Prognostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with Barcelona Clinic Liver Cancer stages 0 and A hepatocellular carcinomas: a multicenter retrospective cohort study

  • Seung Hyup Hyun
  • Jae Seon Eo
  • Jeong Won Lee
  • Joon Young Choi
  • Kyung-Han Lee
  • Sae Jung Na
  • Il Ki Hong
  • Jin Kyoung Oh
  • Yong An Chung
  • Bong-Il Song
  • Tae-Sung Kim
  • Kyung Sik Kim
  • Dae Hyuk MoonEmail author
  • Mijin YunEmail author
Original Article



We evaluated the prognostic value of pretreatment 18F-fluorodeoxyglucose positron emission tomography with computed tomography (FDG PET/CT) in patients with Barcelona Clinic Liver Cancer (BCLC) stage 0 or A hepatocellular carcinoma (HCC) who had received curative treatment or transarterial chemoembolization (TACE).


Between 2009 and 2010, 317 patients diagnosed with HCC at seven hospitals were enrolled. Among these, 195 patients underwent curative treatments including resection, liver transplantation, and radiofrequency ablation. TACE was performed in 122 patients. The tumor-to-normal liver standardized uptake value ratio (TLR) of the primary tumor was measured using pretreatment FDG PET/CT. The prognostic significance of TLR and other clinical variables was assessed using Cox regression models. Differences in the overall survival (OS) associated with TLR or other significant clinical factors were examined using the Kaplan-Meier method.


Over a median follow-up period of 46 months, 77 patients died from cancer. In the curative cohort, higher TLR (≥2) was significantly associated with death (hazard ratio [HR] = 2.68; 95 % CI, 1.16–6.15; P = 0.020) in multivariable analysis. Patients with a higher TLR had significantly worse OS than patients with a lower TLR (5-year overall survival, 61 % vs. 79.4 %; P = 0.006). In the TACE cohort, the Model for End-Stage Liver Disease (MELD) score (≥8) was a significant independent prognostic factor for OS (HR = 3.34; 95 % CI, 1.49–7.48; P = 0.003), whereas TLR was not associated with OS. The Kaplan-Meier curves showed significantly poorer OS in patients with higher MELD scores (≥8) than in those with lower MELD scores (5-year survival rate, 33.1 % vs. 79.6 %; P < 0.001).


Pretreatment TLR measured using FDG PET/CT was an independent prognostic factor for OS in patients with BCLC stage 0 or A HCC undergoing curative treatment. In contrast, underlying liver function appeared to be important in predicting the prognosis of patients undergoing TACE.


FDG PET/CT Hepatocellular carcinoma Standardized uptake value Prognosis Multicenter trial 


Compliance with ethical standards


This research was supported by the Korean Society of Nuclear Medicine Clinical Trial Network (KSNM CTN) working group funded by the Korean Society of Nuclear Medicine (KSNM-CTN-2014-02-1) and Korea University (grant no. K1422321).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Informed consent

Written informed consent was waived.

Supplementary material

259_2016_3348_MOESM1_ESM.docx (21 kb)
Table S1 (DOCX 21 kb)
259_2016_3348_MOESM2_ESM.docx (20 kb)
Table S2 (DOCX 20 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Seung Hyup Hyun
    • 1
  • Jae Seon Eo
    • 2
  • Jeong Won Lee
    • 3
  • Joon Young Choi
    • 1
  • Kyung-Han Lee
    • 1
  • Sae Jung Na
    • 4
  • Il Ki Hong
    • 5
  • Jin Kyoung Oh
    • 6
  • Yong An Chung
    • 6
  • Bong-Il Song
    • 7
  • Tae-Sung Kim
    • 8
  • Kyung Sik Kim
    • 9
  • Dae Hyuk Moon
    • 10
    Email author
  • Mijin Yun
    • 11
    Email author
  1. 1.Department of Nuclear Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
  2. 2.Department of Nuclear MedicineKorea University Guro Hospital, Korea University College of MedicineSeoulRepublic of Korea
  3. 3.Department of Nuclear Medicine, International St. Mary’s HospitalCatholic Kwandong University College of MedicineIncheonRepublic of Korea
  4. 4.Department of Nuclear Medicine, Uijeongbu St. Mary’s HospitalThe Catholic University of KoreaSeoulRepublic of Korea
  5. 5.Department of Nuclear MedicineKyung Hee University Hospital, School of Medicine, Kyung Hee UniversitySeoulRepublic of Korea
  6. 6.Department of Nuclear Medicine, Incheon St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaIncheonRepublic of Korea
  7. 7.Department of Nuclear Medicine, Dongsan Medical CenterKeimyung University School of MedicineDaeguRepublic of Korea
  8. 8.Department of Nuclear MedicineResearch Institute and Hospital, National Cancer CenterGoyangRepublic of Korea
  9. 9.Department of SurgeryYonsei University College of MedicineSeoulRepublic of Korea
  10. 10.Department of Nuclear Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  11. 11.Department of Nuclear Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea

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