Sun Muchuan, Zhang Guoxu, Guo Jia, Hao Shanhu, Wang Zhiguo, Fan Guoguang
Department of Nuclear Medicine, No. 4 Hospital of China Medical University.
Department of Nuclear Medicine, General Hospital of Shenyang Military.
Nucl Med Commun. 2018 Jun;39(6):564-571. doi: 10.1097/MNM.0000000000000842.
This study was designed to investigate whether pretreatment fluorine-18-fluorodeoxyglucose (F-FDG) PET/computed tomography (CT) lean body mass-corrected parameters could predict the overall survival (OS) better than the established predictors in patients with hepatocellular carcinoma (HCC).
We retrospectively analyzed 61 patients with HCC with pretreatment F-FDG-PET/CT. Besides obtaining clinical factors, we measured both lean body mass-corrected and body weight-corrected PET/CT parameters, including metabolic tumor volume, maximal standardized uptake value of the tumor, total lesion glycolysis, tumor-to-normal liver uptake ratio, and so on. The prognostic value of those factors for OS was assessed by statistical software.
In the univariate analysis, PET/CT parameters, ascites, serum α-fetoprotein, alkaline phosphatase, aspartate transaminase (AST), tumor number, tumor size of the maximal one, vascular invasion, TNM stage, Child-Pugh class, Barcelona Clinic Liver Cancer (BCLC) staging, and Okuda staging were significant predictors of OS. In multivariate and Kaplan-Meier analyses, lean body mass-corrected maximum standardized uptake value (lbmSUVmax) more than 3.35 g/ml, AST more than 42.00 U/l, and BCLC staging B-C were significant independent predictors of poor OS. When BCLC staging variable was stratified by four categories instead of two in the multivariate analysis, it was not the statistically significant independent predictor anymore, but lbmSUVmax and AST still were.
Pretreatment F-FDG-PET/CT lean body mass-corrected parameters can predict the OS in patients with HCC. Moreover, lbmSUVmax and AST, as the independent predictors of OS, could supplement the prognostic value of the BCLC staging system.
本研究旨在探讨在肝细胞癌（HCC）患者中，与已确立的预测指标相比，治疗前氟-18-氟脱氧葡萄糖（F-FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）瘦体重校正参数是否能更好地预测总生存期（OS）。
我们回顾性分析了61例接受治疗前F-FDG-PET/CT检查的HCC患者。除获取临床因素外，我们还测量了瘦体重校正和体重校正的PET/CT参数，包括代谢肿瘤体积、肿瘤最大标准化摄取值、总病变糖酵解、肿瘤与正常肝脏摄取比值等。通过统计软件评估这些因素对OS的预后价值。
在单因素分析中，PET/CT参数、腹水、血清甲胎蛋白、碱性磷酸酶、天冬氨酸转氨酶（AST）、肿瘤数量、最大肿瘤大小、血管侵犯、TNM分期、Child-Pugh分级、巴塞罗那临床肝癌（BCLC）分期和奥田分期是OS的显著预测指标。在多因素和Kaplan-Meier分析中，瘦体重校正的最大标准化摄取值（lbmSUVmax）大于3.35 g/ml、AST大于42.00 U/l以及BCLC分期B-C是OS不良的显著独立预测指标。在多因素分析中，当将BCLC分期变量按四类而非两类进行分层时，它不再是具有统计学意义的独立预测指标，但lbmSUVmax和AST仍然是。
治疗前F-FDG-PET/CT瘦体重校正参数可预测HCC患者的OS。此外，lbmSUVmax和AST作为OS的独立预测指标，可补充BCLC分期系统的预后价值。
