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Prognostic value of 18F-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 Hyup1
  • Eo, Jae Seon2
  • Lee, Jeong Won3
  • Choi, Joon Young1
  • Lee, Kyung-Han1
  • Na, Sae Jung4
  • Hong, Il Ki5
  • Oh, Jin Kyoung6
  • Chung, Yong An6
  • Song, Bong-Il7
  • Kim, Tae-Sung8
  • Kim, Kyung Sik9
  • Moon, Dae Hyuk10
  • Yun, Mijin11
  • 1 Sungkyunkwan University School of Medicine, Department of Nuclear Medicine, Samsung Medical Center, Seoul, Republic of Korea , Seoul (South Korea)
  • 2 Korea University Guro Hospital, Korea University College of Medicine, Department of Nuclear Medicine, Seoul, Republic of Korea , Seoul (South Korea)
  • 3 Catholic Kwandong University College of Medicine, Department of Nuclear Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea , Incheon (South Korea)
  • 4 The Catholic University of Korea, Department of Nuclear Medicine, Uijeongbu St. Mary’s Hospital, Seoul, Republic of Korea , Seoul (South Korea)
  • 5 Kyung Hee University Hospital, School of Medicine, Kyung Hee University, Department of Nuclear Medicine, Seoul, Republic of Korea , Seoul (South Korea)
  • 6 The Catholic University of Korea, Department of Nuclear Medicine, Incheon St. Mary’s Hospital, College of Medicine, Incheon, Republic of Korea , Incheon (South Korea)
  • 7 Keimyung University School of Medicine, Department of Nuclear Medicine, Dongsan Medical Center, Daegu, Republic of Korea , Daegu (South Korea)
  • 8 Research Institute and Hospital, National Cancer Center, Department of Nuclear Medicine, Goyang, Republic of Korea , Goyang (South Korea)
  • 9 Yonsei University College of Medicine, Department of Surgery, Seoul, Republic of Korea , Seoul (South Korea)
  • 10 University of Ulsan College of Medicine, Department of Nuclear Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea , Seoul (South Korea)
  • 11 Yonsei University College of Medicine, Department of Nuclear Medicine, Severance Hospital, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea , Seoul (South Korea)
Type
Published Article
Journal
European Journal of Nuclear Medicine
Publisher
Springer-Verlag
Publication Date
Mar 02, 2016
Volume
43
Issue
9
Pages
1638–1645
Identifiers
DOI: 10.1007/s00259-016-3348-y
Source
Springer Nature
Keywords
License
Yellow

Abstract

PurposeWe evaluated the prognostic value of pretreatment 18F-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).MethodsBetween 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.ResultsOver 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).ConclusionsPretreatment 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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