Significance of preoperative fluorodeoxyglucose-positron emission tomography in prediction of tumor recurrence after liver transplantation for hepatocellular carcinoma patients: a Japanese multicenter study

Abstract

Background In the present study, we conducted a multicenter nationwide survey to investigate the effects of preoperative fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) on the prediction of hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT). Methods From 16 Japanese LT centers, data were collected on 182 recipients with HCC who underwent living donor liver transplantation (LDLT) between February 2005 and November 2013. PET-positive status was defined as increased uptake of FDG in the tumor compared to the surrounding non-tumor liver tissue. The median follow-up after LDLT was 54.5 months (range 1-125 months). Results Postoperative HCC recurrence occurred in 23 patients. Multivariate analysis revealed that exceeding the Milan criteria (MC), alpha-fetoprotein (AFP) level ≥115 ng/ml, and PET-positive status were significant and independent risk factors for recurrence. In the over-MC group, a subgroup of patients with AFP level <115 ng/ml and PET-negative status (n = 22) had a significantly lower 5-year recurrence rate than the other patients (n = 27, 19% vs. 53%, P = 0.019). Conclusions These results suggest that preoperative FDG-PET status offers additional information on HCC recurrence risk after LT. Over-MC patients with PET-negative status and lower AFP level may achieve successful outcome comparable to that of within-MC patients.

Expanded living‐donor liver transplantation criteria for patients with hepatocellular carcinoma based on the Japanese nationwide survey: the 5‐5‐500 rule ‐ a retrospective study

“…The importance of biomarkers, other than the morphologic characteristics of tumors, has recently increased. Not only tumor makers such as AFP and DCP, but the neutrophil‐to‐lymphocyte ratio , fluorine‐18‐fluorodeoxyglucose positron emission tomography , and tumor progression during the waiting period are reportedly able to predict recurrence, and the model to predict tumor recurrence calculated by the combination of these markers seem promising in predicting HCC recurrence after liver transplantation. Despite the promise, however, these biomarkers (besides tumor size and number) have not yet reached the conventional practical decision‐making criteria, nor has there been a consensus regarding which biomarker should be incorporated into the conventional selection criteria based on the tumor morphologic features.…”

18F-FDG-PET for Assessing Biological Viability and Prognosis in Liver Transplant Patients with Hepatocellular Carcinoma

“…The prognostic value of combining 18 F-FDG-PET with AFP was just recently confirmed by a Japanese multicenter study including 182 HCC patients. 80 Apart from Milan Out status, which was the strongest prognostic factor ( p < 0.001), only AFP level ≥115 ng/ml (relative risk = 3.077; 95%CI 1.748–7.023; p = 0.008) and PET-positivity (RR = 2.554; 95%CI 1.101–5.924; p = 0.029) were identified as independent promoters of HCC relapse. The following risk groups were defined: group A: meeting the MC (n = 133); group B: beyond MC + AFP level <115 ng/ml + PET− status (n = 22); group C: beyond MC + AFP level ≥115 ng/ml and/or PET+ status (n = 27).…”

Role of pre-transplant 18F-FDG PET/CT in predicting hepatocellular carcinoma recurrence after liver transplantation

“…A Japanese multicenter study including 182 LDLT recipients from 16 Japanese LT centers investigated the significance of pre-transplant 18F-FDG-PET/CT at a much larger scale. While patients beyond MC had a significantly higher recurrence rate at 5 years compared with those within MC (38% vs 7%, P < 0.001), a subgroup of “beyond MC” patients with negative PET/CT and low AFP (< 115 ng/mL) showed similar recurrence rate with “within MC” patients (19%, P = 0.1)[ 61 ]. Similar data were recently published by the Taiwan group who combined pre-transplant PET/CT results with UCSF criteria for predicting the risk of post-transplant HCC recurrence.…”