68Ga-FAPI-04 PET/MR预测新辅助免疫综合治疗后的胃肠道恶性肿瘤病理完全缓解  

68Ga-FAPI-04 PET/MR for predicting pathological complete response to neoadjuvant immunotherapy in patients with gastrointestinal cancer

作　　者：张晓[1] 冯源 覃春霞[1] 盖永康 阮伟伟 李梦婷[1] 兰晓莉[1] Zhang Xiao;Feng Yuan;Qin Chunxia;Gai Yongkang;Ruan Weiwei;Li Mengting;Lan Xiaoli(Department of Nuclear Medicine,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Hubei Key Laboratory of Molecular Imaging,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院核医学科、分子影像湖北省重点实验室,武汉430022

出　　处：《中华核医学与分子影像杂志》2025年第3期144-148,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：国家自然科学基金(82030052,82372026)。

摘　　要：目的探讨术前68Ga-成纤维细胞激活蛋白抑制剂(FAPI)-04 PET/MR检查对胃肠道恶性肿瘤患者新辅助免疫综合治疗后病理完全缓解(pCR)的预测作用。方法回顾性收集2021年2月至2024年1月在华中科技大学同济医学院附属协和医院完成68Ga-FAPI-04 PET/MR检查,并接受新辅助免疫综合治疗及手术的35例胃肠道恶性肿瘤患者[男23例、女12例,年龄(59.1±7.9)岁]。收集并分析患者的临床基本信息、PET参数[包括SUV、瘦体质量标准化SUV峰值(SUL peak)、FAPI阳性肿瘤体积(FTV)和FAPI阳性病灶总负荷(TLF)]以及手术病理。将患者分为pCR和非pCR组,采用两独立样本t检验或Mann-Whitney U检验比较组间资料差异。采用ROC曲线分析确定各参数预测pCR的效能,并行Delong检验。结果手术病理达到pCR者14例,pCR率为40.0%(14/35)。在视觉评估中,68Ga-FAPI-04 PET预测pCR的能力有局限性,包括12例假阳性和1例假阴性。在PET定量评价中,非pCR患者SUV_(max)(t=2.50,P=0.018)、SUL peak(t=3.11,P=0.004)、FTV(U=3.00,P=0.030)和TLF(U=2.96,P=0.042)均高于pCR组。FTV<1.925cm^(3)对pCR的预测效能优于PET视觉评估(Z=3.61,P<0.001),其对pCR的预测准确性为82.86%(29/35)。结论68Ga-FAPI-04 PET/MR检查可用于指导新辅助免疫治疗后的胃肠道恶性肿瘤患者后续治疗决策。PET定量指标具有较好的预测pCR的能力,有望为可否避免手术提供参考依据。ObjectiveTo determine if preoperative 68Ga-fibroblast activation protein inhibitor(FAPI)-04 PET/MR could contribute to predicting pathological complete response(pCR)in patients with gastrointestinal cancer undergoing neoadjuvant immunotherapy.MethodsIn this retrospective study,35 patients(23 males,12 females,age(59.1±7.9)years)with gastrointestinal cancer who underwent 68Ga-FAPI-04 PET/MR after receiving neoadjuvant immunotherapy between February 2021 and January 2024 were enrolled.Clinical data,PET imaging parameters including SUV,peak of SUV normalized by lean body mass(SUL peak),FAPI-positive tumor volume(FTV),and total FAPI-positive lesion burden(TLF),and pathological data were collected and analyzed.Patients were divided into pCR group and non-pCR group,and the independent-sample t test or Mann-Whitney U test was performed to compare those parameters between the 2 groups.ROC curve analysis(Delong test)was performed to evaluate the diagnostic efficiency of each parameter to predict pCR.ResultsThe overall pCR rate of the neoadjuvant therapy was 40.0%(14/35).In the visual evaluation,68Ga-FAPI-04 PET was limited in predicting pCR,showing false positivity in 12 patients and false negative in 1 patent.While SUV_(max)(t=2.50,P=0.018),SUL peak(t=3.11,P=0.004),FTV(U=3.00,P=0.030)and TLF(U=2.96,P=0.042)in non-pCR group were all higher than those in pCR group.The predictive efficiency of FTV<1.925cm^(3) for pCR was better than the efficiency of PET visual evaluation(Z=3.61,P<0.001),with the prediction accuracy of 82.86%(29/35).Conclusions 68Ga-FAPI-04 PET/MR may provide an effective clinical tool for guiding further treatment of patients with gastrointestinal cancer undergoing neoadjuvant immunotherapy.The quantitative features derived from 68Ga-FAPI-04 PET appear promising in predicting pCR,which are expected to provide a reference for avoiding surgery.

关 键 词：胃肠肿瘤 喹啉类 同位素标记 镓放射性同位素 肿瘤辅助疗法 免疫疗法 正电子发射断层显像术 磁共振成像 

分 类 号：R730.44[医药卫生—肿瘤] R735[医药卫生—临床医学] R445.2