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. 2025 May 19.
doi: 10.1007/s00259-025-07325-9. Online ahead of print.

First clinical investigation to predict lymphovascular and/or perineural invasion in gastric cancer using 18F-FAPI-42 PET/CT parameters

Lilan Fu #  1   2   3 , Fei Xie #  1   2 , Penghui Sun  1   2 , Ye Dong  1   2 , Kemin Zhou  1   2 , Li Jiang  1   2 , Ruihe Wu  1   2 , Yanjiang Han  1   2 , Hubing Wu  4   5 , Ganghua Tang  6   7 , Wenlan Zhou  8   9
Affiliations

First clinical investigation to predict lymphovascular and/or perineural invasion in gastric cancer using 18F-FAPI-42 PET/CT parameters

Lilan Fu et al. Eur J Nucl Med Mol Imaging. .

Abstract

Objective: This study was conducted to explore the predictive value of PET parameters derived from 18F-FAPI-42 PET/CT in assessing lymphovascular and/or perineural invasion (LVI/PNI) in gastric cancer (GC) patients.

Methods: 72 GC patients who underwent 18F-FAPI-42 PET/CT prior to surgical resection were included. Clinicopathological factors and PET parameters were collected and analyzed in LVI/PNI-negative and LVI/PNI-positive groups. The predictive value of PET parameters for LVI/PNI status was evaluated using the receiver operating characteristic (ROC) curve. A nomogram was developed using significant predictors from multivariate stepwise regression analysis and its performance was assessed by decision curve analysis (DCA).

Results: Univariate analysis indicated a significant association between LVI/PNI status and PET parameters (SUVmax, SUVmean, and TBR) (all p < 0.001). The area under the ROC curve (AUC) values for predicting LVI/PNI were 0.932 [95% CI (0.877-0.987)] for SUVmax, 0.923 [95% CI (0.861-0.984)] for SUVmean, and 0.925 [95% CI (0.865-0.985)] for TBR. The optimal cutoff values for prediction, along with their corresponding sensitivity and specificity, were 3.86 (93.3% and 81.5%) for SUVmax, 2.04 (93.3% and 81.5%) for SUVmean, and 9.75 (91.1% and 81.5%) for TBR. Multivariate analysis identified histological grade and SUVmax as independent risk factors for LVI/PNI prediction. Our nomogram had good discriminatory ability (AUC = 0.934) and offered net benefits in predicting LVI/PNI status by DCA.

Conclusion: This study demonstrates that FAPI uptake parameters exhibit an exceptionally high capacity and serve as a noninvasive preoperative tool for predicting LVI/PNI status in GC, with SUVmax emerging as the most suitable predictive indicator.

Keywords: Fibroblast activating protein inhibitor; Gastric cancer; Lymphovascular invasion; Perineural invasion; Positron emission tomography.

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Conflict of interest statement

Declarations. Ethical approval: All procedures in this study were performed in accordance with the ethics standards of the Helsinki Declaration. The study was approved by the Chinese Ethics Committee of Registering Clinical Trials (ChiECRCT20210617). Consent to participate: Informed consent was obtained from all participants included in this study. Consent for publication: All the authors approved the publication of this article. Competing interests: All authors declare that they have no commercial or financial interest.

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