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Prognostic value of F-18-fluorodeoxyglucose positron emission tomography/computed tomography in patients with Barcelona Clinic Liver Cancer stages 0 and A hepatocellular carcinomas: a multicenter retrospective cohort study

Authors
Hyun, Seung HyupEo, Jae SeonLee, Jeong WonChoi, Joon YoungLee, Kyung-HanNa, Sae JungHong, Il KiOh, Jin KyoungChung, Yong AnSong, Bong-IlKim, Tae-SungKim, Kyung SikMoon, Dae HyukYun, Mijin
Issue Date
8월-2016
Publisher
SPRINGER
Keywords
FDG PET/CT; Hepatocellular carcinoma; Standardized uptake value; Prognosis; Multicenter trial
Citation
EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING, v.43, no.9, pp.1638 - 1645
Indexed
SCIE
SCOPUS
Journal Title
EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING
Volume
43
Number
9
Start Page
1638
End Page
1645
URI
https://scholar.korea.ac.kr/handle/2021.sw.korea/88028
DOI
10.1007/s00259-016-3348-y
ISSN
1619-7070
Abstract
Purpose We evaluated the prognostic value of pretreatment F-18-fluorodeoxyglucose positron emission tomography with computed tomography (FDG PET/CT) in patients with Barcelona Clinic Liver Cancer (BCLC) stage 0 or A hepatocellular carcinoma (HCC) who had received curative treatment or transarterial chemoembolization (TACE). Methods Between 2009 and 2010, 317 patients diagnosed with HCC at seven hospitals were enrolled. Among these, 195 patients underwent curative treatments including resection, liver transplantation, and radiofrequency ablation. TACE was performed in 122 patients. The tumor-to-normal liver standardized uptake value ratio (TLR) of the primary tumor was measured using pretreatment FDG PET/CT. The prognostic significance of TLR and other clinical variables was assessed using Cox regression models. Differences in the overall survival (OS) associated with TLR or other significant clinical factors were examined using the Kaplan-Meier method. Results Over a median follow-up period of 46 months, 77 patients died from cancer. In the curative cohort, higher TLR (>= 2) was significantly associated with death (hazard ratio [HR]=2.68; 95 % CI, 1.16-6.15; P=0.020) in multivariable analysis. Patients with a higher TLR had significantly worse OS than patients with a lower TLR (5-year overall survival, 61 % vs. 79.4 %; P=0.006). In the TACE cohort, the Model for End-Stage Liver Disease (MELD) score (>= 8) was a significant independent prognostic factor for OS (HR=3.34; 95 % CI, 1.49-7.48; P=0.003), whereas TLR was not associated with OS. The Kaplan-Meier curves showed significantly poorer OS in patients with higher MELD scores (>= 8) than in those with lower MELD scores (5-year survival rate, 33.1 % vs. 79.6 %; P<0.001). Conclusions Pretreatment TLR measured using FDG PET/CT was an independent prognostic factor for OS in patients with BCLC stage 0 or A HCC undergoing curative treatment. In contrast, underlying liver function appeared to be important in predicting the prognosis of patients undergoing TACE.
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