Presenter(s)
Chen Wang, MD - Shandong Cancer Hospital and Institute, Jinan, Shandong
C. Wang1, K. Xu2, X. Zhang3, and J. Yue3; 1Shandong University, Jinan, China, 2Shandong Cancer Hospital and Institute, Jinan, Shandong, China, 3Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
Purpose
/ Ob je ct ive
( s
): This study hypothesizes that in patients with hepatocellular carcinoma (HCC), the baseline [18F] AlF-NOTA-FAPI-04 PET/CT fibroblast activation protein (FAP) uptake levels are significantly correlated with the degree of liver cirrhosis and progression-free survival (PFS). The primary objective is to validate the diagnostic efficacy of FAPI uptake parameters in liver fibrosis stratification, and to assess their role as independent predictive factors for systemic treatment response and prognosis. Ma te ri als
/Methods: A total of 64 HCC patients, prospectively enrolled and diagnosed by dual imaging modalities, underwent baseline FAPI PET/CT scans before treatment. Among them, 22 patients had cancerous and adjacent tissue samples obtained via histopathology for immunohistochemical analysis of fibrosis markers (a-SMA, collagen) and cancer-associated fibroblast (CAF) markers. Advanced HCC patients underwent a second PET scan after two cycles of targeted therapy combined with immunotherapy to analyze dynamic changes in FAPI uptake. Boolean operations were performed on tumor regions of interest (ROI) and Total liver regions (TROI) to background (BROI), from which PET metabolic parameters were calculated. Spearman’s correlation was used to evaluate the relationship between FAPI variables and clinical liver fibrosis markers and liver function indices (FIB-4, Child-Pugh). Diagnostic efficacy was assessed by binary logistic regression and receiver operating characteristic curve (AUC), while PFS predictive factors were analyzed using Cox regression and Kaplan-Meier methods.
Results: Baseline FAPI PET parameters SUVmax and SUVmean showed significant differences in Child-Pugh stratification (A vs. B) (P=0.025; P=0.001), and TSUVmean and BTLF effectively distinguished moderate to severe fibrosis in FIB-4 stratification (AUC=0.77, 0.71). Multivariate Cox analysis revealed that TSUVmean (HR=28.39, P=0.001) and BTLF (HR=10.28, P=0.005) are independent predictors of PFS.
Conclusion: FAPI PET/CT parameters can quantitatively assess liver fibrosis in HCC patients and predict systemic treatment responses and survival outcomes. TSUVmean and BTLF are promising PET parameters for HCC, providing a basis for personalized treatment decisions.
