Yang Sung Hoon, Suh Kyung-Suk, Lee Hae Won, Cho Eung-Ho, Cho Jai Young, Cho Yong Beom, Yi Nam-Joon, Lee Kuhn Uk
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Liver Transpl. 2006 Nov;12(11):1655-60. doi: 10.1002/lt.20861.
Positron emission tomography (PET) using F-18 fluoro-2-deoxy-d-glucose ((18)F-FDG) is now well established as a noninvasive diagnostic tool for the detection of a variety of malignant tumors. However, in the case of hepatocellular carcinoma (HCC), several investigators have reported controversial conclusions and an inadequate sensitivity for PET (50-55%). Nevertheless, a high positive rate of (18)F-FDG accumulation has been reported in patients with high-grade HCC and in those with markedly elevated alpha-fetoprotein (AFP) levels. Here, we retrospectively reviewed 38 HCC cases that received liver transplantation (LT) at our center between November 2000 and July 2004 and underwent whole-body PET imaging. (18)F-FDG uptake was assessed in the liver, and its prognostic significance was investigated. Of 38 patients enrolled, 13 patients had positive PET scans for a liver tumor. When we analyzed the association between tumor factors and PET+ (greater PET lesion uptake) in the liver, preoperative AFP level and vascular invasion were found to be significantly associated with PET+ (P = 0.003 and P < 0.001, respectively). However, the association between histological grade and PET+ findings did not reach statistical significant difference (P = 0.074). Moreover, the 2-year recurrence-free survival rate of PET- patients was significantly higher than that of PET+ patients (85.1% vs. 46.1%) (P = 0.0005). Of 6 PET+ patients who met the Milan criteria, 4 patients (66.7%) had recurrence, but all 20 PET- patients who met the Milan criteria were recurrence free. Thus, PET imaging could be a good preoperative tool for estimating the post-LT risk of tumor recurrence, because histological grade and vascular invasion cannot be determined preoperatively. Importantly, our results indicate that tumor recurrence can be highly anticipated for PET-imaging-positive HCC patients who satisfy the Milan criteria. We advise that PET+ HCC patients be selected cautiously for LT.
使用F-18氟代-2-脱氧-D-葡萄糖（(18)F-FDG）的正电子发射断层扫描（PET）现已成为检测多种恶性肿瘤的成熟非侵入性诊断工具。然而，对于肝细胞癌（HCC），一些研究者报告了有争议的结论，且PET的敏感性不足（50 - 55%）。尽管如此，在高级别HCC患者和甲胎蛋白（AFP）水平显著升高的患者中，已报告(18)F-FDG摄取的阳性率较高。在此，我们回顾性分析了2000年11月至2004年7月期间在本中心接受肝移植（LT）并进行全身PET成像的38例HCC病例。评估肝脏中(18)F-FDG的摄取情况，并研究其预后意义。在纳入的38例患者中，13例患者肝脏肿瘤的PET扫描呈阳性。当我们分析肿瘤因素与肝脏中PET +（更高的PET病变摄取）之间的关联时，发现术前AFP水平和血管侵犯与PET +显著相关（分别为P = 0.003和P < 0.001）。然而，组织学分级与PET +结果之间的关联未达到统计学显著差异（P = 0.074）。此外，PET阴性患者的2年无复发生存率显著高于PET阳性患者（85.1%对46.1%）（P = 0.0005）。在符合米兰标准的6例PET阳性患者中，4例（66.7%）复发，但所有20例符合米兰标准的PET阴性患者均无复发。因此，PET成像可能是评估LT后肿瘤复发风险的良好术前工具，因为术前无法确定组织学分级和血管侵犯情况。重要的是，我们的结果表明，对于符合米兰标准的PET成像阳性HCC患者，肿瘤复发的可能性很高。我们建议对PET阳性的HCC患者进行LT时要谨慎选择。
