Clinical impact of anatomical resection on long-term outcomes after hepatectomy for primary solitary hepatocellular carcinoma with or without preoperative positron emission tomography positivity

Abstract

Background: There is little evidence indicating that anatomical resection (AR) is associated with improved survival in patients with solitary hepatocellular carcinoma (HCC) who were preoperatively evaluated by positron emission tomography (PET). The aim of our study was to compare the oncologic outcomes of AR in PET-positive versus PET-negative patients with HCC.Methods: From January 2007 to September 2015, 259 patients with preoperative PET underwent hepatectomy as the primary treatment for solitary HCC. Patients were divided into four groups according to PET uptake and hepatectomy type [AR or non-anatomical resection (NAR)]: Group 1 (PET-negative and AR, n=62); Group 2 (PET-negative and NAR, n= 46); Group 3 (PET-positive and AR, n=100); Group 4 (PET-positive and NAR, n=51).Results: PET positivity was associated with higher protein induced by vitamin K antagonist-II (P=0.025), lager tumor size (P=0.05), microvascular invasion (MVI) (P=0.012), and portal vein invasion (P=0.031). In Kaplan-Meier analysis for RFS, Group 1 showed remarkable difference from Group 3 and Group 4 (P=0.045, P=0.023, respectively). In the PET-positive subgroup with HCC under 3 cm, AR was associated with better RFS than NAR (P=0.016).Conclusions: A combination of AR and PET negativity showed good prognosis in long-term outcomes.Finally, AR can decrease the risk of tumor recurrence in patients with a solitary PET-positive HCC less than 3 cm.

Prediction models of hepatocellular carcinoma recurrence after liver transplantation: A comprehensive review

“…While radiologic examination methods for diagnosing HCC mainly use CT or MRI, some studies have shown the usefulness of positron emission tomography (PET)/CT in deciding the treatment plan for HCC. 66,67 This depends on the phenomenon that well-differentiated HCC shows PET-negativity due to similar fluoro-deoxyglucose metabolism as a normal liver, whereas poorly differentiated HCC has a further decrease in glucose-6-phosphatase activity, leading to a high PET-positivity similar to metastasis. One study showed that the 5-year recurrence rate was 19% in the subgroup of patients with AFP <115 ng/mL and PET-negativity even though they were beyond the MC which was very low compared to the observed 53% in the group with high AFP levels or PETpositivity.…”

“…While radiologic examination methods for diagnosing HCC mainly use CT or MRI, some studies have shown the usefulness of positron emission tomography (PET)/CT in deciding the treatment plan for HCC [ 66 , 67 ]. This depends on the phenomenon that well-differentiated HCC shows PET-negativity due to similar fluoro-deoxyglucose metabolism as a normal liver, whereas poorly differentiated HCC has a further decrease in glucose-6-phosphatase activity, leading to a high PET-positivity similar to metastasis.…”