Increased 18F-FDG Uptake of Hepatocellular Carcinoma on Positron Emission Tomography Independently Predicts Tumor Recurrence in Liver Transplant Patients

Kornberg, Arno; Küpper, B.; Thrum, Katharina; Katenkamp, Kathrin; Steenbeck, J.; Sappler, A.; Habrecht, O.; Gottschild, D

doi:10.1016/j.transproceed.2009.06.115

Cited by 44 publications

(30 citation statements)

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“…Other studies found some additional factors to be significant, such as the metabolic status of the HCC, the extent of vascular invasion (23,24), and the degree of differentiation (23,24). Aside from one discordant result (25), the use of 18 F-FDG PET/CT TBR as a metabolic activity index has been reported to be efficacious in predicting HCC recurrence after liver transplantation (14).…”

Section: Discussionmentioning

confidence: 99%

Prediction of Posttransplantation Recurrence of Hepatocellular Carcinoma Using Metabolic and Volumetric Indices of¹⁸F-FDG PET/CT

et al. 2016

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18 F-FDG PET is an effective method of predicting recurrence of hepatocellular carcinoma (HCC) after liver transplantation. We compared recently introduced metabolic and volumetric 18 F-FDG PET/ CT indices with the current clinicopathologic predictors for ability to predict recurrence. Methods: In total, 110 HCC patients who underwent 18 F-FDG PET and liver transplantation were enrolled. On PET, SUVs and tumor-to-background ratios (TBRs) were measured as metabolic activity indices. Various metabolic tumor volumes and uptake-volume products (UVP) were also measured as volumetric indices. The ability of these indices and other clinicopathologic factors to predict recurrence was compared. Results: All metabolic and volumetric indices were significant for recurrence prediction on receiver-operating-characteristic curve analyses (P , 0.001). On univariate survival analyses, all PET indices-as well as tumor size, tumor number, the Milan criteria, tumor grade, vascular invasion, and T-stage-were significant factors. However, on multivariate analyses, tumor size, tumor grade, maximum TBR, and UVP calculated by inferior vena cava activity were significant factors (P 5 0.004, 0.014, 0.009, and 0.021, respectively). When the Milan criteria and PET factors were included in the multivariate analysis, the Milan criteria (P 5 0.029), maximum TBR (P , 0.001), and UVP (P 5 0.016) were significant. Conclusion: Volumetric and metabolic activity indices of 18 F-FDG PET are effective predictors of posttransplantation HCC recurrence. In addition to clinicopathologic factors, these indices need to be considered in the selection of candidates for liver transplantation.

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Section: Discussionmentioning

confidence: 99%

Prediction of Posttransplantation Recurrence of Hepatocellular Carcinoma Using Metabolic and Volumetric Indices of¹⁸F-FDG PET/CT

et al. 2016

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“…29 Second, the increased uptake of 18 F-FDG reflects the rapid growth of the HCC and poor histologic differentiation associated with aggressive biological behavior. 17,19,26,30 In addition, the higher expression of metalloproteinase-9 in tumor cells with enhanced glucose metabolism might make invasion into surrounding tissues and extrahepatic spread much easier. 31 In the same context, HCC with a high uptake of 18 F-FDG exhibited microvascular invasion more frequently, which proved to be an important histopathological parameter, resulting in treatment failures like intrahepatic/extrahepatic dissemination.…”

Section: Discussionmentioning

confidence: 99%

“…There are few data on the clinical significance of 18 F-FDG-PET in HCC patients who have undergone nonsurgical treatments. 14,15,[17][18][19] Furthermore, to date, there have been no data on the appropriate application of the clinical significance of 18 F-FDG-PET in patients who have undergone localized CCRT followed by repetitive HAIC for locally advanced HCCs.…”

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confidence: 99%

¹⁸F‐fluorodeoxyglucose uptake on positron emission tomography as a prognostic predictor in locally advanced hepatocellular carcinoma

Kim

Kang

Kim

et al. 2011

Cancer

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BACKGROUND: Metabolic activity assessed by 18 F-fluorodeoxyglocuse-positron emission tomography ( 18 F-FDG-PET) reflects biological aggressiveness and prognoses in various tumors. The authors present a correlation between tumor metabolic activity and clinical outcomes in patients with hepatocellular carcinoma (HCC). METHODS: Over a 3-year period (2005)(2006)(2007)(2008), 135 locally advanced HCC patients were treated with localized concurrent chemoradiotherapy (CCRT; external beam radiotherapy at 45 grays for 5 weeks plus concurrent hepatic arterial infusion of 5-fluorouracil during the first and fifth week) followed by repetitive hepatic arterial infusional chemotherapy with 5-fluorouracil and cisplatin. Among them, the authors studied 107 who received 18 F-FDG-PET before CCRT. Maximal standardized uptake values (SUVs) of tumors were calculated. RESULTS: The median maximal tumor SUV was 6.1 (range, 2.4-$19.2). Patients with low maximal tumor SUVs (<6.1) had a higher disease control rate than those with high maximal tumor SUVs (!6.1) (86.8% vs 68.5%, respectively, P ¼ .023). Both median progression-free survival (PFS; 8.4 vs 5.2 months; P ¼ .003) and overall survival (OS; 17.9 vs 11.3 months; P ¼ .013) were significantly longer in the low maximal tumor SUV group than in the high maximal tumor SUV group, respectively. In multivariate analysis, low maximal tumor SUV and objective responses to CCRT remained significant for PFS and OS. The high maximal tumor SUV group was more likely to have extrahepatic metastasis within 6 months than the low maximal tumor SUV group (58.1% vs 26.8%, respectively; P < .001). Similar results were obtained for the maximal tumor SUV/normal liver maximal SUV ratio (<2 vs !2) concerning progression, death, and extrahepatic metastasis. CONCLUSIONS: Metabolic activity may be useful not only in predicting prognosis and treatment responses, but also in establishing optimal treatment plans in locally advanced HCC. Cancer 2011;117:4779-

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“…[11][12][13][14] The preoperative AFP level and vascular invasion in poorly differentiated HCCs were found to be significantly associated with positive fludeoxyglucose F 18 ([ 18 F]-FDG) PET findings, 11,13,14 and its uptake during PET was specifically predictive of microvascular invasion and tumor recurrence after liver transplantation for HCC. 13 Recommendations (Fig. 1) • We found no publications addressing the specific points of timing or optimal imaging modalities for screening liver transplant candidates on the wait list.…”

Section: Discussionmentioning

confidence: 99%

Tools for monitoring patients with hepatocellular carcinoma on the waiting list and after liver transplantation

Kneteman¹,

Livraghi²,

Madoff³

et al. 2011

Liver Transpl

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For patients who are initially being listed for liver transplantation and for patients who are seeking to retain their active status on the wait list, the first step in the diagnostic consideration of hepatocellular carcinoma (HCC) is the accurate identification and staging of the tumors. Advances in imaging and biomarkers have improved our ability to diagnose HCC and in parallel have reduced the incidence of incidental HCC after liver transplantation. For the initial diagnosis, high sensitivity and high specificity are paramount considerations. The requirements change, however, when we are considering listing for transplantation: then, the prediction of the risk for posttransplant tumor recurrence and patient survival assume primacy. We must understand with confidence not only that the patient has a tumor but also that the tumor will affect the 5-year patient survival rate through the risk of tumor recurrence.Our first task in making the decision to list a patient with HCC for liver transplantation is to rule out factors representing absolute contraindications: extrahepatic disease and macrovascular tumor invasion. Beyond these variables, an understanding of the risk of posttransplant HCC recurrence is dominated by 2 major variables: tumor mass and tumor biology. Three major types of information can inform the decision to list a patient with HCC for liver transplantation. The first and usually dominant factors are the imaging characteristics, which include the size and number of the malignant lesions. The second type consists of biomarkers, which are most commonly abnormal proteins in the circulation that signify the presence of more dedifferentiated malignant cells with a higher propensity to invade and metastasize. The third type consists of factors from histological evaluations of tumor tissue obtained by biopsy or excision; these include factors such as the tumor grade, the presence of microvascular invasion, and protein, messenger RNA (mRNA), or DNA markers that have been correlated with more aggressive tumor behavior.Our team was tasked with generating recommendations for the best protocol for monitoring HCC patients on the wait list and for screening them for tumor recurrence after transplantation. The role of

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Increased 18F-FDG Uptake of Hepatocellular Carcinoma on Positron Emission Tomography Independently Predicts Tumor Recurrence in Liver Transplant Patients

Cited by 44 publications

References 8 publications

Prediction of Posttransplantation Recurrence of Hepatocellular Carcinoma Using Metabolic and Volumetric Indices of¹⁸F-FDG PET/CT

Prediction of Posttransplantation Recurrence of Hepatocellular Carcinoma Using Metabolic and Volumetric Indices of¹⁸F-FDG PET/CT

¹⁸F‐fluorodeoxyglucose uptake on positron emission tomography as a prognostic predictor in locally advanced hepatocellular carcinoma

Tools for monitoring patients with hepatocellular carcinoma on the waiting list and after liver transplantation

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Increased 18F-FDG Uptake of Hepatocellular Carcinoma on Positron Emission Tomography Independently Predicts Tumor Recurrence in Liver Transplant Patients

Cited by 44 publications

References 8 publications

Prediction of Posttransplantation Recurrence of Hepatocellular Carcinoma Using Metabolic and Volumetric Indices of18F-FDG PET/CT

Prediction of Posttransplantation Recurrence of Hepatocellular Carcinoma Using Metabolic and Volumetric Indices of18F-FDG PET/CT

18F‐fluorodeoxyglucose uptake on positron emission tomography as a prognostic predictor in locally advanced hepatocellular carcinoma

Tools for monitoring patients with hepatocellular carcinoma on the waiting list and after liver transplantation

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Product

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Prediction of Posttransplantation Recurrence of Hepatocellular Carcinoma Using Metabolic and Volumetric Indices of¹⁸F-FDG PET/CT

Prediction of Posttransplantation Recurrence of Hepatocellular Carcinoma Using Metabolic and Volumetric Indices of¹⁸F-FDG PET/CT

¹⁸F‐fluorodeoxyglucose uptake on positron emission tomography as a prognostic predictor in locally advanced hepatocellular carcinoma