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

Abstract

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-

Prognostic Significance of18F-FDG Uptake in Hepatocellular Carcinoma Treated with Transarterial Chemoembolization or Concurrent Chemoradiotherapy: A Multicenter Retrospective Cohort Study

“…Currently, the value of 18 F-FDG uptake as an independent prognostic factor is controversial in this group of patients (18)(19)(20)(21)(22); however, in this study, we found that the TLR of HCC was a significant independent prognostic factor for both PFS and OS. The patients with a TLR of 2.0 or less had a median PFS of 9.8 mo and a median OS of 24 mo, whereas a median PFS of 6.2 mo and a median OS of less than 10 mo were found in patients with a TLR greater than 2.0.…”

Prognostic Stratification of Metastatic Gastroenteropancreatic Neuroendocrine Neoplasms by 18F-FDG PET: Feasibility of a Metabolic Grading System

“…18 F-FDG PET imaging has been shown to prognosticate survival in various tumor entities (11,12). Especially in tumors with variable 18 F-FDG uptake, such as hepatocellular carcinoma (13,14), prostate cancer (15,16), and gastrointestinal stroma tumors (17,18), a correlation between 18 F-FDG avidity and biologic behavior of the tumor (indicated by patient survival) has been shown to facilitate outcome prediction or metabolic grading by noninvasive measures. Recent studies have also shown such value for NENs (19,20).…”

Use of choline PET for studying hepatocellular carcinoma

“…The unfavourable prognostic value of HCC tumour visualisation on FDG PET in patients who are candidates for or scheduled for liver transplantation has also been reported by several teams [41][42][43][44], whereas patients with non-FDG-avid HCC even at more advanced stage (beyond the Milan criteria) achieved excellent 5-year recurrence-free survival after liver transplantation [44]. FDG uptake has also shown predictive value for survival after non-surgical treatments [45][46][47].…”