Hyun Seung Hyup, Eo Jae Seon, Lee Jeong Won, Choi Joon Young, Lee Kyung-Han, Na Sae Jung, Hong Il Ki, Oh Jin Kyoung, Chung Yong An, Song Bong-Il, Kim Tae-Sung, Kim Kyung Sik, Moon Dae Hyuk, Yun Mijin
Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Nuclear Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
Eur J Nucl Med Mol Imaging. 2016 Aug;43(9):1638-45. doi: 10.1007/s00259-016-3348-y. Epub 2016 Mar 2.
We evaluated the prognostic value of pretreatment (18)F-fluorodeoxyglucose positron emission tomography with computed tomography (FDG PET/CT) in patients with Barcelona Clinic Liver Cancer (BCLC) stage 0 or A hepatocellular carcinoma (HCC) who had received curative treatment or transarterial chemoembolization (TACE).
Between 2009 and 2010, 317 patients diagnosed with HCC at seven hospitals were enrolled. Among these, 195 patients underwent curative treatments including resection, liver transplantation, and radiofrequency ablation. TACE was performed in 122 patients. The tumor-to-normal liver standardized uptake value ratio (TLR) of the primary tumor was measured using pretreatment FDG PET/CT. The prognostic significance of TLR and other clinical variables was assessed using Cox regression models. Differences in the overall survival (OS) associated with TLR or other significant clinical factors were examined using the Kaplan-Meier method.
Over a median follow-up period of 46 months, 77 patients died from cancer. In the curative cohort, higher TLR (≥2) was significantly associated with death (hazard ratio [HR] = 2.68; 95 % CI, 1.16-6.15; P = 0.020) in multivariable analysis. Patients with a higher TLR had significantly worse OS than patients with a lower TLR (5-year overall survival, 61 % vs. 79.4 %; P = 0.006). In the TACE cohort, the Model for End-Stage Liver Disease (MELD) score (≥8) was a significant independent prognostic factor for OS (HR = 3.34; 95 % CI, 1.49-7.48; P = 0.003), whereas TLR was not associated with OS. The Kaplan-Meier curves showed significantly poorer OS in patients with higher MELD scores (≥8) than in those with lower MELD scores (5-year survival rate, 33.1 % vs. 79.6 %; P < 0.001).
Pretreatment TLR measured using FDG PET/CT was an independent prognostic factor for OS in patients with BCLC stage 0 or A HCC undergoing curative treatment. In contrast, underlying liver function appeared to be important in predicting the prognosis of patients undergoing TACE.
我们评估了在接受根治性治疗或经动脉化疗栓塞术（TACE）的巴塞罗那临床肝癌（BCLC）0期或A期肝细胞癌（HCC）患者中，治疗前18F-氟脱氧葡萄糖正电子发射断层扫描联合计算机断层扫描（FDG PET/CT）的预后价值。
2009年至2010年期间，七家医院的317例被诊断为HCC的患者入组。其中，195例患者接受了包括切除、肝移植和射频消融在内的根治性治疗。122例患者接受了TACE。使用治疗前FDG PET/CT测量原发肿瘤的肿瘤与正常肝脏标准化摄取值比值（TLR）。使用Cox回归模型评估TLR和其他临床变量的预后意义。使用Kaplan-Meier方法检验与TLR或其他显著临床因素相关的总生存期（OS）差异。
在中位随访期46个月内，77例患者死于癌症。在根治性治疗队列中，多变量分析显示较高的TLR（≥2）与死亡显著相关（风险比[HR]=2.68；95%可信区间，1.16-6.15；P=0.020）。TLR较高的患者的OS明显比TLR较低的患者差（5年总生存率，61%对79.4%；P=0.006）。在TACE队列中，终末期肝病模型（MELD）评分（≥8）是OS的显著独立预后因素（HR=3.34；95%可信区间，1.49-7.48；P=0.003），而TLR与OS无关。Kaplan-Meier曲线显示，MELD评分较高（≥8）的患者的OS明显比评分较低的患者差（5年生存率，33.1%对79.6%；P<0.001）。
使用FDG PET/CT测量的治疗前TLR是接受根治性治疗的BCLC 0期或A期HCC患者OS的独立预后因素。相比之下，基础肝功能似乎对预测接受TACE治疗患者的预后很重要。
