Preoperative FDG-PET Predicts Recurrence Patterns in Hepatocellular Carcinoma

Abstract

Preoperative FDG-PET predicts hepatocellular carcinoma recurrences within the MC or no recurrence and recurrences after 1 year or later. FDG-PET may be useful for selecting appropriate patients for liver resection as an initial surgical strategy.

The Impact of Tumor Size on Long-Term Survival Outcomes After Resection of Solitary Hepatocellular Carcinoma: Single-Institution Experience with 2558 Patients

“…FDG accumulates similarly in highly differentiated HCC and normal liver, with the signal strength of FDG being relatively weak, making FDG uptake a predictor of the grade of HCC differentiation. 29,30 By contrast, considering its relatively lower statistical impact, FDG-PET finding might not have been an independent risk factor if the study population had been smaller.…”

Predictability of preoperative 18F-FDG PET for histopathological differentiation and early recurrence of primary malignant intrahepatic tumors

“…Differentiation between the tumor and physiological noise in the liver is sometimes difficult in 18 F-FDG PET because normal liver tissue exhibits heterogeneity in 18 F-FDG uptake, and physiological noise in the liver is apparent [23]. Background nontumor liver uptake varies to some extent, and the contrast between the liver tumor and background liver noise may depend on the extent of tumor uptake itself as well as on the general liver background [23].…”

“…Background nontumor liver uptake varies to some extent, and the contrast between the liver tumor and background liver noise may depend on the extent of tumor uptake itself as well as on the general liver background [23]. Thus, TNR showed similar or better prognostic value than SUV in PET diagnosis of HCC [18,19,36].…”

“…Hence, the 18 F-FDG uptake on the PET scan, similar to size and number criteria, might be an important prognostic factor in the establishment of a treatment and surveillance protocol [17]. However, which PET scan values should be used for the prognostic outcome or histological degree in HCC or CC remains debatable [8,22,23]. In addition, the PET scan result should be interpreted separately for malignant liver tumors [22,24,25].…”

Use of choline PET for studying hepatocellular carcinoma

“…Overall survival and disease-free survival at 2 years after resection have been found to be lower in patients whose HCC nodules strongly accumulated FDG on preoperative PET (T/NTR B 2) [37,38]. The predictive value of high FDG uptake on recurrence after resection has been confirmed by subsequent studies [39,40]. The unfavourable prognostic value of HCC tumour visualisation on FDG PET in patients who are candidates for or scheduled for liver transplantation has also been reported by several teams [41][42][43][44], whereas patients with non-FDG-avid HCC even at more advanced stage (beyond the Milan criteria) achieved excellent 5-year recurrence-free survival after liver transplantation [44].…”