[18F]FDG and [68Ga]Ga-FAPI-04–Directed Imaging for Outcome Prediction in Patients with High-Grade Neuroendocrine Neoplasms

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FIGURE 1.
Maximum-intensity projection (MIP), CT, PET, and fused images of [⁶⁸Ga]Ga-FAPI-04 PET/CT and [¹⁸F]FDG PET/CT of patient 2. Images show concordant high uptake in multiple lymph node metastases and advanced peritoneal carcinomatosis. In addition, [¹⁸F]FDG PET shows osseous metastases not seen on [⁶⁸Ga]Ga-FAPI-04 PET (arrows). Time difference between scans was 1 d.
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FIGURE 2.
Kaplan–Meier curves of PFS of patients with (n = 9, red line) or without (n = 11, blue line) discordant FDG+/FAPI− lesions. Patients with discordant lesions showed significantly shorter median PFS (4 mo) than patients without (9 mo, P = 0.0063).

TABLE 1.

Patient Characteristics

Patient no.	Age (y)	Sex	Primary tumor	Histology	Ki-67 (%)	Indication	Previous therapy	Therapy until progression
1	59	F	Colon	MiNEN	80	Primary staging	—	Carboplatin/etoposide
2	63	F	Colon	MiNEN	>85	Primary staging	—	Carboplatin/etoposide
3	69	M	CUP	NEC	>80	Primary staging	—	Radiotherapy (bone metastasis)
4	81	M	CUP	NEC	>80	Primary staging	—	Carboplatin/etoposide/atezolizumab
5	56	M	Pancreas	G3	70	Restaging	Cisplatin/etoposide	Octreotide, PRRT
6	38	F	Pancreas	G3	60	Primary staging	—	Octreotide, PRRT
7	75	F	Small intestine	G3	20	Restaging	Surgery, TACE, everolimus	Temozolomide/capecitabine
8	57	M	CUP	NEC	Unknown	Primary staging	—	Carboplatin/etoposide
9	42	M	Pancreas	G3	40	Primary staging	—	Streptozocin/5-fluorouracil
10	53	M	Stomach	MiNEN	90	Restaging	Cisplatin/etoposide	Surgery, cisplatin/etoposide
11	49	F	Breast	NEC	90	Primary staging	—	Surgery, adjuvant radiotherapy
12	64	M	Bladder	NEC	90	Primary staging	—	Carboplatin/etoposide
13	66	F	CUP	NEC	70	Primary staging	—	Carboplatin/etoposide
14	60	F	Colon	MiNEN	90	Primary staging	—	Carboplatin/etoposide
15	59	M	Pancreas	NEC	14	Restaging	Octreotide, PRRT, TACE, FOLFOX	Carboplatin/etoposide
16	53	M	Pancreas	G3	40	Restaging	Octreotide, streptozocin/ 5-fluorouracil, temozolomide/capecitabine	Octreotide, PRRT
17	68	M	Stomach	NEC	90	Primary staging	—	Carboplatin/etoposide
18	68	M	Pancreas	MiNEN	80	Primary staging	—	FOLFIRINOX
19	67	F	CUP	NEC	70	Primary staging	—	Surgery, adjuvant radiotherapy, carboplatin/etoposide/atezolizumab
20	58	F	Colon	MiNEN	75	Restaging	Cisplatin/etoposide	Cisplatin/etoposide

CUP = cancer of unknown primary; PRRT = peptide receptor radionuclide therapy; TACE = transarterial chemoembolization; FOLFOX = folinic acid, fluorouracil, and oxaliplatin; FOLFIRINOX = folinic acid, fluorouracil, irinotecan hydrochloride, and oxaliplatin.

TABLE 2.

Univariate Analysis

Parameter	Hazard ratio	95% CI	P
[¹⁸F]FDG TV (per 10 cm³)	1.024	1.007–1.046	0.0204
[¹⁸F]FDG TLU (per 10 cm³)	1.004	1.001–1.007	0.0135
[¹⁸F]FDG SUV_mean	1.114	0.9721–1.262	0.0961
[¹⁸F]FDG SUV_max	1.063	0.9799–1.145	0.1190
[¹⁸F]FDG SUV_peak	1.100	0.9644–1.248	0.1419
[⁶⁸Ga]Ga-FAPI-04 TV (per 10 cm³)	1.032	1.001–1.062	0.0277
[⁶⁸Ga]Ga-FAPI-04 TLU (per 10 cm³)	1.001	1.002–1.003	0.5262
[⁶⁸Ga]Ga-FAPI-04 SUV_mean	1.028	0.9040–1.153	0.6463
[⁶⁸Ga]Ga-FAPI-04 SUV_max	1.020	0.9579–1.081	0.5101
[⁶⁸Ga]Ga-FAPI-04 SUV_peak	1.015	0.9278–1.093	0.7173
FDG+/FAPI− lesions	5.673	1.619–26.16	0.0110
Histology (G3 NET, NEC, MiNEN)	1.386	0.7465–2.609	0.2977
Age (y)	1.057	1.003–1.121	0.0477