Division of Hepatology, Department of Internal Medicine, The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, #505 Banpo-dong, Seocho-gu, Seoul, 06591, South Korea.
Division of Nuclear Medicine, Department of Radiology, College of Medicine, The Catholic University of Korea, #505 Banpo-dong, Seocho-gu, Seoul, 06591, South Korea.
Eur J Nucl Med Mol Imaging. 2018 Mar;45(3):384-391. doi: 10.1007/s00259-017-3871-5. Epub 2017 Nov 10.
Sorafenib, an oral multikinase inhibitor, is a recommended treatment option available for patients with Barcelona Clinic Liver Cancer (BCLC)-C stage hepatocellular carcinoma (HCC). This study aimed to evaluate the performance of F-fluorodeoxyglucose positron emission tomography (F-FDG PET) for predicting tumour progression during sorafenib treatment.
We formed a retrospective cohort comprising patients treated with sorafenib for at least 30 days and undergoing F-FDG PET/CT within 1 month before treatment. For statistical analyses, the tumour-to-liver standardised uptake value (SUV) ratio (TLR) of the most hypermetabolic lesion was measured.
Among a total of 35 patients, two obtained partial remission, and 11 showed stable disease after the first response evaluation. Patients with a TLR ≥ 2.9 (n = 17) had a median overall survival (OS) of 3.7 months after sorafenib treatment, whereas patients with a TLR < 2.9 (n = 18) had median OS of 12.2 months (P < 0.001), although the disease control rate was not significantly different between the two groups. Pretreatment TLR ≥ 2.9 (hazard ratio [HR] = 6.318, P = 0.002) and Child-Pugh class B (HR = 4.316, P = 0.044) were poor prognostic factors for OS, and a TLR ≥ 2.9 (HR = 2.911, P = 0.024) was the only poor prognostic factor for progression-free survival in a multivariate analysis.
Pretreatment tumour metabolic activity assessed by F-FDG PET is an independent prognostic factor for survival in patients with BCLC-C stage HCC receiving sorafenib monotherapy, although it may not predict tumour response to the treatment.
索拉非尼是一种口服多激酶抑制剂，是巴塞罗那临床肝癌（BCLC）-C 期肝细胞癌（HCC）患者的推荐治疗选择。本研究旨在评估氟-18 氟代脱氧葡萄糖正电子发射断层扫描（F-FDG PET）在预测索拉非尼治疗期间肿瘤进展方面的性能。
我们组成了一个回顾性队列，包括至少接受 30 天索拉非尼治疗且在治疗前 1 个月内接受 F-FDG PET/CT 检查的患者。为了进行统计分析，测量了最代谢活跃病变的肿瘤与肝脏标准化摄取比值（TLR）。
在总共 35 名患者中，有 2 名获得部分缓解，有 11 名在首次反应评估后表现为稳定疾病。TLR≥2.9（n=17）的患者在接受索拉非尼治疗后中位总生存期（OS）为 3.7 个月，而 TLR<2.9（n=18）的患者中位 OS 为 12.2 个月（P<0.001），尽管两组的疾病控制率无显著差异。治疗前 TLR≥2.9（风险比[HR] = 6.318，P = 0.002）和 Child-Pugh 分级 B（HR = 4.316，P = 0.044）是 OS 的不良预后因素，而在多变量分析中，TLR≥2.9（HR = 2.911，P = 0.024）是唯一与无进展生存期相关的不良预后因素。
在接受索拉非尼单药治疗的 BCLC-C 期 HCC 患者中，F-FDG PET 评估的治疗前肿瘤代谢活性是生存的独立预后因素，尽管它可能无法预测肿瘤对治疗的反应。
