Jreige Mario, Mitsakis Periklis, Van Der Gucht Axel, Pomoni Anastasia, Silva-Monteiro Marina, Gnesin Silvano, Boubaker Ariane, Nicod-Lalonde Marie, Duran Rafael, Prior John O, Denys Alban, Schaefer Niklaus
Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland.
Eur J Nucl Med Mol Imaging. 2017 Jul;44(7):1215-1222. doi: 10.1007/s00259-017-3653-0. Epub 2017 Feb 23.
To compare the value of pretreatment functional and morphological imaging parameters for predicting survival in patients undergoing transarterial radioembolization using yttrium-90 (Y-TARE) for unresectable hepatocellular carcinoma (uHCC).
We analysed data from 48 patients in our prospective database undergoing Y-TARE treatment for uHCC (31 resin, 17 glass). All patients underwent F-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 Y-TARE. Kaplan-Meier estimates of progression-free survival (PFS) and overall survival (OS) were used to assess the prognostic value of F-FDG PET/CT metabolic parameters, including SUV, tumour-to-liver (T/L) uptake ratio and SUV 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.
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 Y-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 SUV (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 SUV and T/L uptake ratio (both P = 0.02; median OS 30.9 vs. 9 months). The multivariate analysis confirmed that lesion SUV 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 SUV; HR 2.6, 95% CI 1.1-5.9, P = 0.02, for median SUV:) and OS (HR 3.2, 95% CI 1-10.9, P = 0.04 for Q1 SUV; 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.
Lesion SUV and T/L uptake ratio as assessed by F-FDG PET/CT, but not morphological imaging, were predictive markers of survival in patients undergoing Y-TARE for uHCC.
比较钇-90（Y-TARE）经动脉放射性栓塞治疗不可切除肝细胞癌（uHCC）患者时，治疗前功能和形态学成像参数对预测生存的价值。
我们分析了前瞻性数据库中48例接受Y-TARE治疗uHCC患者的数据（31例使用树脂微球，17例使用玻璃微球）。所有患者在治疗前检查时均接受了F-FDG PET/CT和形态学成像（CT和MRI扫描）。患者在这些成像检查与Y-TARE治疗之间未接受任何治疗。采用Kaplan-Meier法估计无进展生存期（PFS）和总生存期（OS），以评估F-FDG PET/CT代谢参数的预后价值，包括SUV、肿瘤与肝脏（T/L）摄取比值和健康肝脏SUV，以及形态学数据，包括病灶数量和大小、门静脉浸润（PVI）。在单因素和多因素分析中，将包括Child-Pugh分级、巴塞罗那临床肝癌（BCLC）分期、肿瘤大小、PVI和血清AFP水平在内的HCC相关预后因素与代谢参数进行比较。
存活患者的中位随访时间为16.2个月（范围11.4 - 50.1个月）。Y-TARE治疗后，34例患者（70.8%）出现复发，中位复发时间为7.4个月（范围1.4 - 27.9个月）；34例死于疾病的患者中，24例（70.8%）出现复发，中位复发时间为8.1个月（范围2.2 - 35.2个月）。PFS的显著预后标志物为病灶SUV均值和中位数（均P = 0.01；中位PFS分别为10.2个月和7.4个月），OS的显著预后标志物为病灶SUV和T/L摄取比值的第一四分位数（Q1）截断值（均P = 0.02；中位OS分别为30.9个月和9个月）。多因素分析证实，病灶SUV和T/L摄取比值是PFS（风险比，HR，2.7，95% CI 1.2 - 6.1，P = 0.02，均值SUV；HR 2.6，95% CI 1.1 - 5.9，P = 0.02，中位数SUV）和OS（HR 3.2，95% CI 1 - 10.9，P = 0.04，Q1 SUV；HR 3.7，95% CI 1.1 - 12.2，P = 0.03，Q1 T/L摄取比值）的独立阴性预测因子，无论是采用BCLC分期系统还是血清AFP水平进行检验。
F-FDG PET/CT评估的病灶SUV和T/L摄取比值，而非形态学成像，是接受Y-TARE治疗uHCC患者生存的预测标志物。
