Identifying Patients Who May Benefit from Liver Resection Compared to Living Donor Liver Transplantation for Hepatocellular Carcinoma Using ¹⁸F‐FDG PET

Abstract

Background This study aimed to assess an oncologic setting where patients with hepatocellular carcinoma (HCC) could benefit from liver resection (LR) compared to living donor liver transplantation (LDLT) using 18 F-fluorodeoxyglucose (FDG) positron emission tomography. Methods The consecutive data of patients with HCC who underwent 18 F-FDG PET before LR (LR group, n = 314) and LDLT (LDLT group, n = 65) between 2003 and 2015 were retrospectively analyzed. Tumor 18 F-FDG avidity was quantified as the tumor to liver standardized uptake value ratio (TLR, cut-off value was defined at 2). Multivariate analysis was performed to assess significant preoperative tumor factors in the LR group. Survival outcomes between the two groups were stratified by these factors. ResultsThe 5-year overall survival (OS: 56.9% vs. 73.8%, LR vs. LDLT, p \ 0.001) and recurrence-free survival rate (RFS: 27.4% vs. 70.7%, p \ 0.001) were significantly better in the LDLT group compared to the LR group. In the LR study, multivariate analysis identified TLR and tumor multiplicity as significant preoperative tumor factors for OS. In patients with solitary and TLR \ 2 HCC, the 5-year OS rate was not significantly different between the LR and LDLT groups (70.3% vs. 71.8%, p = 0.352); meanwhile, RFS rate was better in the LDLT group (34.3% vs. 71.8%, p = 0.001). Conclusions LDLT is associated with better long-term outcomes than LR in patients with HCC; however, selected patients with solitary and TLR \ 2 HCC may benefit from LR.

Frontline resection or liver transplantation in patients with single‐nodule hepatocellular carcinoma

“…In doubtful cases, a positron emission tomography could be useful to evaluate the biological behaviour of the tumour preoperatively. Indeed, tumour avidity for fluorodeoxyglucose in the positron emission tomography is more frequent in poorly differentiated HCCs with microvascular invasion 11 and it has been consistently associated with increased risk of tumour recurrence and shorter overall survival 12,13 . Although there is no agreement on the optimal threshold of standardized uptake value to discourage resection in favour of LT, a tumour‐to‐normal liver standardized uptake value ratio >1.5 in the positron emission tomography has been associated with increased risk of extrahepatic tumour recurrence after surgical resection 14 .…”