ArticleEuropean journal of nuclear medicine and molecular imaging2026
The predictive value of
Article in European journal of nuclear medicine and molecular imaging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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- The value ofEuropean journal of nuclear medicine and molecular imaging · 2026Article
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Abstract
purposeFibroblast activation protein (FAP) may contribute to radiotherapy resistance. This study aimed to compare baseline 18F-labeled fibroblast activation protein inhibitor (18F-FAPI) PET/CT and 18F-FDG PET/CT in short-term target lesion response (TLR) and clinical outcome prediction in unresectable hepatocellular carcinoma (uHCC) patients treated with Yttrium-90(90Y) resin microsphere selective internal radiation therapy (SIRT).
methodsPatients with uHCC undergoing pre-SIRT 18F-FDG and 18F-FAPI PET/CT were prospectively recruited. Semiquantitative parameters, including target/whole-body metabolic tumor volume (MTV-target/MTV-WB) and total lesion glycolysis (TLG-target/TLG-WB), were obtained from 18F-FDG PET/CT, while target/whole-body FAPI-avid tumor volume (FTV-target/FTV-WB) and total lesion FAP expression (TLF-target/TLF-WB) were derived from 18F-FAPI PET/CT. Voxel-based tumor absorbed dose(TAD) parameters for target lesions were calculated from post-SIRT PET/CT, including the mean TAD (Dmean) and TAD to 50%, 75%, and 90% of the tumor volume (D50, D75, D90). Short-term (3-month) target lesion response was assessed by mRECIST 1.1 criteria. Primary endpoints were short-term TLR and progression-free survival (PFS). The secondary endpoint was overall survival (OS).
resultsForty-three uHCC patients (mean age 51.0 ± 10.2 years, 88.4% male) were included. The short-term TLR rate was 60.5% (26/43), with a control rate of 88.4%. The TLR group showed significantly lower MTV-target, TLG-target, FTV-target, and TLF-target than the non-target lesion response group (NTLR), with similar trends for Dmean/D50/D75. Higher pre-SIRT FTV-target (> 303.5 cm³) and TLF-target (> 1129.1) were independent predictors of short-term response [odds ratio = 6.33, 95% confidence interval (CI): 1.43–28.00, P = 0.015]. Median PFS was 6.6(95%CI:4.4–10.5) months, and median OS was 13.1(95%CI:10.5-not reached) months. Higher FTV-WB(> 333.9cm3)/TLF-WB (> 1256.1) predicted worse PFS, though not independently. Post-SIRT monotherapy [hazard ratio (HR) = 3.27, 95%CI:1.18–9.06, P = 0.023), higher alpha-fetoprotein (> 343.1ng/mL) (HR = 3.25, 95%CI:1.84–8.90, P = 0.022), and lower Dmean (≤ 151 Gy)/D50(≤ 142 Gy) (HR = 2.64, 95%CI:1.07–6.55, P = 0.036) were independent prognostic factors for PFS.
conclusionPre-SIRT FAPI-avid volumetric parameters demonstrated potential value for predicting short-term TLR in uHCC patients receiving SIRT, in addition to TAD. 18F-FAPI PET/CT may facilitate uHCC patient selection before SIRT.
trial registrationChinese Clinical Trial Registry (ChiCTR2500107817), registered on 19 August 2025, retrospectively registered.
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