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Volumetric parameters on FDG PET can predict early intrahepatic recurrence-free survival in patients with hepatocellular carcinoma after curative surgical resection

  • Jeong Won Lee
  • Sang Hyun Hwang
  • Hyun Jeong Kim
  • Dongwoo Kim
  • Arthur Cho
  • Mijin YunEmail author
Original Article

Abstract

Purpose

This study assessed the prognostic values of volumetric parameters on 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in predicting early intrahepatic recurrence-free survival (RFS) after curative resection in patients with hepatocellular carcinoma (HCC).

Methods

A retrospective analysis was performed on 242 patients with HCC who underwent staging FDG PET and subsequent curative surgical resection. The tumor-to-non-tumorous liver uptake ratio, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the HCC lesions on PET were measured. The prognostic values of clinical factors and PET parameters for predicting overall RFS, overall survival (OS), extrahepatic RFS, and early and late intrahepatic RFS were assessed.

Results

The median follow-up period was 54.7 months, during which 110 patients (45.5%) experienced HCC recurrence and 62 (25.6%) died. Patients with extrahepatic and early intrahepatic recurrence showed worse OS than did those with no recurrence or late intrahepatic recurrence (p < 0.001). Serum bilirubin level, MTV, and TLG were independent prognostic factors for overall RFS and OS (p < 0.05). Only MTV and TLG were prognostic for extrahepatic RFS (p < 0.05). Serum alpha-fetoprotein and bilirubin levels, MTV, and TLG were prognostic for early intrahepatic RFS (p < 0.05) and hepatitis C virus (HCV) positivity and serum albumin level were independently prognostic for late intrahepatic RFS (p < 0.05).

Conclusion

Intrahepatic recurrence showed different prognoses according to the time interval of recurrence in which early recurrence had as poor survival as extrahepatic recurrence. MTV and TLG on initial staging PET were significant independent factors for predicting early intrahepatic and extrahepatic RFS in patients with HCC after curative resection. Only HCV positivity and serum albumin level were significant for late intrahepatic RFS, which is mainly attributable to the de novo formation of new primary HCC.

Keywords

Hepatocellular carcinoma Recurrence Prognosis FDG PET Metabolic tumor volume 

Notes

Compliance with ethical standards

Funding

This work was supported by National Research Foundation of Korea grants funded by the Korean government (MSIP; NRF-2011-0030086 and NRF-2016R1E1A1A01943303), and the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Science, ICT, and Future Planning (2012R1A1A3008042).

Conflict of interest

Jeong Won Lee declares that he has no conflict of interest.

Sang Hyun Hwang declares that he has no conflict of interest.

Hyun Jeong Kim declares that she has no conflict of interest.

Dongwoo Kim declares that he has no conflict of interest.

Arthur Cho declares that he has no conflict of interest.

Mijin Yun declares that she has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

The institutional review board of our university approved this retrospective study, and the requirement to obtain informed consent was waived.

Supplementary material

259_2017_3764_Fig3_ESM.gif (468 kb)
Supplementary Fig. 1

FDG PET/CT images of a 32-year-old woman with a single HCC showing an example of the measurement of MTV. PET and contrast-enhanced liver CT images were co-registered using a fusion module in viewer software. Three 1-cm-sized VOIs were drawn in the non-tumorous liver tissue on transxial FDG PET (a) and fused PET/CT images (b) and mean and standard deviation of SUV of non-tumorous liver tissue were measured. Afterwards, a VOI was drawn over the HCC lesion on FDG PET (c) and fused PET/CT images (d) along the rim of HCC lesion seen on the arterial or portal phase of contrast-enhanced CT images (e), and maximum and mean SUV of the HCC lesion were calculated. Voxels above an SUV of the 97.5th percentile of the non-tumorous liver tissue were automatically computed on FDG PET (f), fused PET/CT (g), and contrast-enhanced CT (h) images and the sum of volume of those voxels was calculated and defined as MTV. The present patient had a MTV of 22.2 cm3 and a TLG of 64.5 g and experienced intrahepatic recurrence 9.4 months after curative surgical resection. (GIF 467 kb)

259_2017_3764_MOESM1_ESM.tif (6.4 mb)
High-resolution image (TIFF 6529 kb)
259_2017_3764_MOESM2_ESM.docx (16 kb)
Supplementary Table 1 (DOCX 16 kb)

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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Jeong Won Lee
    • 1
  • Sang Hyun Hwang
    • 2
  • Hyun Jeong Kim
    • 2
  • Dongwoo Kim
    • 2
  • Arthur Cho
    • 2
  • Mijin Yun
    • 2
    Email author
  1. 1.Department of Nuclear MedicineCatholic Kwandong University College of MedicineIncheonSouth Korea
  2. 2.Department of Nuclear MedicineYonsei University College of MedicineSeoulSouth Korea

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