Seo Satoru, Hatano Etsuro, Higashi Tatsuya, Hara Tadashi, Tada Masaharu, Tamaki Nobuyuki, Iwaisako Keiko, Ikai Iwao, Uemoto Shinji
Department of Surgery and Diagnostic Imaging, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Syogoin, Sakyo-ku, Kyoto 606-8507, Japan.
Clin Cancer Res. 2007 Jan 15;13(2 Pt 1):427-33. doi: 10.1158/1078-0432.CCR-06-1357.
To investigate the diagnostic value of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) for prediction of tumor differentiation, P-glycoprotein (P-gp) expression, and outcome in hepatocellular carcinoma (HCC) patients.
Seventy HCC patients who underwent curative resection were prospectively enrolled in the study. FDG-PET was done 2 weeks preoperatively, and the standardized uptake value (SUV) and the tumor to nontumor SUV ratio (TNR) were calculated from FDG uptake. Tumor differentiation and P-gp expression were examined with H&E and immunohistochemical staining, respectively.
SUV and TNR were significantly higher in poorly differentiated HCCs than in well-differentiated (P = 0.001 and 0.002) and moderately differentiated HCCs (P < 0.0001 and P < 0.0001). The percentage P-gp-positive area was significantly higher in well-differentiated HCCs than in poorly differentiated (P < 0.0001) and moderately differentiated HCCs (P = 0.0001). Inverse correlations were found between SUV and P-gp expression (r = -0.44; P < 0.0001) and between TNR and P-gp expression (r = -0.47; P = 0.01). Forty-three (61.4%) patients had postoperative recurrence. The overall and disease-free survival rates in the high TNR (> or =2.0) group were significantly lower than in the low TNR (<2.0) group (P = 0.0001 and 0.0002). In multivariate analysis, a high alpha-fetoprotein level (risk ratio, 5.46; P = 0.003; risk ratio, 8.78; P = 0.006) and high TNR (risk ratio, 1.3; P = 0.03; risk ratio, 1.6; P = 0.02) were independent predictors of postoperative recurrence and overall survival.
The results suggest that preoperative FDG-PET reflects tumor differentiation and P-gp expression and may be a good predictor of outcome in HCC.
探讨氟-18氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）对预测肝细胞癌（HCC）患者肿瘤分化、P-糖蛋白（P-gp）表达及预后的诊断价值。
前瞻性纳入70例行根治性切除术的HCC患者。术前2周进行FDG-PET检查，根据FDG摄取计算标准化摄取值（SUV）和肿瘤与非肿瘤SUV比值（TNR）。分别采用苏木精-伊红（H&E）染色和免疫组化染色检测肿瘤分化和P-gp表达。
低分化HCC的SUV和TNR显著高于高分化HCC（P = 0.001和0.002）及中分化HCC（P < 0.0001和P < 0.0001）。高分化HCC的P-gp阳性面积百分比显著高于低分化HCC（P < 0.0001）和中分化HCC（P = 0.0001）。发现SUV与P-gp表达之间呈负相关（r = -0.44；P < 0.0001），TNR与P-gp表达之间也呈负相关（r = -0.47；P = 0.01）。43例（61.4%）患者术后复发。高TNR（≥2.0）组的总生存率和无病生存率显著低于低TNR（<2.0）组（P = 0.0001和0.0002）。多因素分析显示，高甲胎蛋白水平（风险比，5.46；P = 0.003；风险比，8.78；P = 0.006）和高TNR（风险比，1.3；P = 0.03；风险比，1.6；P = 0.02）是术后复发和总生存的独立预测因素。
结果表明术前FDG-PET可反映肿瘤分化和P-gp表达，可能是HCC预后的良好预测指标。
