Lung cancer is one of the most common cancers and the leading cause of cancer-related death worldwide. Despite advancements, the overall survival rate for lung cancer remains between 10% and 20% in most countries. However, recent progress in diagnostic tools and therapeutic strategies has led to meaningful improvements in survival outcomes, highlighting the growing importance of personalized management based on accurate disease assessment.18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) has become essential in the management of lung cancer, serving as a key imaging modality for initial diagnosis, staging, treatment response assessment, and follow-up evaluation. Recent developments in radiomics and artificial intelligence (AI), including machine learning and deep learning, have revolutionized the analysis of complex imaging data, enhancing the diagnostic and predictive capabilities of FDG PET/CT in lung cancer. However, the limitations of FDG, including its low specificity for malignancy, have driven the development of novel oncologic radiotracers. One such target is fibroblast activation protein (FAP), a type II transmembrane glycoprotein that is overexpressed in activated cancer-associated fibroblasts within the tumor microenvironment of various epithelial cancers. As a result, FAP-targeted radiopharmaceuticals represent a novel theranostic approach, offering the potential to integrate PET imaging with radioligand therapy (RLT). In this review, we provide a comprehensive overview of FDG PET/CT in lung cancer, along with recent advances in AI. Additionally, we discuss FAP-targeted radiopharmaceuticals for PET imaging and their potential application in RLT for the personalized management of lung cancer.
肺癌是全球范围内最常见的恶性肿瘤之一，也是癌症相关死亡的主要原因。尽管诊疗技术不断进步，但在大多数国家，肺癌的总体生存率仍维持在10%至20%之间。然而，近年来诊断工具与治疗策略的进展已显著改善了患者的生存结局，凸显了基于精准疾病评估的个体化管理日益重要。18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG PET/CT）已成为肺癌诊疗体系的核心组成部分，作为关键影像学手段广泛应用于初诊分期、疗效评估及随访监测。近期放射组学与人工智能（包括机器学习和深度学习）的技术革新，彻底改变了复杂影像数据的分析模式，显著提升了FDG PET/CT在肺癌诊断与预后预测方面的能力。然而，FDG在恶性肿瘤特异性方面的局限性，推动了新型肿瘤靶向放射性示踪剂的研发。其中成纤维细胞活化蛋白（FAP）作为重要靶点备受关注，这种II型跨膜糖蛋白在多种上皮源性肿瘤微环境的活化癌症相关成纤维细胞中过度表达。因此，靶向FAP的放射性药物代表了一种新型诊疗一体化策略，为PET显像与放射性配体治疗的整合提供了可能。本综述系统阐述了FDG PET/CT在肺癌诊疗中的应用价值，并探讨人工智能技术的最新进展。同时，我们深入分析了靶向FAP的PET显像放射性药物及其在放射性配体治疗中的潜在应用，以期为肺癌个体化诊疗提供新思路。
Recent Advances in PET and Radioligand Therapy for Lung Cancer: FDG and FAP
肿瘤(癌症)患者之家