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Prognostic value of fibroblast activation protein expressing tumor volume calculated from [68 Ga]Ga-FAPI PET/CT in patients with esophageal squamous cell carcinoma

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Abstract

Background

This study aimed to investigate the prognostic value of semiquantitative parameters derived from [68 Ga]Ga-fibroblast activation protein inhibitor (FAPI) PET/CT for patients with esophageal squamous cell carcinoma (ESCC) treated with definitive chemoradiotherapy.

Methods

We conducted a retrospective analysis on patients from a prospective parent study (NCT04416165). A total of 45 patients with locally advanced ESCC who underwent [68 Ga]Ga-FAPI from December 2019 to March 2021 were included. The maximum standard uptake value (SUVmax), gross tumor volume (GTV), and total lesion-FAPI (TL-FAPI) of the primary tumor were calculated from the corresponding PET/CT image. Unpaired parameters were compared using Student’s t test or the Mann–Whitney U test. Paired parameters were compared using the paired t test or the Wilcoxon matched-pairs signed-rank test. Kaplan–Meier curves were generated to calculate progression-free survival (PFS) and overall survival (OS) rates, and Cox regression analysis was performed to determine which PET/CT parameters were prognostic factors for PFS and/or OS.

Results

Thirty-four of the 45 patients met the criteria, and the median follow-up time was 24 months (16–29 months). SUVmax-FAPI, GTVFAPI, and TL-FAPI in patients with stage T4 tumors were significantly higher than those in patients with stage T2/T3 tumors (all P < 0.01). In the univariate Cox regression analysis, T stage, N stage, GTVFAPI, and TL-FAPI were associated with PFS, and T stage, GTVFAPI, and TL-FAPI were associated with OS. Upon multivariable analysis, GTVFAPI was an independent prognostic factor for both PFS (hazard ratio (HR), 5.76; 95% confidence interval (CI), 2.13–15.57, P = 0.001) and OS (HR, 4.96; 95% CI, 2.55–18.79, P = 0.001).

Conclusion

This pilot study revealed that [68 Ga]Ga-FAPI PET/CT may have prognostic value for patients with ESCC treated with definitive chemoradiotherapy. It may aid in personalized patient management by steering treatment modifications before therapy. Prospective studies with larger samples and longer observation periods are needed.

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Data availability

Data generated or analyzed during the study are available from the corresponding author by request.

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Funding

This work was funded by the National Natural Science Foundation of China (Grant numbers 82071961 and 81772893), Natural Science Foundation of Fujian Province (Grant number 2020J011220), Key Scientific Research Program for Yong Scholars in Fujian (2021ZQNZD016), Fujian Natural Science Foundation for Distinguished Yong Scholars (2022D005), and Key Medical and Health Projects in Xiamen (Grant number 3502Z20209002).

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Author notes

  1. Liang Zhao, Yizhen Pang, and Shanyu Chen contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine and Minnan PET Center, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China

    Liang Zhao, Yizhen Pang, Jianhao Chen, Long Sun, Hua Wu & Haojun Chen

  2. Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China

    Liang Zhao, Yizhen Pang, Shanyu Chen, Jianhao Chen, Yimin Li, Yifeng Yu & Qin Lin

  3. Department of General Surgery, Xinji Health Center, Xiangyang, China

    Chunbin Huang

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  1. Liang Zhao
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Correspondence to Haojun Chen or Qin Lin.

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Zhao, L., Pang, Y., Chen, S. et al. Prognostic value of fibroblast activation protein expressing tumor volume calculated from [68 Ga]Ga-FAPI PET/CT in patients with esophageal squamous cell carcinoma. Eur J Nucl Med Mol Imaging 50, 593–601 (2023). https://doi.org/10.1007/s00259-022-05989-1

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