Abstract:Objectives
To compare the detection rates of [68Ga]Ga-FAPI-04 PET MRI/CT vs. [18F]-FDG PET MRI/CT in gastric cancer.
Methods
An extensive librarian-led literature search of PubMed, Embase, Web of Science, the Cochrane Central Library, and ClinicalTrials.gov was performed. The primary outcomes were sensitivity in patient-based evaluations, detection of lymph node metastases, and peritoneal involvement.
Results
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“…Our systematic review, which gathers original studies on GC from 2018 onwards, provides strong clinical evidence to support the superior diagnostic sensitivity of 68 Ga-FAPI over 18 F-FDG for identifying primary tumours, recurrent tumours, lymph node infiltration, and distant metastases. In contrast to the previous meta-analysis 51 , 52 , our study brings forth some important nuances and enhancements. For one, we presented the comparative results and a subgroup analysis of the diagnostic accuracy of 68 Ga-FAPI versus 18 F-FDG PET/CT in gastric cancer, which was not extensively covered in previous work.…”
Section: Discussioncontrasting
confidence: 82%
“…Additionally, we calculated and compared the SUVmax and TBRs derived from these two PET scans, providing more depth to our results. Significantly, our study involves a larger patient population than Wang's study 51 , encompassing 358 patients as opposed to 148, adding robustness to our findings. We also have observations on the diagnostic accuracy for lymph node metastases.…”
Purpose:
Recent studies suggest that
68
Ga-FAPI PET/CT demonstrated superiority over
18
F-FDG PET/CT in the evaluation of various cancer types, especially in gastric cancer (GC). By comprehensively reviewing and analysing the differences between
68
Ga-FAPI and
18
F-FDG in GC, some evidence is provided to foster the broader clinical application of FAPI PET imaging.
Methods:
In this review, studies published up to July 3, 2023, that employed radionuclide labelled FAPI as a diagnostic radiotracer for PET in GC were analysed. These studies were sourced from both the PubMed and Web of Science databases. Our statistical analysis involved a bivariate meta-analysis of the diagnostic data and a meta-analysis of the quantitative metrics. These were performed using R language.
Results:
The meta-analysis included 14 studies, with 527 patients, of which 358 were diagnosed with GC. Overall,
68
Ga-FAPI showed higher pooled sensitivity (0.84 [95% CI 0.67-0.94]
vs.
0.46 [95% CI 0.32-0.60]), specificity (0.91 [95% CI 0.76-0.98]
vs.
0.88 [95% CI 0.74-0.96]) and area under the curve (AUC) (0.92 [95% CI 0.77-0.98]
vs.
0.52 [95% CI 0.38-0.86]) than
18
F-FDG. The evidence showed superior pooled sensitivities of
68
Ga-FAPI PET over
18
F-FDG for primary tumours, local recurrence, lymph node metastases, distant metastases, and peritoneal metastases. Furthermore,
68
Ga-FAPI PET provided higher maximum standardized uptake value (SUVmax) and tumour-to-background ratios (TBR). For bone metastases, while
68
Ga-FAPI PET demonstrated slightly lower patient-based pooled sensitivity (0.93
vs.
1.00), it significantly outperformed
18
F-FDG in the lesion-based analysis (0.95
vs.
0.65). However, SUVmax (mean difference [MD] 1.79 [95% CI -3.87-7.45]) and TBR (MD 5.01 [95% CI -0.78-10.80]) of bone metastases showed no significant difference between
68
Ga-FAPI PET/CT and
18
F-FDG PET/CT.
Conclusion:
Compared with
18
F-FDG,
68
Ga-FAPI PET imaging showed improved diagnostic accuracy in the evaluation of GC. It can be effectively applied to the early diagnosis, initial staging, and detection of recurrence/metastases of GC.
68
Ga-FAPI may have the potential of replacing
18
F-FDG in GC in future applications.
“…Our systematic review, which gathers original studies on GC from 2018 onwards, provides strong clinical evidence to support the superior diagnostic sensitivity of 68 Ga-FAPI over 18 F-FDG for identifying primary tumours, recurrent tumours, lymph node infiltration, and distant metastases. In contrast to the previous meta-analysis 51 , 52 , our study brings forth some important nuances and enhancements. For one, we presented the comparative results and a subgroup analysis of the diagnostic accuracy of 68 Ga-FAPI versus 18 F-FDG PET/CT in gastric cancer, which was not extensively covered in previous work.…”
Section: Discussioncontrasting
confidence: 82%
“…Additionally, we calculated and compared the SUVmax and TBRs derived from these two PET scans, providing more depth to our results. Significantly, our study involves a larger patient population than Wang's study 51 , encompassing 358 patients as opposed to 148, adding robustness to our findings. We also have observations on the diagnostic accuracy for lymph node metastases.…”
Purpose:
Recent studies suggest that
68
Ga-FAPI PET/CT demonstrated superiority over
18
F-FDG PET/CT in the evaluation of various cancer types, especially in gastric cancer (GC). By comprehensively reviewing and analysing the differences between
68
Ga-FAPI and
18
F-FDG in GC, some evidence is provided to foster the broader clinical application of FAPI PET imaging.
Methods:
In this review, studies published up to July 3, 2023, that employed radionuclide labelled FAPI as a diagnostic radiotracer for PET in GC were analysed. These studies were sourced from both the PubMed and Web of Science databases. Our statistical analysis involved a bivariate meta-analysis of the diagnostic data and a meta-analysis of the quantitative metrics. These were performed using R language.
Results:
The meta-analysis included 14 studies, with 527 patients, of which 358 were diagnosed with GC. Overall,
68
Ga-FAPI showed higher pooled sensitivity (0.84 [95% CI 0.67-0.94]
vs.
0.46 [95% CI 0.32-0.60]), specificity (0.91 [95% CI 0.76-0.98]
vs.
0.88 [95% CI 0.74-0.96]) and area under the curve (AUC) (0.92 [95% CI 0.77-0.98]
vs.
0.52 [95% CI 0.38-0.86]) than
18
F-FDG. The evidence showed superior pooled sensitivities of
68
Ga-FAPI PET over
18
F-FDG for primary tumours, local recurrence, lymph node metastases, distant metastases, and peritoneal metastases. Furthermore,
68
Ga-FAPI PET provided higher maximum standardized uptake value (SUVmax) and tumour-to-background ratios (TBR). For bone metastases, while
68
Ga-FAPI PET demonstrated slightly lower patient-based pooled sensitivity (0.93
vs.
1.00), it significantly outperformed
18
F-FDG in the lesion-based analysis (0.95
vs.
0.65). However, SUVmax (mean difference [MD] 1.79 [95% CI -3.87-7.45]) and TBR (MD 5.01 [95% CI -0.78-10.80]) of bone metastases showed no significant difference between
68
Ga-FAPI PET/CT and
18
F-FDG PET/CT.
Conclusion:
Compared with
18
F-FDG,
68
Ga-FAPI PET imaging showed improved diagnostic accuracy in the evaluation of GC. It can be effectively applied to the early diagnosis, initial staging, and detection of recurrence/metastases of GC.
68
Ga-FAPI may have the potential of replacing
18
F-FDG in GC in future applications.
“…2 A-B). A meta-analysis including 5 studies, confirmed the higher sensitivity of FAPI PET over FDG PET in detection of primary tumour (100% vs. 84.43%), lymph node metastases (81.97% vs. 67.21%), and peritoneal metastases (100% vs. 44.74%) of gastric cancer [ 52 ]. Fig.…”
Section: Fap-targeted Imaging In Gastrointestinal Oncologymentioning
F18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) plays a crucial role in tumour diagnosis, staging, and therapy response evaluation of various cancer types and has been a standard imaging modality used in clinical oncology practice for many years. However, it has certain limitations in evaluating some particular gastrointestinal cancer types due to low FDG-avidity or interphering physiological background activity. Fibroblast activation protein (FAP), a protein of the tumour microenvironment, is overexpressed in a wide range of cancers which makes it an attractive target for both tumour imaging and therapy. Recently, FAP-targeted radiopharmaceuticals are widely used in clinical research and achieved great results in tumour imaging. Considering the limitations of FDG PET/CT and the lack of physiological FAP-targeted tracer uptake in liver and intestinal loops, gastrointestinal cancers are among the most promising indications of FAP-targeted imaging. Herein, we present a comprehensive review of FAP-targeted imaging in gastrointestinal cancers in order to clarify the current and potential future role of this class of molecules in gastrointestinal oncology.
“…Numerous studies have established a correlation between active aerobic glycolysis and the onset and progression of gastric cancer, with several molecular mechanisms being implicated [ 5 ]. In a prior investigation, glucose uptake in patients with stomach cancer was assessed by F-fluorodeoxyglucose (FDG)-PET, and all gastric malignancies with high levels of Glut-1 showed improved glucose uptake, with the exception of signet-ring cell carcinoma [ 6 ]. In addition, DNA polymerase is also thought to be involved in maintaining mitochondrial homeostasis.…”
Background
Abnormal glucose metabolism is one of the determinants of maintaining malignant characteristics of cancer. Targeting cancer metabolism is regarded as a new strategy for cancer treatment. Our previous studies have found that TOP1MT is a crucial gene that inhibits glycolysis and cell metastasis of gastric cancer (GC) cells, but the mechanism of its regulation of glycolysis remains unclear.
Methods
Transcriptome sequencing data, clinic-pathologic features of GC from a variety of public databases, and WGCNA were used to identify novel targets of TOP1MT. Immunohistochemical results of 250 patients with GC were used to analyze the relative expression relationship between TOP1MT and PDK4. The function of TOP1MT was investigated by migration assays and sea-horse analysis in vitro.
Results
We discovered a mitochondrial topoisomerase I, TOP1MT, which correlated with a higher risk of metastasis. Functional experiments revealed that TOP1MT deficiency promotes cell migration and glycolysis through increasing PDK4 expression. Additionally, the stimulating effect of TOP1MT on glycolysis may be effectively reversed by PDK4 inhibitor M77976.
Conclusions
In brief, our work demonstrated the critical function of TOP1MT in the regulation of glycolysis by PDK4 in gastric cancer. Inhibiting glycolysis and limiting tumor metastasis in GC may be accomplished by suppressing PDK4.
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