The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

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

  • Kim, Min Jin (Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Kim, Young Seok (Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Cho, Youn Hee (Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Jang, Hee Yoon (Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Song, Jeong-Yeop (Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Lee, Sae Hwan (Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Jeong, Soung Won (Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Kim, Sang Gyune (Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Jang, Jae Young (Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Kim, Hong Su (Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Kim, Boo Sung (Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Lee, Won Hyung (Department of Nuclear Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Park, Jung Mi (Department of Nuclear Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Lee, Jae Myung (Department of Radiology, Soonchunhyang University Bucheon Hospital) ;
  • Lee, Min Hee (Department of Radiology, Soonchunhyang University Bucheon Hospital) ;
  • Choi, Deuk Lin (Department of Radiology, Soonchunhyang University Hospital)
  • Received : 2014.05.25
  • Accepted : 2014.08.25
  • Published : 2015.05.01
⟨ Previous Next ⟩

Abstract

Background/Aims: $^{18}F-Fluorodeoxyglucose$ positron-emission tomography ($^{18}F-FDG$ PET) has been used to assess the biological behavior of hepatocellular carcinoma (HCC). In this study, we investigated the usefulness of $^{18}F-FDG$ 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 $^{18}F-FDG$ PET. $^{18}F-FDG$ 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 (${\geq}1.83$) 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: $^{18}F-FDG$ uptake calculated by the Tmax/Lmean using PET predicted tumor progression and survival in patients with BCLC intermediate-stage HCC treated by TACE.

Keywords

Acknowledgement

Supported by : Soonchunhyang University

References

  1. Rigo P, Paulus P, Kaschten BJ, et al. Oncological applications of positron emission tomography with fluorine-18 fluorodeoxyglucose. Eur J Nucl Med 1996;23:1641-1674. https://doi.org/10.1007/BF01249629
  2. Giannopoulou C. The role of SPET and PET in monitoring tumour response to therapy. Eur J Nucl Med Mol Imaging 2003;30:1173-1200. https://doi.org/10.1007/s00259-003-1208-z
  3. Khan MA, Combs CS, Brunt EM, et al. Positron emission tomography scanning in the evaluation of hepatocellular carcinoma. J Hepatol 2000;32:792-797.
  4. Teefey SA, Hildeboldt CC, Dehdashti F, et al. Detection of primary hepatic malignancy in liver transplant candidates: prospective comparison of CT, MR imaging, US, and PET. Radiology 2003;226:533-542. https://doi.org/10.1148/radiol.2262011980
  5. Jeng LB, Changlai SP, Shen YY, Lin CC, Tsai CH, Kao CH. Limited value of 18F-2-deoxyglucose positron emission tomography to detect hepatocellular carcinoma in hepatitis B virus carriers. Hepatogastroenterology 2003;50:2154-2156.
  6. Trojan J, Schroeder O, Raedle J, et al. Fluorine-18 FDG positron emission tomography for imaging of hepatocellular carcinoma. Am J Gastroenterol 1999;94:3314-3319. https://doi.org/10.1111/j.1572-0241.1999.01544.x
  7. Wolfort RM, Papillion PW, Turnage RH, Lillien DL, Ramaswamy MR, Zibari GB. Role of FDG-PET in the evaluation and staging of hepatocellular carcinoma with comparison of tumor size, AFP level, and histologic grade. Int Surg 2010;95:67-75.
  8. Lee JH, Park JY, Kim do Y, et al. Prognostic value of 18F-FDG PET for hepatocellular carcinoma patients treated with sorafenib. Liver Int 2011;31:1144-1149. https://doi.org/10.1111/j.1478-3231.2011.02541.x
  9. Lee JD, Yun M, Lee JM, et al. Analysis of gene expression profiles of hepatocellular carcinomas with regard to 18F-fluorodeoxyglucose uptake pattern on positron emission tomography. Eur J Nucl Med Mol Imaging 2004;31:1621-1630. https://doi.org/10.1007/s00259-004-1602-1
  10. Yang SH, Suh KS, Lee HW, et al. The role of (18)F-FDGPET imaging for the selection of liver transplantation candidates among hepatocellular carcinoma patients. Liver Transpl 2006;12:1655-1660. https://doi.org/10.1002/lt.20861
  11. Dufour JF, Bargellini I, De Maria N, De Simone P, Goulis I, Marinho RT. Intermediate hepatocellular carcinoma: current treatments and future perspectives. Ann Oncol 2013;24 Suppl 2:ii24-ii29.
  12. Lencioni R. Loco-regional treatment of hepatocellular carcinoma. Hepatology 2010;52:762-773. https://doi.org/10.1002/hep.23725
  13. Jun CH, Ki HS, Lee KH, et al. Impact of serum C-reactive protein level on the prognosis of patients with hepatocellular carcinoma undergoing TACE. Clin Mol Hepatol 2013;19:70-77. https://doi.org/10.3350/cmh.2013.19.1.70
  14. Hashimoto K, Ikeda Y, Korenaga D, et al. The impact of preoperative serum C-reactive protein on the prognosis of patients with hepatocellular carcinoma. Cancer 2005;103:1856-1864. https://doi.org/10.1002/cncr.20976
  15. Trevisani F, D'Intino PE, Morselli-Labate AM, et al. Serum alpha-fetoprotein for diagnosis of hepatocellular carcinoma in patients with chronic liver disease: influence of HBsAg and anti-HCV status. J Hepatol 2001;34:570-575. https://doi.org/10.1016/S0168-8278(00)00053-2
  16. Ueno S, Tanabe G, Nuruki K, et al. Prognostic performance of the new classification of primary liver cancer of Japan (4th edition) for patients with hepatocellular carcinoma: a validation analysis. Hepatol Res 2002;24:395-403. https://doi.org/10.1016/S1386-6346(02)00144-4
  17. Llovet JM, Bru C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 1999;19:329-338. https://doi.org/10.1055/s-2007-1007122
  18. Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 2010;30:52-60. https://doi.org/10.1055/s-0030-1247132
  19. Kim SE, Lee HC, Kim KM, et al. Applicability of the BCLC staging system to patients with hepatocellular carcinoma in Korea: analysis at a single center with a liver transplant center. Korean J Hepatol 2011;17:113-119. https://doi.org/10.3350/kjhep.2011.17.2.113
  20. Choi JY. Treatment algorithm for intermediate and advanced stage hepatocellular carcinoma: Korea. Oncology 2011;81 Suppl 1:141-147.
  21. Torizuka T, Tamaki N, Inokuma T, et al. In vivo assessment of glucose metabolism in hepatocellular carcinoma with FDG-PET. J Nucl Med 1995;36:1811-1817.
  22. Messa C, Choi Y, Hoh CK, et al. Quantification of glucose utilization in liver metastases: parametric imaging of FDG uptake with PET. J Comput Assist Tomogr 1992;16:684-689. https://doi.org/10.1097/00004728-199209000-00003
  23. Yoon KT, Kim JK, Kim do Y, et al. Role of 18F-fluorodeoxyglucose positron emission tomography in detecting extrahepatic metastasis in pretreatment staging of hepatocellular carcinoma. Oncology 2007;72 Suppl 1:104-110. https://doi.org/10.1159/000111715
  24. Song MJ, Bae SH, Yoo IeR, et al. Predictive value of 18F-fluorodeoxyglucose PET/CT for transarterial chemolipiodolization of hepatocellular carcinoma. World J Gastroenterol 2012;18:3215-3222.
  25. Ahn SG, Kim SH, Jeon TJ, et al. The role of preoperative [18F]fluorodeoxyglucose positron emission tomography in predicting early recurrence after curative resection of hepatocellular carcinomas. J Gastrointest Surg 2011;15:2044-2052. https://doi.org/10.1007/s11605-011-1660-1
  26. Kim BK, Kang WJ, Kim JK, et al. 18F-fluorodeoxyglucose uptake on positron emission tomography as a prognostic predictor in locally advanced hepatocellular carcinoma. Cancer 2011;117:4779-4787. https://doi.org/10.1002/cncr.26099
  27. Seo S, Hatano E, Higashi T, et al. Fluorine-18 fluorodeoxyglucose positron emission tomography predicts tumor differentiation, P-glycoprotein expression, and outcome after resection in hepatocellular carcinoma. Clin Cancer Res 2007;13(2 Pt 1):427-433. https://doi.org/10.1158/1078-0432.CCR-06-1357

Cited by

  1. Transcatheter arterial chemoembolization as an examination method for hepatocellular carcinoma undetected by B-mode ultrasound, computed tomography and digital subtratcion angiography: A case report vol.10, pp.3, 2015, https://doi.org/10.3892/ol.2015.3446
  2. Prognostic value of pre-treatment F-18-FDG PET-CT in patients with hepatocellular carcinoma undergoing radioembolization vol.22, pp.47, 2015, https://doi.org/10.3748/wjg.v22.i47.10406
  3. Prognostic Significance of 18F-FDG Uptake in Hepatocellular Carcinoma Treated with Transarterial Chemoembolization or Concurrent Chemoradiotherapy: A Multicenter Retrospective Cohort Study vol.57, pp.4, 2016, https://doi.org/10.2967/jnumed.115.167338
  4. Prognostic Value of FDG Uptake of Portal Vein Tumor Thrombosis in Patients With Locally Advanced Hepatocellular Carcinoma vol.42, pp.1, 2017, https://doi.org/10.1097/rlu.0000000000001422
  5. Clinical usefulness of FDG-PET in patients with hepatocellular carcinoma undergoing surgical resection vol.21, pp.4, 2015, https://doi.org/10.14701/ahbps.2017.21.4.194
  6. 18F-fluorodeoxyglucose uptake of hepatocellular carcinoma as a prognostic predictor in patients with sorafenib treatment vol.45, pp.3, 2015, https://doi.org/10.1007/s00259-017-3871-5
  7. Signature of survival: a 18 F-FDG PET based whole-liver radiomic analysis predicts survival after 90 Y-TARE for hepatocellular carcinoma vol.9, pp.4, 2018, https://doi.org/10.18632/oncotarget.23423
  8. Combined therapy of transarterial chemoembolization and stereotactic body radiation therapy versus transarterial chemoembolization for ≤5cm hepatocellular carcinoma: Propensity score matching analysi vol.13, pp.10, 2015, https://doi.org/10.1371/journal.pone.0206381
  9. 18 F-fludeoxyglucose positron emission tomography for diagnosis of HCC: implications for therapeutic strategy in curative and non-curative approaches vol.12, pp.None, 2019, https://doi.org/10.1177/1756284819836205
  10. Emerging role of 18 F-fluorodeoxyglucose positron emission tomography for guiding management of hepatocellular carcinoma vol.25, pp.11, 2015, https://doi.org/10.3748/wjg.v25.i11.1289