Clinical utility and limitations of FDG PET in detecting recurrent hepatocellular carcinoma in postoperative patients

Hayakawa, Nobuyuki; Nakamoto, Yuji; Nakatani, Kazuhiko; Hatano, Etsuro; Seo, Satoru; Higashi, Tatsuya; Saga, Tsuneo; Üemoto, Shinji; Togashi, Kaori

doi:10.1007/s10147-013-0653-3

Cited by 21 publications

(17 citation statements)

References 26 publications

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“…In other words, HK Ⅱ play a key role for prevention of chemotherapyinduced, mitochondria-mediated, tumor cell apoptosis. In addition, this glycolysis pathway can be further accentuated under the hypoxic conditions in many tumors: the hypoxic condition can upregulate glucose transporters and induce multiple enzymes of the glycolytic pathway [10,14,15] . For example, both Ras oncoprotein and hypoxia can independently increase HIF1a and HIF2a transcription factor levels which upregulate glycolysis [14,16,17] .…”

Section: Warburg Effect: Current Clinical Implications In Cancermentioning

confidence: 99%

Metabolic interplay between glycolysis and mitochondrial oxidation: The reverse Warburg effect and its therapeutic implication

Lee¹

2015

WJBC

124

115

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Aerobic glycolysis, i.e. , the Warburg effect, may contribute to the aggressive phenotype of hepatocellular carcinoma. However, increasing evidence highlights the limitations of the Warburg effect, such as high mitochondrial respiration and low glycolysis rates in cancer cells. To explain such contradictory phenomena with regard to the Warburg effect, a metabolic interplay between glycolytic and oxidative cells was proposed, i.e. , the "reverse Warburg effect". Aerobic glycolysis may also occur in the stromal compartment that surrounds the tumor; thus, the stromal cells feed the cancer cells with lactate and this interaction prevents the creation of an acidic condition in the tumor microenvironment. This concept provides great heterogeneity in tumors, which makes the disease difficult to cure using a single agent. Understanding metabolic flexibility by lactate shuttles offers new perspectives to develop treatments that target the hypoxic tumor microenvironment and overcome the limitations of glycolytic inhibitors.

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Section: Warburg Effect: Current Clinical Implications In Cancermentioning

confidence: 99%

Metabolic interplay between glycolysis and mitochondrial oxidation: The reverse Warburg effect and its therapeutic implication

Lee¹

2015

WJBC

124

115

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“…Trojan et al found high FDG uptake in patients with moderately or poorly differentiated HCC, with tumors >5 cm, or with elevated alfa-fetoprotein levels [19]. Hayakawa et al found that less well differentiated HCC express more hexokinase, resulting in higher FDG uptake [20]. In our study, many patients already had large tumors before initiation of treatment (the median tumor size at the time of pretreatment FDG PET/CT was 8.2 cm).…”

Section: Discussionmentioning

confidence: 48%

Refining prognosis in patients with hepatocellular carcinoma through incorporation of metabolic imaging biomarkers

Takeuchi

Rohren

Abdel-Wahab

et al. 2016

Eur J Nucl Med Mol Imaging

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Purpose 18F-fluorodeoxyglucose positron emission tomopraphy/computed tomography (FDGPET/CT) has been proven to be useful for imaging many types of cancer; however, its role is not well defined in hepatocellular carcinoma (HCC). We assessed the prognostic value of metabolic imaging biomarkers as established by baseline pretreatment FDG PET/CT in patients with HCC. Methods We retrospectively analyzed the records of patients with HCC who underwent FDG PET/CT before initial treatment from May 2013 through May 2014. Four PET/CT parameters were measured: maximum standardized uptake value (SUVmax), total lesion glycolysis (TLG), metabolic tumor volume (MTV), and tumor-to-normal-liver SUV ratio (TNR). Optimal cut-off values for the PET/CT parameters to stratify patients in terms of overall survival (OS) were determined. Multivariate analysis was performed to determine whether the PET/CT parameters could add to the prognostic value of the Cancer of the Liver Italian Program (CLIP) scoring system and the Barcelona-Clinic Liver Cancer (BCLC) staging system. Results The analysis included 56 patients. Univariate analysis of the association between OS and continuous variables, including the PET/CT parameters SUVmax, TLG, tumor size, total bilirubin level, and alkaline phosphatase level were significant predictors of OS. SUVmax ≥ 11.7, TLG ≥ 1,341, MTV ≥ 230 mL, and TNR ≥ 4.8 were identified as cut-off values. Multivariate analysis revealed that SUVmax ≥ 11.7 and TNR ≥ 4.8 were independent factors predicting a poor prognosis in both the CLIP scoring system and the BCLC staging system, as was TLG in the BCLC staging system. Conclusion Pretreatment FDG PET/CT in patients with HCC can add to the prognostic value of standard clinical measures. Incorporation of imaging biomarkers derived from FDG PET/CT into HCC staging systems should be considered.

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“…In the end, 7 publications consisting of 8 data sets analyzed the performance of 18 F-FDG PET combined with CT, [ 15 , 27 – 32 ] while 5 publications consisting of 6 data sets analyzed the performance of 18 F-FDG PET [ 14 , 27 , 33 – 35 ] (Supporting Table S2). The number of patients per study ranged from 11 to 121 patients, with all studies evaluating a total of 572 patients.…”

Section: Resultsmentioning

confidence: 99%

18F-FDG PET with or without CT in the diagnosis of extrahepatic metastases or local residual/recurrent hepatocellular carcinoma

Jiang¹,

Li²,

Zhong³

et al. 2018

Medicine

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Clinical utility and limitations of FDG PET in detecting recurrent hepatocellular carcinoma in postoperative patients

Abstract: The sensitivity of FDG PET for recurrent HCC was low, with little change in treatment resulting. However, it can predict prognosis in postoperative patients.

Cited by 21 publications

References 26 publications

Metabolic interplay between glycolysis and mitochondrial oxidation: The reverse Warburg effect and its therapeutic implication

Metabolic interplay between glycolysis and mitochondrial oxidation: The reverse Warburg effect and its therapeutic implication

Refining prognosis in patients with hepatocellular carcinoma through incorporation of metabolic imaging biomarkers

18F-FDG PET with or without CT in the diagnosis of extrahepatic metastases or local residual/recurrent hepatocellular carcinoma

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