DOI: 10.1007/s00259-016-3583-2Pages: 969-978

Refining prognosis in patients with hepatocellular carcinoma through incorporation of metabolic imaging biomarkers

1. Hokkaido University Graduate School of Medicine, Department of Medical Oncology

2. The University of Texas MD Anderson Cancer Center, Department of Nuclear Medicine

3. Baylor College of Medicine, Department of Radiology

4. The University of Texas MD Anderson Cancer Center, Department of Gastrointestinal Medical Oncology

5. Assiut University Hospital, Clinical Oncology Department

6. The University of Texas MD Anderson Cancer Center, Department of Biostatistics

7. The University of Texas MD Anderson Cancer Center, Department of Gastrointestinal Medical Oncology

Correspondence to:
Ahmed O. Kaseb
Email: akaseb@mdanderson.org

Close

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.

To access the full text, please Sign in

If you have institutional access, please click here

  • Accepted: Nov 22, 2016
  • Online: Dec 12, 2016

Article Tools

eanm
EJNMMI Ad