tumor, total FAPI-avid pancreatic volume (FPV) and total pancreatic FAP expression (TPF) of total pancreas.</p><h3 data-test=\\\"abstract-sub-heading\\\">Results</h3><p>Of 34 patients with LAPDAC, 14 patients had a pathologic good response (PGR, Evans III-IV), and 20 patients had a pathologic poor response (PPR, Evans I-II). Both the primary tumor SUV<sub>max</sub>, FTV and TLF, and total pancreas FPV and TPF in the PGR groups were significantly lower than those in the PPR groups. 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引用次数: 0
摘要
目的评价[18F]AlF-NOTA-FAPI-04 PET/CT对局部晚期胰管腺癌（LAPDAC）患者新辅助化疗（NCT）病理反应及预后的预测价值。方法本研究纳入34例经组织病理学和影像学证实的LAPDAC患者，并在NCT前接受[18F]AlF-NOTA-FAPI-04 PET/CT扫描。在4-6个NCT周期后，这些患者接受根治性切除术。采用基于Evans系统的病理肿瘤消退分级（TRG）评估NCT的病理反应。评估PET/CT参数与NCT后TRG、无复发生存期（RFS）和总生存期（OS）的相关性，包括原发肿瘤最大标准化摄取值（SUVmax）、FAPI-avid肿瘤体积（FTV）、病灶总FAP表达量（TLF）、全胰腺总FAPI-avid胰腺体积（FPV）和总胰腺FAP表达量（TPF）。结果34例LAPDAC患者中，14例病理良好反应（PGR, Evans III-IV）， 20例病理不良反应（PPR, Evans I-II）。PGR组原发肿瘤SUVmax、FTV、TLF及胰腺总FPV、TPF均显著低于PPR组。此外，SUVmax和TLF在低分化的LAPDAC中高于中分化的肿瘤。FTV、TLF、FPV和TPF与RFS和OS密切相关。多因素分析显示，FTV >； 54.21和TLF >； 290.21患者NCT后LAPDAC的RFS和OS分别较差（HR = 3.24, P = 0.014和HR = 3.35, P = 0.019）和OS （HR = 7.35, P = 0.002和HR = 7.09, P = 0.004）。结论[18F]AlF-NOTA-FAPI-04 PET/CT参数对预测LAPDAC术后病理TRG有较好的效果。FTV和TLF是影响RFS和OS的独立预后因素。
Value of [18F]AlF-NOTA-FAPI-04 PET/CT for predicting pathological response and survival in patients with locally advanced pancreatic ductal adenocarcinoma receiving neoadjuvant chemotherapy
Objectives
This study aimed to evaluate the predictive value of [18F]AlF-NOTA-FAPI-04 PET/CT for pathological response to neoadjuvant chemotherapy (NCT) and prognosis in patients with locally advanced pancreatic ductal adenocarcinoma (LAPDAC).
Methods
This study included 34 patients with histopathologically and radiologically confirmed LAPDAC who received [18F]AlF-NOTA-FAPI-04 PET/CT scans before NCT. After 4–6 cycles of NCT, these patients underwent radical resection. Pathological response to NCT was assessed by pathological tumor regression grades (TRG) based on the Evans system. PET/CT parameters were evaluated for their association with TRG, recurrence-free survival (RFS) and overall survival (OS) after NCT, including the maximum standardized uptake value (SUVmax), FAPI-avid tumor volume (FTV), total lesion FAP expression (TLF) of primary tumor, total FAPI-avid pancreatic volume (FPV) and total pancreatic FAP expression (TPF) of total pancreas.
Results
Of 34 patients with LAPDAC, 14 patients had a pathologic good response (PGR, Evans III-IV), and 20 patients had a pathologic poor response (PPR, Evans I-II). Both the primary tumor SUVmax, FTV and TLF, and total pancreas FPV and TPF in the PGR groups were significantly lower than those in the PPR groups. Furthermore, SUVmax and TLF were higher in poorly differentiated LAPDAC than in well-moderately differentiated neoplasms. The FTV, TLF, FPV and TPF were closely associated with RFS and OS. On multivariate analysis, patients with FTV > 54.21 and TLF > 290.21 had a worse RFS and OS, respectively (HR = 3.24, P = 0.014 and HR = 3.35, P = 0.019) and OS (HR = 7.35, P = 0.002 and HR = 7.09, P = 0.004) in LAPDAC after NCT.
Conclusions
The parameters of [18F]AlF-NOTA-FAPI-04 PET/CT had the excellent performance for predicting pathologic TRG after NCT in LAPDAC. FTV and TLF were independent postoperative prognostic factors for RFS and OS for LAPDAC.
期刊介绍：
The European Journal of Nuclear Medicine and Molecular Imaging serves as a platform for the exchange of clinical and scientific information within nuclear medicine and related professions. It welcomes international submissions from professionals involved in the functional, metabolic, and molecular investigation of diseases. The journal's coverage spans physics, dosimetry, radiation biology, radiochemistry, and pharmacy, providing high-quality peer review by experts in the field. Known for highly cited and downloaded articles, it ensures global visibility for research work and is part of the EJNMMI journal family.
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