Satoshi Takeuchi1,2, Eric M Rohren2,3, Reham Abdel-Wahab4,5, Lianchun Xiao6, Jeffrey S Morris6, Homer A Macapinlac2, Manal M Hassan3, Ahmed O Kaseb7,8. 1. Department of Medical Oncology, Hokkaido University Graduate School of Medicine, North 15 West 7 Kita-ku, Sapporo, Japan. 2. Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1483, Houston, TX, 77030, USA. 3. Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA. 4. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 426, Houston, TX, 77030, USA. 5. Clinical Oncology Department, Assiut University Hospital, Al Hamraa Ath Thaneyah, Qesm Than Asyut, Assiut, Egypt. 6. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1411, Houston, TX, 77030, USA. 7. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 426, Houston, TX, 77030, USA. akaseb@mdanderson.org. 8. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1483, Houston, TX, 77030, USA. akaseb@mdanderson.org.
Abstract
PURPOSE: 18F-fluorodeoxyglucose positron emission tomopraphy/computed tomography (FDGPET/CT) has been proven to be useful for imaging many types of cancer; however, its role is not well defined in hepatocellular carcinoma (HCC). We assessed the prognostic value of metabolic imaging biomarkers as established by baseline pretreatment FDG PET/CT in patients with HCC. METHODS: We retrospectively analyzed the records of patients with HCC who underwent FDG PET/CT before initial treatment from May 2013 through May 2014. Four PET/CT parameters were measured: maximum standardized uptake value (SUVmax), total lesion glycolysis (TLG), metabolic tumor volume (MTV), and tumor-to-normal-liver SUV ratio (TNR). Optimal cut-off values for the PET/CT parameters to stratify patients in terms of overall survival (OS) were determined. Multivariate analysis was performed to determine whether the PET/CT parameters could add to the prognostic value of the Cancer of the Liver Italian Program (CLIP) scoring system and the Barcelona-Clinic Liver Cancer (BCLC) staging system. RESULTS: The analysis included 56 patients. Univariate analysis of the association between OS and continuous variables, including the PET/CT parameters SUVmax, TLG, tumor size, total bilirubin level, and alkaline phosphatase level were significant predictors of OS. SUVmax ≥ 11.7, TLG ≥ 1,341, MTV ≥ 230 mL, and TNR ≥ 4.8 were identified as cut-off values. Multivariate analysis revealed that SUVmax ≥ 11.7 and TNR ≥ 4.8 were independent factors predicting a poor prognosis in both the CLIP scoring system and the BCLC staging system, as was TLG in the BCLC staging system. CONCLUSION: Pretreatment FDG PET/CT in patients with HCC can add to the prognostic value of standard clinical measures. Incorporation of imaging biomarkers derived from FDG PET/CT into HCC staging systems should be considered.
PURPOSE:18F-fluorodeoxyglucose positron emission tomopraphy/computed tomography (FDGPET/CT) has been proven to be useful for imaging many types of cancer; however, its role is not well defined in hepatocellular carcinoma (HCC). We assessed the prognostic value of metabolic imaging biomarkers as established by baseline pretreatment FDG PET/CT in patients with HCC. METHODS: We retrospectively analyzed the records of patients with HCC who underwent FDG PET/CT before initial treatment from May 2013 through May 2014. Four PET/CT parameters were measured: maximum standardized uptake value (SUVmax), total lesion glycolysis (TLG), metabolic tumor volume (MTV), and tumor-to-normal-liver SUV ratio (TNR). Optimal cut-off values for the PET/CT parameters to stratify patients in terms of overall survival (OS) were determined. Multivariate analysis was performed to determine whether the PET/CT parameters could add to the prognostic value of the Cancer of the Liver Italian Program (CLIP) scoring system and the Barcelona-Clinic Liver Cancer (BCLC) staging system. RESULTS: The analysis included 56 patients. Univariate analysis of the association between OS and continuous variables, including the PET/CT parameters SUVmax, TLG, tumor size, total bilirubin level, and alkaline phosphatase level were significant predictors of OS. SUVmax ≥ 11.7, TLG ≥ 1,341, MTV ≥ 230 mL, and TNR ≥ 4.8 were identified as cut-off values. Multivariate analysis revealed that SUVmax ≥ 11.7 and TNR ≥ 4.8 were independent factors predicting a poor prognosis in both the CLIP scoring system and the BCLC staging system, as was TLG in the BCLC staging system. CONCLUSION: Pretreatment FDG PET/CT in patients with HCC can add to the prognostic value of standard clinical measures. Incorporation of imaging biomarkers derived from FDG PET/CT into HCC staging systems should be considered.
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