Korean J Intern Med.  2015 May;30(3):308-315. 10.3904/kjim.2015.30.3.308.

Use of 18F-FDG PET to predict tumor progression and survival in patients with intermediate hepatocellular carcinoma treated by transarterial chemoembolization

• Kim MJ
• Kim YS
• Cho YH
• Jang HY
• Song JY
• Lee SH
• Jeong SW
• Kim SG
• Jang JY
• Kim HS
• Kim BS
• Lee WH
• Park JM
• Lee JM
• Lee MH
• Choi DL

• KMID: 2160703
• DOI: http://doi.org/10.3904/kjim.2015.30.3.308

Abstract

BACKGROUND/AIMS
18F-Fluorodeoxyglucose positron-emission tomography (18F-FDG PET) has been used to assess the biological behavior of hepatocellular carcinoma (HCC). In this study, we investigated the usefulness of 18F-FDG PET for predicting tumor progression and survival in patients with intermediate Barcelona Clinic Liver Cancer (BCLC) intermediate-stage HCC treated by transarterial chemoembolization (TACE).
METHODS
From February 2006 to March 2013, 210 patients treated with TACE, including 77 patients with BCLC intermediate-stage HCC, underwent examination by 18F-FDG PET. 18F-FDG uptake was calculated based on the tumor maximum (Tmax) standardized uptake value (SUV), the liver mean (Lmean) SUV, and the ratio of the Tmax SUV to the Lmean SUV (Tmax/Lmean).
RESULTS
The mean follow-up period for the 77 patients (52 males, 25 females; average age, 63.3 years) was 22.2 months. The median time to progression of HCC in patients with a low Tmax/Lmean (< 1.83) and high Tmax/Lmean (> or = 1.83) was 17 and 6 months, respectively (p < 0.001). The median overall survival time of patients with a low and high Tmax/Lmean was 44 and 14 months, respectively (p = 0.003). Multivariate analysis revealed that the Tmax/Lmean was an independent predictor of overall survival (hazard ratio [HR], 1.96; 95% confidence interval [CI], 1.210 to 3.156; p = 0.006) and tumor progression (HR, 2.05; 95% CI, 1.264 to 3.308; p = 0.004).
CONCLUSIONS
18F-FDG uptake calculated by the Tmax/Lmean using PET predicted tumor progression and survival in patients with BCLC intermediate-stage HCC treated by TACE.

Keyword

Carcinoma, hepatocellular; Fluorodeoxyglucose F18; Positron-emission tomography; Tomography, X-ray computed

MeSH Terms

Aged
Carcinoma, Hepatocellular/mortality/*radionuclide imaging/*surgery
*Chemoembolization, Therapeutic/adverse effects/mortality
Disease Progression
Female
*Fluorodeoxyglucose F18
Humans
Kaplan-Meier Estimate
Liver Neoplasms/mortality/*radionuclide imaging/*surgery
Male
Middle Aged
Multimodal Imaging
Neoplasm Staging
*Positron-Emission Tomography
Predictive Value of Tests
Proportional Hazards Models
*Radiopharmaceuticals
Retrospective Studies
Risk Factors
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Fluorodeoxyglucose F18
Radiopharmaceuticals