Patients with non-[18F]fludeoxyglucose-avid advanced hepatocellular carcinoma on clinical staging may achieve long-term recurrence-free survival after liver transplantation

Abstract

There is increasing evidence that a relevant number of patients with hepatocellular carcinoma (HCC) exceeding the Milan criteria may benefit from liver transplantation (LT). We retrospectively analyzed the prognostic significance of [ 18 F]fludeoxyglucose ([ 18 F]FDG) positron emission tomography (PET) for identifying appropriate LT candidates with advanced HCC on clinical staging. Between 1995 and 2008, 111 patients with HCC were listed for LT. All underwent a pretransplant PET evaluation. LT was performed for 91 of these patients. The tumor recurrence rate after LT was 3.6% for patients with non-[ 18 F]FDG-avid (PET À ) tumors, but it was 54.3% for patients with [ 18 F]FDG-avid (PET þ ) tumors (P < 0.001). The 5-year recurrence-free survival rates were comparable for patients with tumors meeting the Milan criteria (86.2%) and patients with PET À HCC exceeding the Milan criteria (81%) at LT, but these rates were significantly higher than the rate for liver recipients with [ 18 F]FDG-avid advanced HCC (21%, P ¼ 0.002). In a multivariate analysis, negative PET findings (odds ratio ¼ 21.6, P < 0.001), an alpha-fetoprotein level <400 IU/mL (odds ratio ¼ 3.3, P ¼ 0.013), and a total tumor diameter <10 cm (odds ratio ¼ 3.0, P ¼ 0.022) were identified as pretransplant prognostic variables for recurrence-free survival. A PET þ status was assessed as the only independent clinical predictor of tumor-related patient dropout from the waiting list (hazard ratio ¼ 5.7, P ¼ 0.01). Patients with non-[ 18 F]FDG-avid HCC beyond the Milan criteria according to clinical staging may achieve excellent long-term recurrence-free survival after LT.

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

“…In some previous studies, the metabolic status of HCC as seen on 18 F-FDG PET was the only significant factor predicting long-term survival (21) and early recurrence (,6 mo) after liver transplantation (22). 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).…”

The Evolution of Criteria for Liver Transplantation for Hepatocellular Carcinoma: From Milan to San Francisco and All Around the World!

“…The utility of 18-FDG-PET in determining tumor biology has been shown by Kornberg et al 80 . They reported that pre-OLT factors with high predictive value for recurrence-free survival were: negative PET uptake, AFP < 400 IU/mL and total tumor diameter < 10 cm.…”

Indications for living donor liver transplantation in patients with hepatocellular carcinoma

“…Tumor biomarkers could contribute to overcome the restrictions of the conventional selection criteria, thereby increasing the number of the patients indicated for LDLT (27). One recent study (28) demonstrated a comparable 5-year recurrence-free survival rate between LDLT recipients whose tumors exceeded the Milan criteria but who had negative PET and recipients whose tumors met the Milan criteria (81% vs. 86%).…”