Prediction of Tumor Recurrence by 18 F-FDG PET in Liver Transplantation for Hepatocellular Carcinoma

Kang

et al. 2011

Cancer

BACKGROUND: Metabolic activity assessed by 18 F-fluorodeoxyglocuse-positron emission tomography ( 18 F-FDG-PET) reflects biological aggressiveness and prognoses in various tumors. The authors present a correlation between tumor metabolic activity and clinical outcomes in patients with hepatocellular carcinoma (HCC). METHODS: Over a 3-year period (2005)(2006)(2007)(2008), 135 locally advanced HCC patients were treated with localized concurrent chemoradiotherapy (CCRT; external beam radiotherapy at 45 grays for 5 weeks plus concurrent hepatic arterial infusion of 5-fluorouracil during the first and fifth week) followed by repetitive hepatic arterial infusional chemotherapy with 5-fluorouracil and cisplatin. Among them, the authors studied 107 who received 18 F-FDG-PET before CCRT. Maximal standardized uptake values (SUVs) of tumors were calculated. RESULTS: The median maximal tumor SUV was 6.1 (range, 2.4-$19.2). Patients with low maximal tumor SUVs (<6.1) had a higher disease control rate than those with high maximal tumor SUVs (!6.1) (86.8% vs 68.5%, respectively, P ¼ .023). Both median progression-free survival (PFS; 8.4 vs 5.2 months; P ¼ .003) and overall survival (OS; 17.9 vs 11.3 months; P ¼ .013) were significantly longer in the low maximal tumor SUV group than in the high maximal tumor SUV group, respectively. In multivariate analysis, low maximal tumor SUV and objective responses to CCRT remained significant for PFS and OS. The high maximal tumor SUV group was more likely to have extrahepatic metastasis within 6 months than the low maximal tumor SUV group (58.1% vs 26.8%, respectively; P < .001). Similar results were obtained for the maximal tumor SUV/normal liver maximal SUV ratio (<2 vs !2) concerning progression, death, and extrahepatic metastasis. CONCLUSIONS: Metabolic activity may be useful not only in predicting prognosis and treatment responses, but also in establishing optimal treatment plans in locally advanced HCC. Cancer 2011;117:4779-

“…Thereafter, another metabolic parameter suggested by the previous investigator, 15 maximal tumor SUV/normal liver maximal SUV ratio was calculated.…”

Section: Pet Interpretationmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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¹⁸F‐fluorodeoxyglucose uptake on positron emission tomography as a prognostic predictor in locally advanced hepatocellular carcinoma

Kang

et al. 2011

Cancer

Experimental and Therapeutic Medicine

“…On the other hand, yoon et al (15) and Sugiyama et al (16) reported that PET is useful for the screening of extrahepatic metastasis from HCC. Recently, the usefulness of FDG-PET for predicting HCC recurrence following liver transplantation was proposed (17,18). However, few reports have described FDG-PET as useful for predicting prognosis after resection (1,2).…”

Section: Discussionmentioning

confidence: 99%

FDG positron emission tomography/computed tomography findings for the prediction of early recurrence of hepatocellular carcinoma after surgical resection

Hiraoka

Ochi

Hidaka

et al. 2010

Abstract.We investigated the predictive value of fluorine-18-fluorodenoxyglucose positron emission tomography/computed tomography for pathological malignant potential and early recurrence of hepatocellular carcinoma (HCC) after resection. From April 2006 to October 2009, 53 patients with naïve HCC were enrolled. Accumulations of 2-[18F]-fluoro-2-deoxy-Dglucose (FDG) standardized uptake value (SUVmax) in both HCC and non-HCC areas of the liver as well as the ratio of SUVmax (R-SUV; HCC/liver) were calculated. The results were evaluated to determine prognostic factors for early recurrence. One patient was graded as tumor node metastasis stage I, 35 as II, 14 as III and 3 as stage IV. Elevated protein induced by vitamin K absence or antagonist II (≥200 mAU/ml) as well as elevated fucosylated α-fetoprotein (≥15%), tumor size (≥5 cm) and high R-SUV (≥1.5) were risk factors for early recurrence in a univariate analysis (P<0.05). In a multivariate analysis, high R-SUV (≥1.5) was the only risk factor (P<0.05). The recurrence-free rate in patients with low R-SUV (<1.5, n=34) was higher than that in those with high R-SUV (≥1.5, n=19) (1-and 2-year rates: 100 and 67%, 67 and 17%; respectively, P<0.01). Patients with Edmondson III showed higher R-SUV values than those with Edmondson I and II (3.0±1.8, 1.4±0.3 and 1.9±0.9, respectively, P<0.01), while those with microvascular invasion (vp)(+), micro-intrahepatic metastasis (im) (+) or non-boundary type showed higher R-SUV values than vp(-), im(-) and boundary type (3.6±2.4 vs. 2.0±0.9, 3.5±2.3 vs. 1.9±0.8 and 2.9±1.8 vs. 1.6±0.5, respectively, P<0.01).R-SUV is proposed to be a useful marker for the prediction of early recurrence of HCC after resection.

“…Emerging evidence seems to suggest that 18 FDG-avid HCC may harbor poor prognostic features such as high grade and microvascular invasion that may herald poorer recurrence-free survival after LT. Some workers have even proposed the use of 18 FDG-PET to refine morphologic criteria before LT [44,45]. Dual-tracer PET ( 18 FDG + 11 C-acetate) may fare better due to superior avidity of well-differentiated HCC for acetate; however, its application is limited by high costs, excessive radiation exposure, and availability [46,47].…”

Section: Diagnosis and Staging Of Hcc Before Ltmentioning

confidence: 99%

Liver Transplantation for HCC: A Review

Kakodkar¹,

Soin²

2011

Indian J Surg

Hepatocellular carcinoma (HCC) often occurs in patients with chronic liver disease or cirrhosis. Liver transplantation for hepatocellular carcinoma has the potential to eliminate both the tumor as well as the underlying cirrhosis and is the ideal treatment for HCC in cirrhotic liver as well as massive HCC in noncirrhotic liver. Limitations in organ availability, necessitate stringent selection of patients who would likely to derive most benefit. Selection criteria have considered tumor size, number, volume as well as biological features. The Milan criteria set the benchmark for tumors that would benefit from liver transplantation but were found to be excessively restrictive. Modest expansion in criteria has also been shown to be associated with equivalent survival. Microvascular invasion is the single most important adverse prognostic factor for survival. Living donor liver transplantation has expanded donor options and has the advantage of lower waiting period and not impacting the non-HCC waiting list. Acceptable outcomes have been obtained with living donor liver transplantation for larger and more numerous tumors in the absence of microvascular invasion. Downstaging of tumors to prevent progression while waiting for an organ or for reduction in size to allow enrolment for transplantation has met with variable success.