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Predictors of Macrovascular Invasion and Extrahepatic Metastasis in Treatment Naive Hepatocellular Carcinoma: When Is [18F] FDG PET/CT Relevant?

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Abstract

Purpose

Hypermetabolic macrovascular invasion (MVI) and extrahepatic metastasis (EHM) occur in aggressive hepatocellular carcinoma (HCC) and carry unfavorable prognosis. [18F] FDG PET/CT, despite having low sensitivity in primary HCC, is valuable in patients with aggressive HCC for detection of hypermetabolic MVI and EHM. The study aimed at identifying the parameters that could predict hypermetabolic MVI and/or EHM in treatment naive HCC patients for tailored approach to utilize [18F] FDG PET/CT.

Methods

Data of 131 treatment naive HCC patients (median age, 60 years; range, 21–80 years; 90.8% males) who underwent [18F] FDG PET/CT were retrospectively analyzed to determine the proportion of patients with hypermetabolic MVI and/or EHM. Logistic regression analysis was performed to define independent predictors of hypermetabolic MVI and/or EHM.

Results

78/131 (59.5%) patients had hypermetabolic MVI and/or EHM. 52/131 (39.7%) patients had EHM. 56/131 (42.7%) patients had hypermetabolic MVI of which, 30 had concomitant EHM with majority (90%; 27/30) having distant metastasis. 26/131 (19.8%) patients had hypermetabolic MVI without EHM while 22/131 (16.8%) patients had EHM without hypermetabolic MVI of which, majority (95.5%; 21/22) had distant metastasis. Hypermetabolic MVI was associated with EHM (χ2 = 7.868; p value = 0.007). AFP > 93.7 ng/ml, SUVmax > 3.5, and maximum tumor size > 5.0 cm were the independent predictors of hypermetabolic MVI and/or EHM.

Conclusion

In treatment naive HCC patients with AFP > 93.7 ng/ml or maximum tumor size > 5.0 cm, [18F] FDG PET/CT can be valuable.

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Data Availability

Original raw data is available on reasonable request to the corresponding author.

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Acknowledgements

We would like to thank Dr. Shiv Kumar Sarin, Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi for providing overall administrative, technical, and material support.

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Authors and Affiliations

  1. Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India

    Khangembam Bangkim Chandra

  2. Department of Nuclear Medicine, National Cancer Institute, All India Institute of Medical Sciences, New Delhi, India

    Abhinav Singhal

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  1. Khangembam Bangkim Chandra
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Contributions

Both authors contributed to the study concept and design, scan review, data mining, data entry, and analysis. The first draft of the manuscript was written by Khangembam Bangkim Chandra while proofreading and editing of the draft manuscript was performed by Abhinav Singhal. Both authors read and approved the final manuscript.

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Correspondence to Abhinav Singhal.

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Conflict of Interest

Khangembam Bangkim Chandra and Abhinav Singhal declare no conflict of interest.

Ethical Statement

All procedures involving human participants were in accordance with the Declaration of Helsinki 1964 as revised in 2013 and its later amendments or comparable ethical standards. The Institutional Ethics Committee, Institute of Liver and Biliary Sciences, New Delhi, approved the retrospective study (ref no: IEC/2019/69/MA03).

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The Institutional Ethics Committee waived the requirement for informed written consent.

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Chandra, K.B., Singhal, A. Predictors of Macrovascular Invasion and Extrahepatic Metastasis in Treatment Naive Hepatocellular Carcinoma: When Is [18F] FDG PET/CT Relevant?. Nucl Med Mol Imaging 55, 293–301 (2021). https://doi.org/10.1007/s13139-021-00714-6

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  • DOI: https://doi.org/10.1007/s13139-021-00714-6

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