The impact of FAPI PET on staging and management in patients with digestive system tumors: a systematic review and meta-analysis.

Background: Recent studies have reported the excellent diagnostic performance of fibroblast-activated protein inhibitor (FAPI) positron emission tomography (PET) in patients with digestive system tumors. We performed a systematic review and meta-analysis to investigate the impact of FAPI PET on staging and management changes in those patients and to further elucidate the important role of FAPI PET in clinical practice. Methods: A thorough literature search was performed in PubMed, EMBASE, MEDLINE, and Scopus databases until May 31, 2024, for eligible studies regarding the impact of FAPI PET on staging and management in patients with digestive system tumors. Quality assessment was performed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and QUADAS-comparative (QUADAS-C). The proportions of changes were pooled using a random- or fixed-effect model according to the heterogeneity. Sub-group analyses were utilized to explore heterogeneity. Results: We included 13 studies in the systematic review and 11 studies encompassing 492 patients for meta-analysis. The pooled proportions of staging and management changes were 26% [95% confidence interval (95% CI): 21-32%; I2=36%] and 21% (95% CI: 12-31%; I2=82%), respectively. For initial staging, the pooled proportion of staging change was 40% (95% CI: 8-76%; I2=93%) in patients staged as 0-III. The pooled proportion of staging change was 30% (95% CI: 22-31%; I2=0%) in restaging group. Relative proportions of major and minor management change were 34.9% (45/129) and 41.9% (54/129), respectively. Conclusions: FAPI PET can significantly alter the staging and management plan in patients with digestive system tumors. Further prospective studies are warranted to evaluate the impact of FAPI PET on staging and management changes for certain types of cancer.