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

Annals of Surgical Oncology volume 25, pages 542–549 (2018)Cite this article

Abstract

Background

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.

Methods

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.

Results

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).

Conclusion

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.

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Disclosures

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.

Funding

No financial support was received for this work.

Author information

Affiliations

  1. Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Tomoaki Yoh MD, Satoru Seo MD, PhD, Satoshi Ogiso MD, PhD, Takayuki Kawai MD, PhD, Yukihiro Okuda MD, PhD, Takamichi Ishii MD, PhD, Kojiro Taura MD, PhD, Toshimi Kaido MD, PhD & Shinji Uemoto MD, PhD

  2. National Institute of Radiological Sciences, National Institutes of Quantum and Radiological Science and Technology, Chiba, Japan

    Tatsuya Higashi MD, PhD

  3. Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, Japan

    Yuji Nakamoto MD, PhD

  4. Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan

    Etsuro Hatano MD, PhD

Authors
  1. Tomoaki Yoh MD
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  2. Satoru Seo MD, PhD
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  3. Satoshi Ogiso MD, PhD
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  4. Takayuki Kawai MD, PhD
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  5. Yukihiro Okuda MD, PhD
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  6. Takamichi Ishii MD, PhD
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  7. Kojiro Taura MD, PhD
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  8. Tatsuya Higashi MD, PhD
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  10. Etsuro Hatano MD, PhD
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  11. Toshimi Kaido MD, PhD
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  12. Shinji Uemoto MD, PhD
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Corresponding author

Correspondence to Satoru Seo MD, PhD.

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Yoh, T., Seo, S., Ogiso, S. et al. Proposal of a New Preoperative Prognostic Model for Solitary Hepatocellular Carcinoma Incorporating 18F-FDG-PET Imaging with the ALBI Grade. Ann Surg Oncol 25, 542–549 (2018). https://doi.org/10.1245/s10434-017-6262-z

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  • DOI: https://doi.org/10.1245/s10434-017-6262-z

Keywords

  • ALBI Grade
  • Prognostic Model
  • Child-Pugh Grade
  • Japan Integrated Staging Score
  • Transcatheter Arterial Chemoembolization (TACE)