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Prognostic value of preoperative [68 Ga]Ga-FAPI-04 PET/CT in patients with resectable pancreatic ductal adenocarcinoma in correlation with immunohistological characteristics

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Abstract

Purpose

Our aim was to assess the prognostic value of [68 Ga]Ga-FAPI-04 positron emission tomography (PET) uptake in PDAC and to evaluate the correlation between in vivo lesional radioactivity with pathological characteristics of pancreatic ductal adenocarcinoma (PDAC).

Methods

We retrospectively analyzed treatment‐naïve PDAC patients who underwent preoperative [68 Ga]Ga-FAPI-04 PET/CT followed by pancreatectomy. The tracer uptake was determined as maximum tumor standardized uptake value (SUVmax), FAPI-avid tumor volume (FTV), total lesion FAP expression (TLF) as well total pancreatic uptake (TSUVmax), total FAPI-avid pancreatic volume (FPV), and total pancreatic FAP expression (TPF). Spearman’s correlation analysis was performed to evaluate the association between [68 Ga]Ga-FAPI-04 PET/CT imaging and ex vivo immunohistological FAP expression and pathological characteristics of surgical specimens (differentiation, size, vascularity, perineural invasion, and lymph node metastases). Kaplan–Meier and hazard ratio (HR, log-rank) methods were used to evaluate the prognostic value of [68 Ga]Ga-FAPI-04 PET/CT and clinicopathological factors.

Results

Thirty-seven surgical PDAC patients were included. The ex vivo expression of FAP was significantly associated with the tumor SUVmax and TLF. FAP expression was more abundant in poorly differentiated PDAC than in well- to moderately differentiated neoplasms. Tumor SUVmax or TLF and pancreatic TSUVmax or TPF were significantly correlated with tumor size, differentiation, and perineural invasion, respectively. SUVmax had a significant independent prognostic value for recurrence-free survival (HR = 2.46, P < 0.05), while [68 Ga]Ga-FAPI-04 TPF predicted overall survival (HR = 12.82, P < 0.05).

Conclusion

The in vivo [68 Ga]Ga-FAPI-04 uptake in localized PDAC showed a significant correlation with ex vivo FAP expression and aggressive pathological characteristics. [68 Ga]Ga-FAPI-04 PET/CT also presented a potential for postoperative prognostication of PDAC. Elevated fibroblast activity induced by obstructive pancreatitis might be associated with the patient's survival.

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Data availability

The datasets generated or analyzed during this study are available from the corresponding author on reasonable request.

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Funding

This work was sponsored in part by the National Natural Science Foundation of China (Grant No. 82071967), the National Key Research and Development Program of China (Grant No. 2020YFC2002702), CAMS Initiative for Innovative Medicine (No. CAMS-2018-I2M-3–001), CAMS initiative for innovative medicine (2016ZX310174-4), Tsinghua University-Peking Union Medical College Hospital Initiative Scientific Research Program (Grant No. 52300300519), and Capital’s Funds for Health Improvement and Research (CFH-2018–2-4014).

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Authors and Affiliations

  1. Department of Nuclear Medicine, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine and State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Science and PUMC, Beijing, China

    Jie Ding, Zhixin Hao, Chao Ren & Li Huo

  2. Department of General Surgery, PUMC Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing, China

    Jiangdong Qiu, Hua Huang, Qiaofei Liu, Wenjing Liu, Taiping Zhang & Wenming Wu

  3. Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria

    Marcus Hacker & Xiang Li

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  1. Jie Ding
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Contributions

All authors were involved in the study conception and design. Jie Ding, Zhixin Hao, Hua Huang, Qiaofei Liu Wenjing Liu, and Chao Ren were involved in acquisition of data. Jie Ding and Jiangdong Qiu were involved in analysis and interpretation of the data. Jie Ding, Xiang Li, and Jiangdong Qiu were involved in drafting of the manuscript. All authors were involved with critical revisions of the manuscript.

Corresponding authors

Correspondence to Taiping Zhang, Wenming Wu or Li Huo.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the Institutional Ethics Committee of the Peking Union Medical College Hospital (Beijing, China, IRB protocol #ZS1810).

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Informed consent was obtained from all individual participants included in the study for publication.

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The authors declare no competing interests.

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Ding J and Li X shared the authorship.

Jie Ding is the first author.

This article is part of the Topical Collection on Oncology - Digestive tract

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Ding, J., Qiu, J., Hao, Z. et al. Prognostic value of preoperative [68 Ga]Ga-FAPI-04 PET/CT in patients with resectable pancreatic ductal adenocarcinoma in correlation with immunohistological characteristics. Eur J Nucl Med Mol Imaging 50, 1780–1791 (2023). https://doi.org/10.1007/s00259-022-06100-4

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