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Purpose <p>This study aimed to investigate the spatiotemporal correlation between tumor metabolism and cancer-associated fibroblast activity using dual-tracer PET/CT, and to explore their potential association with pathologic response to neoadjuvant chemoradiotherapy (nCRT) in esophageal squamous cell carcinoma (ESCC).</p> Methods <p>This retrospective analysis of a prospective trial (ChiCTR2100051599) included 48 patients with ESCC from February 2022 to August 2024. All patients underwent <sup>68</sup>Ga-FAPI and <sup>18</sup>F-FDG PET/CT before pre-nCRT (S1) and after nCRT (S2). Two primary metrics were used to quantify their spatial correlations by voxel-wise correlation analyses: the SUV Correlation Coefficient (SUV_R), reflecting static uptake concordance, and the Dose-Response Matrix Correlation Coefficient (DRM_R), reflecting concordance in treatment dose sensitivity. The conventional parameters derived from FAPI- and FDG- PET were also extracted: SUV<sub>max</sub>, SUV<sub>mean</sub>, SUV_CV, SUV<sub>max</sub>ratio, SUV<sub>mean</sub>ratio, DRM<sub>max</sub>, DRM<sub>median</sub>, DRM_CV and the resistant tumor volume (V(DRM<sub>&gt; 0.7</sub>)). The associations of these metrics with pathological tumor regression grade (TRG) were evaluated in an exploratory manner, except for DRM-related metrics.</p> Results <p>A strong voxel-wise correlation was observed between pre-nCRT FAPI and FDG uptake (S1 SUV_R = 0.80 ± 0.17), which was weaker after nCRT (S2 SUV_R = 0.51 ± 0.23). Two dose-response matrices showed a strong correlation (DRM_R = 0.82 ± 0.14). The bivariate Logistic model, integrating the post-treatment SUV_R and SUV_CV_FDG, significantly predicted pathological response (<i>p</i> = 0.007), achieving an optimization-corrected AUC of 0.78 (95%CI: 0.62–0.95).</p> Conclusion <p>The pre-nCRT tumor voxel intensity and dose response constructed using either FDG or FAPI PET imaging exhibited a strong spatial correlation. In this exploratory analysis, the post-nCRT FAPI-FDG correlation coefficient was associated with pathologic response when combined with SUV_CV_FDG in a Logistic model.</p>

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Spatiotemporal voxel-wise concordance between 68Ga-FAPI and 18F-FDG PET/CT: association with pathologic response in esophageal squamous cell carcinoma receiving neoadjuvant chemoradiotherapy

  • 期刊论文

  • 发表日期：

    2026年5月12日

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  • Jiaona Dai,
  • Lixiang Yang,
  • Hui Wang,
  • Huijun Zhou,
  • Bingwen Zou,
  • Di Yan,
  • Rong Tian

摘要

Purpose

This study aimed to investigate the spatiotemporal correlation between tumor metabolism and cancer-associated fibroblast activity using dual-tracer PET/CT, and to explore their potential association with pathologic response to neoadjuvant chemoradiotherapy (nCRT) in esophageal squamous cell carcinoma (ESCC).

Methods

This retrospective analysis of a prospective trial (ChiCTR2100051599) included 48 patients with ESCC from February 2022 to August 2024. All patients underwent 68Ga-FAPI and 18F-FDG PET/CT before pre-nCRT (S1) and after nCRT (S2). Two primary metrics were used to quantify their spatial correlations by voxel-wise correlation analyses: the SUV Correlation Coefficient (SUV_R), reflecting static uptake concordance, and the Dose-Response Matrix Correlation Coefficient (DRM_R), reflecting concordance in treatment dose sensitivity. The conventional parameters derived from FAPI- and FDG- PET were also extracted: SUVmax, SUVmean, SUV_CV, SUVmaxratio, SUVmeanratio, DRMmax, DRMmedian, DRM_CV and the resistant tumor volume (V(DRM> 0.7)). The associations of these metrics with pathological tumor regression grade (TRG) were evaluated in an exploratory manner, except for DRM-related metrics.

Results

A strong voxel-wise correlation was observed between pre-nCRT FAPI and FDG uptake (S1 SUV_R = 0.80 ± 0.17), which was weaker after nCRT (S2 SUV_R = 0.51 ± 0.23). Two dose-response matrices showed a strong correlation (DRM_R = 0.82 ± 0.14). The bivariate Logistic model, integrating the post-treatment SUV_R and SUV_CV_FDG, significantly predicted pathological response (p = 0.007), achieving an optimization-corrected AUC of 0.78 (95%CI: 0.62–0.95).

Conclusion

The pre-nCRT tumor voxel intensity and dose response constructed using either FDG or FAPI PET imaging exhibited a strong spatial correlation. In this exploratory analysis, the post-nCRT FAPI-FDG correlation coefficient was associated with pathologic response when combined with SUV_CV_FDG in a Logistic model.