Abstract
Purpose
To compare the value of pretreatment functional and morphological imaging parameters for predicting survival in patients undergoing transarterial radioembolization using yttrium-90 (90Y-TARE) for unresectable hepatocellular carcinoma (uHCC).
Methods
We analysed data from 48 patients in our prospective database undergoing 90Y-TARE treatment for uHCC (31 resin, 17 glass). All patients underwent 18F-FDG PET/CT and morphological imaging (CT and MRI scans) as part of a pretherapeutic work-up. Patients did not receive any treatment between these imaging procedures and 90Y-TARE. Kaplan-Meier estimates of progression-free survival (PFS) and overall survival (OS) were used to assess the prognostic value of 18F-FDG PET/CT metabolic parameters, including SUVmax, tumour-to-liver (T/L) uptake ratio and SUVmean of healthy liver, and morphological data, including number and size of lesions, portal-venous infiltration (PVI). Relevant prognostic factors for HCC including Child-Pugh class, Barcelona Clinic Liver Cancer (BCLC) stage, tumour size, PVI and serum AFP level were compared with metabolic parameters in univariate and multivariate analyses.
Results
The median follow-up in living patients was 16.2 months (range 11.4–50.1 months). Relapse occurred in 34 patients (70.8%) at a median of 7.4 months (range 1.4–27.9 months) after 90Y-TARE, and relapse occurred in 24 of 34 patients (70.8%) who died from their disease at a median of 8.1 months (range 2.2–35.2 months). Significant prognostic markers for PFS were the mean and median lesion SUVmax (both P = 0.01; median PFS 10.2 vs. 7.4 months), and significant prognostic markers for OS were the first quarter (Q1) cut-off values for lesion SUVmax and T/L uptake ratio (both P = 0.02; median OS 30.9 vs. 9 months). The multivariate analysis confirmed that lesion SUVmax and T/L uptake ratio were independent negative predictors of PFS (hazard ratio, HR, 2.7, 95% CI 1.2–6.1, P = 0.02, for mean SUVmax; HR 2.6, 95% CI 1.1–5.9, P = 0.02, for median SUVmax:) and OS (HR 3.2, 95% CI 1–10.9, P = 0.04 for Q1 SUVmax; HR 3.7, 95% CI 1.1–12.2, P = 0.03, for Q1 T/L uptake ratio), respectively, when testing with either the BCLC staging system or serum AFP level.
Conclusion
Lesion SUVmax and T/L uptake ratio as assessed by 18F-FDG PET/CT, but not morphological imaging, were predictive markers of survival in patients undergoing 90Y-TARE for uHCC.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00259-017-3653-0/MediaObjects/259_2017_3653_Fig1_HTML.gif)
Similar content being viewed by others
References
Wallace MC, Preen D, Jeffrey GP, Adams LA. The evolving epidemiology of hepatocellular carcinoma: a global perspective. Expert Rev Gastroenterol Hepatol. 2015;9:765–779.
Taylor I, Bennett R, Sherriff S. The blood supply of colorectal liver metastases. Br J Cancer. 1978;38:749–756.
Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92:205–216.
Larson SM, Schwartz LH. 18F-FDG PET as a candidate for “qualified biomarker”: functional assessment of treatment response in oncology. J Nucl Med. 2006;47:901–903.
Murray KF, Carithers RL, AASLD. AASLD practice guidelines: evaluation of the patient for liver transplantation. Hepatology. 2005;41:1407–1432.
Llovet JM, Brú C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis. 1999;19:329–338.
Gnesin S, Canetti L, Adib S, Cherbuin N, Silva Monteiro M, Bize P, et al. Partition model-based 99mTc-MAA SPECT/CT predictive dosimetry compared with 90Y TOF PET/CT posttreatment dosimetry in radioembolization of hepatocellular carcinoma: a quantitative agreement comparison. J Nucl Med. 2016;57:1672–1678.
Van Der Gucht A, Jreige M, Denys A, Blanc-Durand P, Boubaker A, Pomoni A, et al. Resin versus glass microspheres for yttrium-90 transarterial radioembolization: comparing survival in unresectable hepatocellular carcinoma using pretreatment partition model dosimetry. J Nucl Med. 2017. doi:10.2967/jnumed.116.184713.
Bagni O, Filippi L, Schillaci O. The role of 18F-FDG positron emission tomography in the follow-up of liver tumors treated with 90Yttrium radioembolization. Am J Nucl Med Mol Imaging. 2015;5:220–232.
Sun DW, An L, Wei F, Mu L, Shi XJ, Wang CL, et al. Prognostic significance of parameters from pretreatment (18)F-FDG PET in hepatocellular carcinoma: a meta-analysis. Abdom Radiol (NY). 2016;41:33–41.
Riedl CC, Akhurst T, Larson S, Stanziale SF, Tuorto S, Bhargava A, et al. 18F-FDG PET scanning correlates with tissue markers of poor prognosis and predicts mortality for patients after liver resection for colorectal metastases. J Nucl Med. 2007;48:771–775.
Wong CO, Salem R, Raman S, Gates VL, Dworkin HJ. Evaluating 90Y-glass microsphere treatment response of unresectable colorectal liver metastases by [18F] FDG PET: a comparison with CT or MRI. Eur J Nucl Med Mol Imaging. 2002;29:815–820.
Pöpperl G, Helmberger T, Münzing W, Schmid R, Jacobs TF, Tatsch K. Selective internal radiation therapy with SIR-Spheres in patients with nonresectable liver tumors. Cancer Biother Radiopharm. 2005;20:200–208.
Szyszko T, Al-Nahhas A, Canelo R, Habib N, Jiao L, Wasan H, et al. Assessment of response to treatment of unresectable liver tumours with 90Y microspheres: value of FDG PET versus computed tomography. Nucl Med Commun. 2007;28:15–20.
Haug AR, Heinemann V, Bruns CJ, Hoffmann R, Jakobs T, Bartenstein P, et al. 18F-FDG PET independently predicts survival in patients with cholangiocellular carcinoma treated with 90Y microspheres. Eur J Nucl Med Mol Imaging. 2011;38:1037–1045.
Soydal C, Keskin O, Kucuk ON, Ozkan E, Bilgic S, Idilman R, et al. Prognostic factors for prediction of survival of hepatocellular cancer patients after selective internal radiation therapy. Ann Nucl Med. 2015;29:426–430.
Zerizer I, Al-Nahhas A, Towey D, Tait P, Ariff B, Wasan H, et al. The role of early 18F-FDG PET/CT in prediction of progression-free survival after Y radioembolization: comparison with RECIST and tumour density criteria. Eur J Nucl Med Mol Imaging. 2012;39:1391–1399.
Zalom M, Yu R, Friedman M, Bresee C, Waxman A. FDG PET/CT as a prognostic test after 90Y radioembolization in patients with metastatic hepatic disease. Clin Nucl Med. 2012;37:862–865.
Izuishi K, Yamamoto Y, Mori H, Kameyama R, Fujihara S, Masaki T, et al. Molecular mechanisms of [18F]fluorodeoxyglucose accumulation in liver cancer. Oncol Rep. 2014;31:701–706.
Pant V, Sen IB, Soin AS. Role of 18F-FDG PET CT as an independent prognostic indicator in patients with hepatocellular carcinoma. Nucl Med Commun. 2013;34:749–757.
He Y, Guo Q. Clinical applications and advances of positron emission tomography with fluorine-18-fluorodeoxyglucose (18F-FDG) in the diagnosis of liver neoplasms. Postgrad Med J. 2008;84:246–251.
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. doi:10.2967/jnumed.116.182022.
Kucuk ON, Soydal C, Araz M, Bilgic S, Ibis E. Prognostic importance of 18F-FDG uptake pattern of hepatocellular cancer patients who received SIRT. Clin Nucl Med. 2013;38:e283–e289.
Sabet A, Ahmadzadehfar H, Bruhman J, Sabet A, Meyer C, Wasmuth J-C, et al. Survival in patients with hepatocellular carcinoma treated with 90Y-microsphere radioembolization. Prediction by 18F-FDG PET. Nuklearmedizin. 2014;53:39–45.
Sangro B, Carpanese L, Cianni R, Golfieri R, Gasparini D, Ezziddin S, et al. Survival after yttrium-90 resin microsphere radioembolization of hepatocellular carcinoma across Barcelona Clinic Liver Cancer stages: a European evaluation. Hepatology. 2011;54(3):868–878.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
The procedure followed was in accordance with the ethical standards and guidelines of the responsible committee on human experimentation.
Conflicts of interest
None.
Additional information
All authors approved the manuscript, and agree with its submission to the EJNMMI.
Rights and permissions
About this article
Cite this article
Jreige, M., Mitsakis, P., Van Der Gucht, A. et al. 18F-FDG PET/CT predicts survival after 90Y transarterial radioembolization in unresectable hepatocellular carcinoma. Eur J Nucl Med Mol Imaging 44, 1215–1222 (2017). https://doi.org/10.1007/s00259-017-3653-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00259-017-3653-0