18F–fluorodeoxyglucose uptake of hepatocellular carcinoma as a prognostic predictor in patients with sorafenib treatment
- 663 Downloads
Sorafenib, an oral multikinase inhibitor, is a recommended treatment option available for patients with Barcelona Clinic Liver Cancer (BCLC)-C stage hepatocellular carcinoma (HCC). This study aimed to evaluate the performance of 18F–fluorodeoxyglucose positron emission tomography (18F–FDG PET) for predicting tumour progression during sorafenib treatment.
We formed a retrospective cohort comprising patients treated with sorafenib for at least 30 days and undergoing 18F–FDG PET/CT within 1 month before treatment. For statistical analyses, the tumour-to-liver standardised uptake value (SUV) ratio (TLR) of the most hypermetabolic lesion was measured.
Among a total of 35 patients, two obtained partial remission, and 11 showed stable disease after the first response evaluation. Patients with a TLR ≥ 2.9 (n = 17) had a median overall survival (OS) of 3.7 months after sorafenib treatment, whereas patients with a TLR < 2.9 (n = 18) had median OS of 12.2 months (P < 0.001), although the disease control rate was not significantly different between the two groups. Pretreatment TLR ≥ 2.9 (hazard ratio [HR] = 6.318, P = 0.002) and Child-Pugh class B (HR = 4.316, P = 0.044) were poor prognostic factors for OS, and a TLR ≥ 2.9 (HR = 2.911, P = 0.024) was the only poor prognostic factor for progression-free survival in a multivariate analysis.
Pretreatment tumour metabolic activity assessed by 18F–FDG PET is an independent prognostic factor for survival in patients with BCLC-C stage HCC receiving sorafenib monotherapy, although it may not predict tumour response to the treatment.
Keywords18F–FDG pet Prognosis Sorafenib Tumour response Time to progression
This work was supported by Research Fund of Seoul St. Mary’s Hospital, The Catholic University of Korea. This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (2017R1A2B4010197).
Compliance with ethical standards
Conflict of interests
There are no conflicts of interest in this study.
Ethics approval was provided by the Institutional Ethics Review Board of The Catholic University of Korea (KC17RESI0241).
- 3.Na SJ, Oh JK, Hyun SH, Lee JW, Hong IK, Song BI, et al. 18F-FDG PET/CT can predict survival of advanced hepatocellular carcinoma patients: a multicenter retrospective cohort study. J Nucl Med. 2016. https://doi.org/10.2967/jnumed.116.182022.
- 7.Cheng AL, Kang YK, Chen Z, Tsao CJ, Qin S, Kim JS, et al. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol. 2009;10:25–34. https://doi.org/10.1016/S1470-2045(08)70285-7.CrossRefPubMedGoogle Scholar
- 12.Hyun SH, Eo JS, Lee JW, Choi JY, Lee KH, Na SJ, et al. Prognostic value of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with Barcelona clinic liver cancer stages 0 and a hepatocellular carcinomas: a multicenter retrospective cohort study. Eur J Nucl Med Mol Imaging. 2016;43:1638–45. https://doi.org/10.1007/s00259-016-3348-y.CrossRefPubMedGoogle Scholar
- 16.Kornberg A, Kupper B, Thrum K, Katenkamp K, Steenbeck J, Sappler A, et al. Increased 18F-FDG uptake of hepatocellular carcinoma on positron emission tomography independently predicts tumor recurrence in liver transplant patients. Transplant Proc. 2009;41:2561–3. https://doi.org/10.1016/j.transproceed.2009.06.115.CrossRefPubMedGoogle Scholar
- 17.Lee JW, Yun M, Cho A, Han KH, Kim DY, Lee SM, et al. The predictive value of metabolic tumor volume on FDG PET/CT for transarterial chemoembolization and transarterial chemotherapy infusion in hepatocellular carcinoma patients without extrahepatic metastasis. Ann Nucl Med. 2015;29:400–8. https://doi.org/10.1007/s12149-015-0956-8.CrossRefPubMedGoogle Scholar
- 18.Kim MJ, Kim YS, Cho YH, Jang HY, Song JY, Lee SH, et al. Use of (18)F-FDG PET to predict tumor progression and survival in patients with intermediate hepatocellular carcinoma treated by transarterial chemoembolization. Korean J Intern Med. 2015;30:308–15. https://doi.org/10.3904/kjim.2015.30.3.308.CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Lee JW, Oh JK, Chung YA, Na SJ, Hyun SH, Hong IK, et al. Prognostic significance of (1)(8)F-FDG uptake in Hepatocellular carcinoma treated with Transarterial Chemoembolization or concurrent Chemoradiotherapy: a multicenter retrospective cohort study. J Nucl Med. 2016;57:509–16. https://doi.org/10.2967/jnumed.115.167338.CrossRefPubMedGoogle Scholar
- 22.Jreige M, Mitsakis P, Van Der Gucht A, Pomoni A, Silva-Monteiro M, Gnesin S, et al. 18F-FDG PET/CT predicts survival after 90Y transarterial radioembolization in unresectable hepatocellular carcinoma. Eur J Nucl Med Mol Imaging 2017. https://doi.org/10.1007/s00259-017-3653-0.
- 23.Hartenbach M, Weber S, Albert NL, Hartenbach S, Hirtl A, Zacherl MJ, et al. Evaluating treatment response of Radioembolization in intermediate-stage Hepatocellular carcinoma patients using 18F-Fluoroethylcholine PET/CT. J Nucl Med. 2015;56:1661–6. https://doi.org/10.2967/jnumed.115.158758.CrossRefPubMedGoogle Scholar
- 24.Sabet A, Ahmadzadehfar H, Bruhman J, Sabet A, Meyer C, Wasmuth JC, et al. Survival in patients with hepatocellular carcinoma treated with 90Y-microsphere radioembolization. Prediction by 18F-FDG PET. Nuklearmedizin. 2014;53:39–45. https://doi.org/10.3413/Nukmed-0622-13-09.CrossRefPubMedGoogle Scholar
- 28.Song DS, Song MJ, Bae SH, Chung WJ, Jang JY, Kim YS, et al. A comparative study between sorafenib and hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis. J Gastroenterol. 2015;50:445–54. https://doi.org/10.1007/s00535-014-0978-3.CrossRefPubMedGoogle Scholar
- 29.Edeline J, Boucher E, Rolland Y, Vauleon E, Pracht M, Perrin C, et al. Comparison of tumor response by response evaluation criteria in solid Tumors (RECIST) and modified RECIST in patients treated with sorafenib for hepatocellular carcinoma. Cancer. 2012;118:147–56. https://doi.org/10.1002/cncr.26255.CrossRefPubMedGoogle Scholar