恶性肿瘤药物治疗患者心肌^(68)Ga-FAPI-04摄取特征及相关因素分析

Characteristics and related clinical factors of myocardial 68Ga-FAPI-04 uptake in patients treated with anti-tumor therapy

目的探讨^(68)Ga-成纤维细胞激活蛋白抑制剂(FAPI)-04 PET/CT在检测恶性肿瘤药物治疗患者心肌损伤中的应用价值。方法回顾性分析2021年8月至2024年3月间在上海交通大学医学院附属仁济医院行^(68)Ga-FAPI-04 PET/CT显像评估恶性肿瘤药物疗效的164例患者,包括左心室心肌(LVM)^(68)Ga-FAPI-04摄取阳性组63例[男36例、女27例,年龄(66.7±9.6)岁]和阴性组101例[男42例、女59例,年龄(55.2±14.1)岁]。分析^(68)Ga-FAPI-04心肌摄取的类型及部位;采用Mann-Whitney U检验或Kruskal-Wallis秩和检验比较组间心肌SUV_(max)的差异;采用二元logistic回归分析研究性别、年龄、体质指数(BMI)、既往冠状动脉粥样硬化性心脏病(简称冠心病)史、左心室射血分数(LVEF)、吸烟史、高血压、糖尿病、癌症类型及免疫检查点抑制剂(ICIs)治疗史等临床因素预测LVM^(68)Ga-FAPI-04摄取的价值。结果LVM^(68)Ga-FAPI-04摄取阳性组中50例(79.4%,50/63)表现为局灶型摄取,7例(11.1%,7/63)表现为多灶型摄取,6例(9.5%,6/63)表现为弥漫型摄取;共检测到127个病灶,大多数在室间隔(37.8%,48/127)。阳性组和阴性组心肌SUV_(max)分别为4.00(3.10,5.40)和1.31(1.20,1.40),差异具有统计学意义(z=-10.82,P<0.001)。阳性组局灶型、多灶型和弥漫型心肌摄取SUV_(max)分别为4.00(3.00,5.10)、7.60(3.60,9.30)、3.95(3.05,5.05),差异无统计学意义(H=3.81,P=0.149);不同病变部位心肌SUV_(max)差异亦无统计学意义(H=1.51,P=0.825)。年龄、既往冠心病史、BMI、LVEF和ICIs治疗史是LVM^(68)Ga-FAPI-04摄取阳性的独立预测因素[比值比(OR):0.87~10.43,均P<0.05]。结论^(68)Ga-FAPI-04 PET/CT是一种潜在的诊断恶性肿瘤药物治疗患者心肌损伤的新型显像方式。

Objective To analyze the value of^(68)Ga-fibroblast activation protein inhibitor(FAPI)-04 PET/CT in the detection of myocardial injury in patients treated with anti-tumor therapy.Methods A retrospective study was conducted on 164 patients who underwent^(68)Ga-FAPI-04 PET/CT to evaluate the efficacy of anti-tumor therapy in Renji Hospital,School of Medicine,Shanghai Jiao Tong University between August 2021 and March 2024.The patients were divided into^(68)Ga-FAPI-04-positive group(n=63,36 males,27 females,age(66.7±9.6)years)and^(68)Ga-FAPI-04-negative group(n=101,42 males,59 females,age(55.2±14.1)years)based on the uptake of left ventricular myocardium(LVM).Moreover,FAPI-04 uptake was analyzed based on different types and locations,and the corresponding SUV_(max)differences were analyzed by Kruskal-Wallis rank sum test.The differences of SUV_(max)between^(68)Ga-FAPI-04-positive group and^(68)Ga-FAPI-04-negative group were analyzed by Mann-Whitney U test.The clinical factors such as gender,age,body mass index(BMI),previous history of coronary heart disease,left ventricular ejection fraction(LVEF),smoking history,hypertension,diabetes,cancer types and immune checkpoint inhibitors(ICIs)treatment were collected,and their predictive values for LVM^(68)Ga-FAPI-04 uptake were investigated by the binary logistic regression analysis.Results Fifty patients of the^(68)Ga-FAPI-04-positive group(79.4%,50/63)showed focal uptake of LVM,7 patients(11.1%,7/63)showed multifocal myocardial uptake,and 6 patients(9.5%,6/63)showed diffuse myocardial uptake.A total of 127 uptake lesions were found,and most of them were located in the septum(37.8%,48/127).The SUV_(max)of LVM in^(68)Ga-FAPI-04-positive group and^(68)Ga-FAPI-04-negative group were 4.00(3.10,5.40)and 1.31(1.20,1.40)respectively(z=-10.82,P<0.001).Differences of the SUV_(max)among focal uptake group,multifocal myocardial uptake group,and diffuse myocardial uptake group were not significantly different(4.00(3.00,5.10)vs 7.60(3.60,9.30)vs 3.95(3.05,5.05);H=3.81,P=0.149).There is no statistically significant difference either in FAPI uptake among different sites of LVM(H=1.51,P=0.825).Age,previous history of coronary heart disease,BMI,LVEF and ICIs treatment were independent predictive factors for positive^(68)Ga-FAPI-04 uptake in the LVM(odds ratio(OR)values:0.87-10.43,all P<0.05).Conclusion^(68)Ga-FAPI-04 PET/CT is a potential new imaging method for the visualization of myocardial injury in patients with anti-tumor therapy.