The Prognostic Value of ¹⁸F-FDG PET/CT for Hepatocellular Carcinoma Treated with Transarterial Chemoembolization (TACE)

Abstract

18F-Fluoro-deoxyglucose (FDG) PET/CT can be used to monitor the biological behavior of hepatocellular carcinoma (HCC). Baseline PET/CT has prognostic value in HCC patients, but there is litter knowledge of the PET/CT changes after treatment. We evaluated 27 HCC patients treated with transarterial chemoembolization (TACE) from June 2011 to July 2012, and we investigated the prognostic value of PET/CT. Patients were followed up with regular clinical and laboratory examinations and contrast-enhanced spiral computed tomography (CT). Furthermore, PET/CT assessments were collected and analyzed before (range 1~15 d) and after the first month of TACE (range, 27~45d). We tested the prognostic value of the tumor standardized uptake value (TSUV) and normal liver SUV(LSUV) according to the VOI (volume of interest). The SUVs were used to assess the relationship between the treatment response and survival. To assess their prognostic value, we evaluated the areas under the receiver operating characteristic (ROC) curves of different SUVs for predicting survival. Finally, the median overall survival (OS) and time to progression (TTP) for 27 patients were 15.4 months (95%CI, 3.3-27.5 months) and 11.4 months (95%CI, 6.7-16.1 months), respectively. The ΔTSUVmax%, based on the VOI, had the highest discriminative prognostic value and the cutoff PET/CT response was 0.1 with a sensitivity of 100% and a specificity of 95.2%. The OS was significantly better in the PET/CT response group than in the PET/CT non-response group (p=0.025). In conclusion, an early interim PET/CT after TACE may have prognostic value for HCC patients treated with TACE, and the ΔTSUVmax% may help in determining the HCCs viability in patients with high baseline and follow-up18F-FDG uptake.

The interplay of circulating tumor DNA and chromatin modification, therapeutic resistance, and metastasis

“…[140] Based on the phenomenon that tumor cells take up more glucose than normal cells, in recent years, 18F-fluoro-D-glucose positron emission tomography/ computed tomography (18F-FDG PET/CT) has been used to detect tumor metabolic activity. [141] Many studies have shown that 18F-FDG PET/CT facilitates tumor diagnosis, prognosis prediction and assessment of the therapeutic response. [141][142][143][144][145] Moreover, studies examining the correlation between cfDNA and metabolic tumor burden (MTB) measured by 18F-FDG PET/CT have also be conducted.…”

“…[141] Many studies have shown that 18F-FDG PET/CT facilitates tumor diagnosis, prognosis prediction and assessment of the therapeutic response. [141][142][143][144][145] Moreover, studies examining the correlation between cfDNA and metabolic tumor burden (MTB) measured by 18F-FDG PET/CT have also be conducted. Compared with 18F-FDG PET/ CT, the cfDNA level is not a simple measure of tumor burden, but it correlates to a complex tumor metabolism and biology, which makes it a better biomarker to reflect the biological behavior or aggressiveness of the tumor.…”

Joint Consensus Statement of the Indian National Association for Study of the Liver and Indian Radiological and Imaging Association for the Diagnosis and Imaging of Hepatocellular Carcinoma Incorporating Liver Imaging Reporting and Data System

“…Potential drawbacks that may be encountered when using FDG-PET are false-negative results because of a partial volume effect when dealing with small lesions (<1 cm) or because of diabetes/immune-compromised/infection and falsepositive results because of abscess formation. 131 Liu et al reported 100% specificity and 36% sensitivity of CT for the depiction of residual or recurrent tumor seen as enhancing soft tissue and not necessarily arterially enhancing. 94 Dromain et al found that MRI is known to be superior to CT for the evaluation of HCC after performing lipoidol TACE.…”

Radiological biomarkers for assessing response to locoregional therapies in hepatocellular carcinoma: From morphological to functional imaging

“…Standardized uptake value (SUV) is the accepted semi-quantitative biomarker of tracer uptake in PET. There is growing evidence that in PET-positive HCC, early metabolic response may reflect molecular changes and predict longterm outcome after completion of therapy (79)(80)(81)(82)(83)(84). A SuV on 18 F-FDG PET-CT imaging can serve as an independent prognostic factor in HCC and may predict tumor recurrence after TACE (79,83).…”

“…18 F-FDG PET-CT may help determine the treatment modality for intermediate-to-advanced stage HCCs (80). An early interim PET-CT after TACE may have prognostic value for HCC patients treated with TACE and radiotherapy (83,84). Therefore, the European Organization for Research and Treatment of Cancer (EORTC) has defined response assessment criteria for PET (85).…”