¹⁸F-FDG PET/CT Can Predict Survival of Advanced Hepatocellular Carcinoma Patients: A Multicenter Retrospective Cohort Study

Abstract

Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC) consists of a heterogeneous group of patients with a wide range of survival times, requiring further prognostic stratification to facilitate treatment allocation. We evaluated the prognostic value of F-FDG uptake on PET/CT at the time of presentation in patients with BCLC stage C HCC. A total of 291 patients with BCLC stage C HCC who underwent F-FDG PET/CT between 2009 and 2010 for staging were retrospectively enrolled from 7 university hospitals. The patients were further divided into 2 groups according to the extent of disease, as intrahepatic or extrahepatic. Tumor-to-liver SUV ratio (TLR) of the primary tumor was measured onF-FDG PET/CT. Prognostic values of TLR and other clinical variables were analyzed to predict overall survival (OS) in univariate and multivariate analyses. Differences in the OS stratified by TLR were examined by the Kaplan-Meier method. Higher TLR was associated with extrahepatic disease ( = 0.018). On multivariate analysis, Child-Pugh classification and TLR were independent prognostic factors in the intrahepatic disease group (all < 0.05), whereas TLR was the only independent prognostic factor in the extrahepatic disease group ( < 0.05). Patients with high TLR showed a significantly worse OS than those with low TLR ( < 0.05) in both groups. In patients with BCLC stage C HCC,F-FDG uptake in the primary tumor was significantly higher in patients with extrahepatic disease than in those with intrahepatic disease. In addition, F-FDG uptake on pretreatment PET/CT had an incremental prognostic value for OS in both intrahepatic and extrahepatic disease groups.

The critical role of glucose deprivation in epithelial-mesenchymal transition in hepatocellular carcinoma under hypoxia

“…However, in line with the in vitro/in vivo data, HCCs with low Ki67 in spite of increased GLUT1 expression were correlated with increased EMT-related proteins, such as N-cadherin. These results might have an important implication in the use of 18F-FDG-PET/CT as a useful diagnostic tool for evaluating metastasis 49,53,54 . A previous study by our group found that increased 18F-FDG uptake in patients with HCC was associated with an increased frequency of metastasis 33 .…”

Addition of [18F]Fluorodeoxyglucose Positron Emission Tomography With Computed Tomography to Cross‐Sectional Imaging Improves Staging and Alters Management in Hepatocellular Carcinoma

“…We believe the best role of [ 18 F]FDG PET‐CT in HCC is as a prognostic biomarker, where grade 3 uptake suggests a higher likelihood of progression and poorer overall survival. ( 22 ) High‐grade [ 18 F]FDG avidity may not only signal a change in metabolome but could also identify a more aggressive and invasive phenotype with a higher risk of microvascular invasion and metastatic disease. ( 8,9 ) For example, Kwee et al correlated high tumor [ 18 F]‐fluorocholine uptake with specific gene signatures and increased mortality.…”

Butein Inhibited In Vitro Hexokinase-2-Mediated Tumor Glycolysis in Hepatocellular Carcinoma by Blocking Epidermal Growth Factor Receptor (EGFR)

“…Therefore, the 18F-FDG PET/CT technology, which can examine the status of glucose metabolism in tumor cells, is widely used for cancer diagnosis in clinical applications. Na et al reported that 18F-FDG uptake had an incremental prognostic value for overall survival in advanced HCC patients [ 33 ]. After butein treatment, owing to the decrease in HK-2, the glucose consumption and lactate production in HCC cells were significantly decreased ( Figure 2 ), resulting in the inhibition of HCC cell proliferation and anchorage-independent growth ( Figure 1 ).…”