Ann Surg Treat Res.  2020 Jul;99(1):8-17. 10.4174/astr.2020.99.1.8.

¹⁸F-fluorodeoxyglucose PET/CT as an independent predictor for patients with hepatocellular carcinoma combined with major portal vein tumor thrombus

• Hu XG
• Shen XY
• Nan JN
• Kim IG
• Yoon JK
• Hong SY
• Kim MN
• Kim BW
• Wang HJ

• KMID: 2503455
• DOI: http://doi.org/10.4174/astr.2020.99.1.8

Abstract

Purpose
Hepatocellular carcinoma (HCC) patients with major portal vein tumor thrombosis (mPVTT) complications were generally characterized by extremely poor prognoses. The aim of this study was to explore the role of ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) PET/CT imaging in predicting HCC complicated by mPVTT.
Methods
Five hundred one HCC patients received surgery in our hospital during November 2008 to December 2014, among which 32 patients (6.4%) were diagnosed as HCC complicated by mPVTT. Six cases were excluded for reasons of complex medical conditions, including 2 cases of salvage liver transplantation, 2 cases of re-resection, 1 case of mPVTT combined with inferior vina cava tumor thrombosis, and 1 case of residual portal vein tumor thrombosis. Ultimately, 26 cases were enrolled in this study. The maximal tumor standardized uptake value (SUVmax) was identified as a predictive factor and detected. The univariate and multivariate regression analyses were performed to identify the prognostic factors for recurrence-free survival (RFS) and overall survival (OS) of HCC patients complicated by mPVTT.
Results
Our results showed that the median OS was 16 months. The 1-, 3-, and 5-year cumulative OS was 55.6%, 31.7%, and 31.7%, respectively. The multivariate regression analysis revealed that SUVmax ≥ 4.65 was the only independent risk factor for RFS and OS.
Conclusion
SUVmax was an independent predictor for RFS and OS of patients suffering from both HCC and mPVTT. L ow SUVmax could serve as an effective factor for selecting candidates with low recurrence risks and for helping with improving patient survival after surgical resection.

Keyword

Hepatocellular carcinoma; Portal vein; Positron emission tomography computed tomography; Thrombus

Figure

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  Fig. 1 The surgical procedures for thrombectomy. (A) Schema showing a right liver hepatocellular carcinoma (HCC) and HCC-derived portal vein tumor thrombous (PVTT) extending to the main portal vein. (B) Exposure the hilar structure after the liver parenchyma divided. (C) Extra fascial access to tape the main and the left glissonean pedicle. (D) The hepatic artery and the bile duct were ligated and divided separately. (E) While clamping the main and left portal glissonean pedicle, the anterior wall of the portal vein was transversely incised. The PVTT was peeling off from the portal lumen. (F) The lumen was flushed with heparinized saline and main portal bleeding to remove potentially cancerous residual tissue. (G) Left portal back-bleeding to remove potentially cancerous residual tissue. (H) The posterior wall of the portal vein was dissected by scalpel and the stump was closed with 6/0 prolene by continuous suture.

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  Fig. 2 Receiver operating characteristic (ROC) curve to assess the optimal cutoff value of SUVmax for tumor recurrence (4.65). ROC curve to assess the optimal cutoff value of SUVmax for tumor recurrence (4.65). SUVmax, maximum standard uptake value.

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  Fig. 3 Kaplan-Meier survival analysis shows the overall survival cure of the hepatocellular carcinoma (HCC) patients with major portal vein tumor thrombosis (mPVTT) in the present study. The 5-year overall survival (OS) of the patients with mPVTT in this study was 31.7%.

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  Fig. 4 Kaplan-Meier survival analysis with regard to SUVmax. (A) Patients with low SUVmax (<4.65) showed significantly longer disease-free survival than those with high SUVmax (≥4.65). (B) Patients with low SUVmax (<4.65) showed significantly longer overall survival than those with high SUVmax (≥4.65). SUVmax, maximum standard uptake value. RFS, recurrence-free survival; OS, overall survival.

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