Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Cancer. 2011 Oct 15;117(20):4779-87. doi: 10.1002/cncr.26099. Epub 2011 Apr 5.
Metabolic activity assessed by (18)F-fluorodeoxyglocuse-positron emission tomography ((18)F-FDG-PET) reflects biological aggressiveness and prognoses in various tumors. The authors present a correlation between tumor metabolic activity and clinical outcomes in patients with hepatocellular carcinoma (HCC).
Over a 3-year period (2005-2008), 135 locally advanced HCC patients were treated with localized concurrent chemoradiotherapy (CCRT; external beam radiotherapy at 45 grays for 5 weeks plus concurrent hepatic arterial infusion of 5-fluorouracil during the first and fifth week) followed by repetitive hepatic arterial infusional chemotherapy with 5-fluorouracil and cisplatin. Among them, the authors studied 107 who received (18)F-FDG-PET before CCRT. Maximal standardized uptake values (SUVs) of tumors were calculated.
The median maximal tumor SUV was 6.1 (range, 2.4-∼19.2). Patients with low maximal tumor SUVs (<6.1) had a higher disease control rate than those with high maximal tumor SUVs (≥6.1) (86.8% vs 68.5%, respectively, P = .023). Both median progression-free survival (PFS; 8.4 vs 5.2 months; P = .003) and overall survival (OS; 17.9 vs 11.3 months; P = .013) were significantly longer in the low maximal tumor SUV group than in the high maximal tumor SUV group, respectively. In multivariate analysis, low maximal tumor SUV and objective responses to CCRT remained significant for PFS and OS. The high maximal tumor SUV group was more likely to have extrahepatic metastasis within 6 months than the low maximal tumor SUV group (58.1% vs 26.8%, respectively; P < .001). Similar results were obtained for the maximal tumor SUV/normal liver maximal SUV ratio (<2 vs ≥2) concerning progression, death, and extrahepatic metastasis.
Metabolic activity may be useful not only in predicting prognosis and treatment responses, but also in establishing optimal treatment plans in locally advanced HCC.
通过（18）F-氟代脱氧葡萄糖正电子发射断层扫描（（18）F-FDG-PET）评估的代谢活性反映了各种肿瘤的生物学侵袭性和预后。作者提出了肝癌（HCC）患者肿瘤代谢活性与临床结局之间的相关性。
在 3 年期间（2005-2008 年），对 135 例局部晚期 HCC 患者进行局部同步放化疗（CCRT；5 周内 45 戈瑞外照射放疗，第 1 和第 5 周同时进行肝动脉内输注 5-氟尿嘧啶），然后重复进行肝动脉输注氟尿嘧啶和顺铂化疗。其中，作者研究了 107 例在 CCRT 前接受（18）F-FDG-PET 的患者。计算了肿瘤的最大标准化摄取值（SUV）。
中位最大肿瘤 SUV 为 6.1（范围，2.4-∼19.2）。低最大肿瘤 SUV（<6.1）的患者疾病控制率高于高最大肿瘤 SUV（≥6.1）的患者（分别为 86.8%和 68.5%，P=0.023）。低最大肿瘤 SUV 组的中位无进展生存期（PFS；8.4 个月 vs 5.2 个月；P=0.003）和总生存期（OS；17.9 个月 vs 11.3 个月；P=0.013）均显著长于高最大肿瘤 SUV 组。在多变量分析中，低最大肿瘤 SUV 和 CCRT 的客观反应对 PFS 和 OS 仍然具有显著意义。高最大肿瘤 SUV 组在 6 个月内发生肝外转移的可能性高于低最大肿瘤 SUV 组（分别为 58.1%和 26.8%；P<0.001）。对于最大肿瘤 SUV/正常肝脏最大 SUV 比值（<2 与≥2），在进展、死亡和肝外转移方面也得到了类似的结果。
代谢活性不仅可用于预测预后和治疗反应，还可用于确定局部晚期 HCC 的最佳治疗方案。
