Preoperative Positron Emission Tomography with Fluorine‐18‐Fluorodeoxyglucose is Predictive of Prognosis in Patients with Hepatocellular Carcinoma after Resection

Hatano, Etsuro; Ikai, Iwao; Higashi, Tatsuya; Teramukai, Satoshi; Torizuka, Tatsuo; Saga, Tsuneo; Fujii, Hideaki; Sugiyama, Yasuyuki

doi:10.1007/s00268-005-0791-5

Cited by 101 publications

(108 citation statements)

References 26 publications

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“…For analyzing accuracy in the detection of small tumors or extrahepatic metastases, we prospectively enrolled more patients who had modified UICC stage I, II, and IVb, compared with the patient population of our previous report (27). A high rate of positive findings on 18 F-FDG PET has been reported in patients with elevated serum a-fetoprotein levels (7) and in patients with poorly differentiated HCC (28).…”

Section: Discussionmentioning

confidence: 99%

A Prospective Evaluation of¹⁸F-FDG and¹¹C-Acetate PET/CT for Detection of Primary and Metastatic Hepatocellular Carcinoma

Park¹,

Kim²,

Kim³

et al. 2008

J Nucl Med

254

237

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Because 18 F-FDG PET has insufficient sensitivity for the detection of hepatocellular carcinoma (HCC), 11 C-acetate PET has been proposed as another technique for this use. We prospectively evaluated the value of PET/CT using these 2 tracers for the detection of primary and metastatic HCC. Methods: One hundred twelve patients (99 with HCC, 13 with cholangiocellular carcinoma) underwent biopsy and 18 F-FDG and 11 C-acetate PET/CT. Results: The overall sensitivities of 18 F-FDG, 11 C-acetate, and dual-tracer PET/CT in the detection of 110 lesions in 90 patients with primary HCC were 60.9%, 75.4%, and 82.7%, respectively. Elevated serum a-fetoprotein levels, an advanced tumor stage, portal vein tumor thrombosis, large tumors, and multiple tumors were significantly associated with positive 18 F-FDG PET/CT results. Uptake of 11 C-acetate was associated with large and multiple tumors. For 18 F-FDG, the sensitivities according to tumor size (1-2, 2-5, and $5 cm) were 27.2%, 47.8%, and 92.8%, respectively; for 11 C-acetate, these respective values were 31.8%, 78.2%, and 95.2%. 18 F-FDG was more sensitive in the detection of poorly differentiated HCC. Overall survival was lower in patients with 18 F-FDG PET/CT positive for all indexed lesions than in those with FDG negative or partially positive through the entire follow-up period. In analysis based on biopsied lesions, the sensitivity of 18 F-FDG PET/CT was 64.4% for primary HCC and 84.4% for 11 C-acetate PET/CT. The overall sensitivities of 18 F-FDG, 11 C-acetate, and dual-tracer PET/CT for 35 metastatic HCCs were 85.7%, 77.0%, and 85.7%, respectively. There was no significant difference in the sensitivity of tracers according to metastatic tumor size, location, or differentiation. Conclusion: The addition of 11 C-acetate to 18 F-FDG PET/CT increases the overall sensitivity for the detection of primary HCC but not for the detection of extrahepatic metastases. 18 F-FDG, 11 C-acetate, and dual-tracer PET/CT have a low sensitivity for the detection of small primary HCC, but 18 F-FDG PET/CT has a relatively high sensitivity for the detection of extrahepatic metastases of HCC.

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Section: Discussionmentioning

confidence: 99%

A Prospective Evaluation of¹⁸F-FDG and¹¹C-Acetate PET/CT for Detection of Primary and Metastatic Hepatocellular Carcinoma

Park¹,

Kim²,

Kim³

et al. 2008

J Nucl Med

254

237

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“…Likewise, in HCC, several investigators have reported that 18 F-FDG uptake evaluated by preoperative PET scan is associated with tumor differentiation as well as recurrences and survival after resection or transplantation. [14][15][16][17] Hence, it is feasible that 18 F-FDG uptake on PET scan, like size and number criterion, might be an important prognostic factor in the establishment of treatment and surveillance plans. However, most studies on HCC and 18 F-FDG-PET have focused primarily on either tumor detection in preoperative settings or prognostic value in patients treated with resection or transplantations.…”

mentioning

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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“…However, some reports have indicated that a high FDG uptake reflects malignant potential in HCC (22,23). In the present case, the 4 th segment tumor had higher FDG uptake than the other tumors.…”

Section: Discussionmentioning

confidence: 99%

Abdominal Imaging Findings of a Patient with Hepatocellular Carcinoma Associated with Glycogen Storage Disease Type 1a

et al. 2011

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A hepatic tumor was found in a 57-year-old man with glycogen storage disease type 1a (GSD1a) with a mutation in exon 5 of the glucose-6-phosphatase gene (G727T). Partial hepatectomy was performed, and the tumor was histologically diagnosed as moderately differentiated hepatocellular carcinoma (HCC). On contrast-enhanced ultrasonography, the tumor had a late phase defect. Abdominal imaging with other modalities was also performed. More studies are needed to clarify the differences in imaging findings between GSD1a-associated HCC and other tumors such as adenomas.

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Preoperative Positron Emission Tomography with Fluorine‐18‐Fluorodeoxyglucose is Predictive of Prognosis in Patients with Hepatocellular Carcinoma after Resection

Cited by 101 publications

References 26 publications

A Prospective Evaluation of¹⁸F-FDG and¹¹C-Acetate PET/CT for Detection of Primary and Metastatic Hepatocellular Carcinoma

A Prospective Evaluation of¹⁸F-FDG and¹¹C-Acetate PET/CT for Detection of Primary and Metastatic Hepatocellular Carcinoma

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

Abdominal Imaging Findings of a Patient with Hepatocellular Carcinoma Associated with Glycogen Storage Disease Type 1a

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Preoperative Positron Emission Tomography with Fluorine‐18‐Fluorodeoxyglucose is Predictive of Prognosis in Patients with Hepatocellular Carcinoma after Resection

Cited by 101 publications

References 26 publications

A Prospective Evaluation of18F-FDG and11C-Acetate PET/CT for Detection of Primary and Metastatic Hepatocellular Carcinoma

A Prospective Evaluation of18F-FDG and11C-Acetate PET/CT for Detection of Primary and Metastatic Hepatocellular Carcinoma

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

Abdominal Imaging Findings of a Patient with Hepatocellular Carcinoma Associated with Glycogen Storage Disease Type 1a

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A Prospective Evaluation of¹⁸F-FDG and¹¹C-Acetate PET/CT for Detection of Primary and Metastatic Hepatocellular Carcinoma

A Prospective Evaluation of¹⁸F-FDG and¹¹C-Acetate PET/CT for Detection of Primary and Metastatic Hepatocellular Carcinoma

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