Tumoral fibroblast activation protein expression is associated with proliferation and angiogenesis and can be visualized by PET/CT. We examined the prognostic value of [⁶⁸Ga]Ga-fibroblast activation protein inhibitor (FAPI) (⁶⁸Ga-FAPI)–46 PET/CT for different tumor entities in patients enrolled in 2 prospective imaging studies (NCT05160051, n = 30; NCT04571086, n = 115). Methods: Within 4 wk, 145 patients underwent ⁶⁸Ga-FAPI-46 and [¹⁸F]FDG (¹⁸F-FDG) PET/CT. The association between overall survival (OS) and sex, age, tumor entity, total lesion number, highest SUV_max, and the presence of each nodal, visceral, and bone metastasis was tested using univariate Cox regression analysis. Multivariate analyses were performed for prognostic factors with P values of less than 0.05. Results: In the univariate analysis, shorter OS was associated with total lesion number and the presence of nodal, visceral, and bone metastases on ⁶⁸Ga-FAPI-46 PET/CT (hazard ratio [HR], 1.06, 2.18, 1.69, and 2.05; P < 0.01, < 0.01, = 0.04, and = 0.02, respectively) and ¹⁸F-FDG PET/CT (HR, 1.05, 2.31, 1.76, and 2.30; P < 0.01, < 0.01, = 0.03, and < 0.01, respectively) and with SUV_max on ⁶⁸Ga-FAPI-46 PET/CT (HR, 1.03; P = 0.03). In the multivariate analysis, total lesion number on ⁶⁸Ga-FAPI-46 PET/CT was an independent risk factor for shorter OS (HR, 1.05; P = 0.02). In patients with pancreatic cancer, shorter OS was associated with total lesion number on ⁶⁸Ga-FAPI-46 PET/CT (HR, 1.09; P < 0.01) and bone metastases on ¹⁸F-FDG PET/CT (HR, 31.39; P < 0.01) in the univariate analysis and with total lesion number on ⁶⁸Ga-FAPI-46 PET/CT (HR, 1.07; P = 0.04) in the multivariate analyses. In breast cancer, total lesion number on ⁶⁸Ga-FAPI-46 PET/CT (HR, 1.07; P = 0.02), as well as bone metastases on ¹⁸F-FDG PET/CT (HR, 9.64; P = 0.04), was associated with shorter OS in the univariate analysis. The multivariate analysis did not reveal significant prognostic factors. In thoracic cancer (lung cancer and pleural mesothelioma), the univariate and multivariate analyses did not reveal significant prognostic factors. Conclusion: Disease extent on ⁶⁸Ga-FAPI-46 PET/CT is a predictor of short OS and may aid in future risk stratification by playing a supplemental role alongside ¹⁸F-FDG PET/CT.

肿瘤成纤维细胞激活蛋白表达与增殖和血管生成相关，可以通过 PET/CT 可视化。我们检查了 [ ⁶⁸ Ga]Ga 成纤维细胞激活蛋白抑制剂 (FAPI) ( ⁶⁸ Ga-FAPI)–46 PET/CT 对参加 2 项前瞻性影像学研究的患者中不同肿瘤实体的预后价值 (NCT05160051， n = 30；NCT04571086 ， n = 115）。方法： 4周内，145名患者接受了⁶⁸ Ga-FAPI-46和[ ¹⁸ F]FDG ( ¹⁸ F-FDG) PET/CT。使用单变量 Cox 回归分析测试总生存期 (OS) 与性别、年龄、肿瘤实体、总病变数量、最高 SUV _max以及每个淋巴结、内脏和骨转移的存在之间的关联。对P值小于0.05的预后因素进行多变量分析。结果：在单变量分析中，较短的 OS 与总病灶数量以及⁶⁸ Ga-FAPI-46 PET/CT 上淋巴结、内脏和骨转移的存在相关（风险比 [HR]、1.06、2.18、1.69 和2.05； P < 0.01、< 0.01、= 0.04 和 = 0.02，分别）和¹⁸ F-FDG PET/CT（HR，1.05、2.31、1.76 和 2.30； P < 0.01、< 0.01、= 0.03 和 <分别为 0.01）和⁶⁸ Ga-FAPI-46 PET/CT 上的 SUV_最大值（HR，1.03； P = 0.03）。在多变量分析中， ⁶⁸ Ga-FAPI-46 PET/CT 上的总病灶数是 OS 缩短的独立危险因素（HR，1.05； P = 0.02）。 在胰腺癌患者中，较短的 OS 与⁶⁸ Ga-FAPI-46 PET/CT 上的总病灶数（HR，1.09； P < 0.01）和¹⁸ F-FDG PET/CT 上的骨转移（HR，31.39； P ）相关。 < 0.01）在单变量分析中以及在多变量分析中⁶⁸ Ga-FAPI-46 PET/CT 上的总病灶数（HR，1.07； P = 0.04）。在乳腺癌中， ⁶⁸ Ga-FAPI-46 PET/CT 上的总病灶数（HR，1.07； P = 0.02），以及¹⁸ F-FDG PET/CT 上的骨转移（HR，9.64； P = 0.04），在单变量分析中，与较短的 OS 相关。多变量分析没有揭示显着的预后因素。在胸癌（肺癌和胸膜间皮瘤）中，单变量和多变量分析未揭示显着的预后因素。结论： ⁶⁸ Ga-FAPI-46 PET/CT 的疾病程度是短 OS 的预测因子，并且可能通过与¹⁸ F-FDG PET/CT 一起发挥补充作用来帮助未来的风险分层。