Annals of Surgical Oncology

, Volume 25, Issue 2, pp 542–549 | Cite as

Proposal of a New Preoperative Prognostic Model for Solitary Hepatocellular Carcinoma Incorporating 18F-FDG-PET Imaging with the ALBI Grade

  • Tomoaki Yoh
  • Satoru SeoEmail author
  • Satoshi Ogiso
  • Takayuki Kawai
  • Yukihiro Okuda
  • Takamichi Ishii
  • Kojiro Taura
  • Tatsuya Higashi
  • Yuji Nakamoto
  • Etsuro Hatano
  • Toshimi Kaido
  • Shinji Uemoto
Hepatobiliary Tumors



Existing prognostic systems were not developed using only objective variables available preoperatively, and therefore do not provide ideal prognostication for patients undergoing hepatectomy for hepatocellular carcinoma (HCC). We aimed to develop a preoperative prognostic model using objective variables involving two parameters: 18F-fluorodeoxyglucose-positron emission tomography (18F-FDG-PET) and the albumin-bilirubin (ALBI) grade.


This study included 207 consecutive patients with solitary HCC who underwent 18F-FDG-PET prior to hepatectomy. The tumor to non-tumor maximum standardized uptake value ratio (TNR) was used as an 18F-FDG PET imaging parameter.


The 5-year overall survival (OS) and disease-free survival (DFS) rates were 58.6% and 28.8%, respectively. Multivariate analysis of OS identified TNR ≥ 2 (hazard ratio [HR] 1.743, 95% confidence interval [CI] 1.114–2.648, p = 0.016) and ALBI grade 2 (HR 1.966, 95% CI 1.349–2.884, p < 0.001) as the only significant prognostic factors; tumor diameter and tumor markers were not significant. Patients were divided into low- (TNR < 2 and ALBI grade 1), intermediate- (TNR < 2 and ALBI grade 2, or TNR ≥ 2 and ALBI grade 1), and high-risk (TNR ≥ 2 and ALBI grade 2) groups, which differed significantly in terms of survival (5-year OS: 75.7, 49.6, and 27.3%, respectively, p < 0.001; 5-year DFS: 37.0, 24.9, and 13.6%, respectively, p < 0.001). Compared with other staging systems, our model had the best discriminatory ability (corrected Akaike information criteria 1054.8, p < 0.001) and homogeneity (likelihood ratio Chi square value 27.6, p < 0.001).


A preoperative prognostic model incorporating 18F-FDG-PET imaging with the ALBI grade may be useful for estimating the prognosis of selected patients with solitary HCC.



Tomoaki Yoh, Satoru Seo, Satoshi Ogiso, Takayuki Kawai, Yukihiro Okuda, Takamichi Ishii, Kojiro Taura, Tatsuya Higashi, Yuji Nakamoto, Etsuro Hatano, Toshimi Kaido, and Shinji Uemoto have no conflicts of interest to declare in relation to this article.


No financial support was received for this work.

Supplementary material

10434_2017_6262_MOESM1_ESM.docx (269 kb)
Supplementary material 1 (DOCX 270 kb)


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Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Tomoaki Yoh
    • 1
  • Satoru Seo
    • 1
    Email author
  • Satoshi Ogiso
    • 1
  • Takayuki Kawai
    • 1
  • Yukihiro Okuda
    • 1
  • Takamichi Ishii
    • 1
  • Kojiro Taura
    • 1
  • Tatsuya Higashi
    • 2
  • Yuji Nakamoto
    • 3
  • Etsuro Hatano
    • 4
  • Toshimi Kaido
    • 1
  • Shinji Uemoto
    • 1
  1. 1.Department of Surgery, Graduate School of MedicineKyoto UniversityKyotoJapan
  2. 2.National Institute of Radiological SciencesNational Institutes of Quantum and Radiological Science and TechnologyChibaJapan
  3. 3.Department of Diagnostic Imaging and Nuclear MedicineKyoto UniversityKyotoJapan
  4. 4.Department of SurgeryHyogo College of MedicineNishinomiyaJapan

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