Incremental Value of Pretreatment 18F-FAPI PET/CT and MRI for Predicting Early Treatment Response and Long-Term Prognosis in Nasopharyngeal Carcinoma Undergoing Chemoradiotherapy
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Objectives Effective noninvasive tools for predicting treatment response and prognosis in nasopharyngeal carcinoma (NPC) remain lacking. This study aimed to investigate the predictive value of integrating pretreatment 18 F-fibroblast activation protein inhibitor positron emission tomography/computed tomography ( 18 F-FAPI PET/CT) and magnetic resonance imaging (MRI) for short-term complete response (CR) and progression-free survival (PFS) in patients with NPC undergoing chemoradiotherapy. Materials and Methods This retrospective study analyzed pretreatment 18 F-FAPI PET/CT and contrast-enhanced MRI (CE-MRI) parameters in 46 patients with NPC who underwent chemoradiotherapy. Logistic regression identified predictors of CR and developed predictive models, which were evaluated using receiver operating characteristic (ROC) curves, DeLong test, bootstrap internal validation, and decision curve analysis (DCA). Cox regression identified independent predictors of PFS, while Kaplan–Meier analysis and log-rank test evaluated survival outcomes. Results Nineteen patients (41.3%) achieved CR, whereas 27 (58.7%) did not. Total lesion fibroblast activation protein expression (TLF), signal intensity ratio (SIR), and radiologic extranodal extension (rENE) independently predicted CR. A multimodal model incorporating these variables achieved an area under the curve (AUC) of 0.88, outperforming PET/CT-only (AUC = 0.76) and MRI-only (AUC = 0.79) models numerically. A maximum standardized uptake value of the primary lesion (SUVmax-T) ≥ 17.0 and the presence of rENE independently predicted shorter PFS. The Sankey diagram illustrated that high-risk parameter combinations were associated with non-CR and shorter PFS, while short-term CR was strongly concordant with longer PFS. Conclusion Pretreatment 18 F-FAPI PET/CT and MRI provide complementary information that may improve short-term response assessment and prognostic stratification in NPC.
Source: Research Square
Language: English
Topic: Head and Neck Cancer Studies
Subfield: Otorhinolaryngology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7225337313