¹⁸F-FDG-PET/CT predicts early tumor recurrence in living donor liver transplantation for hepatocellular carcinoma

Abstract

Summary The prognosis including 18F‐fluorodeoxyglucose positron emission tomography/computed tomography (18F‐FDG‐PET/CT) for the early recurrence for hepatocellular carcinoma (HCC) after living donor liver transplantation (LDLT) was not well established. Consecutive patients who underwent 18F‐FDG‐PET/CT and subsequent LDLT for HCC from March 2005 to June 2011 were enrolled. The 191 patients with a median follow‐up of 26.1 months were evaluated. There were 20 patients (10.5%) with early recurrence (≤6 months), 18 patients (9.4%) with late recurrence (>6 months), and 153 patients (80.1%) with no recurrence. Fifty‐five patients (28.8%) displayed increased PET/CT tumor uptake. Three‐year overall and disease‐free survival for PET/CT‐positive patients were 65.5% and 57.1%, respectively, while PET/CT‐negative patients showed respective values of 89.8% and 86.8% (P = 0.001 vs. P < 0.001). Tumor variables associated with PET/CT‐positive finding were preoperative AFP level, Milan, UCSF criteria, maximum tumor size, total tumor size, differentiation, vascular invasion, and serosal invasion. PET/CT‐positive status was identified as an independent prognostic factor for disease‐free survival influencing early recurrence in multivariable analysis (HR 3.945, 95% CI 1.196–13.016, P = 0.024). 18F‐FDG‐PET/CT is an independent and significant predictor of early tumor recurrence in LDLT for HCC.

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).…”

Role of positron emission tomography/computed tomography in living donor liver transplantation for hepatocellular carcinoma

“…However, tumor number and size was very limited to predict important pathologic variables including microvascular invasion and differentiation. Recently, biomarkers, response to transarterial chemoembolization (TACE), gene-expression profile, PET/CT, AFP, and PIVKA-II, have been used for the assessment of tumor aggressiveness (5,(10)(11)(12)(34)(35)(36)(37)(38)(39).…”

“…In LDLT setting, although the patients had the advanced HCC beyond the Milan criteria, the operation could be performed as the willingness of donor and informed consent. Therefore, many criteria using various indicators α-fetoprotein (AFP), protein induced by vitamin K absence or antagonist-II (PIVKA-II), 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and tumor morphology have been proposed (5,(8)(9)(10)(11)(12)(13)(14). In HCC patients, tumor characteristics, including differentiation grade and microvascular invasion, are well-known independent prognostic factors for overall survival (OS) and disease-free survival (DFS) following LT (15).…”

“…Recently, several studies using 18F-FDG PET/CT in LDLT demonstrated the usefulness of PET/CT to detect the extrahepatic metastases and synchronous malignant neoplasm as well as recurrence of HCC with good performance (5,(10)(11)(12)(16)(17)(18)(19). In HCC patients, PET/ CT imaging before surgery or transplantation was not popular in worldwide due to cost-effective or technical issues.…”

Inflammatory and Ischemic Post Liver Transplant Complications Mimic Malignancy on 18F-FDG PET/CT

“…18 F-FDG PET/CT is widely used to assess for extrahepatic metastases prior to liver transplantation (6). PET/CT has also been found to be useful as a predictive parameter for evaluation of early HCC recurrence after liver transplantation (7). In light of the increasing use of PET/CT in liver transplant patients, it is important to be aware of lesions that mimick malignancy.…”