Itoh Shinji, Yoshizumi Tomoharu, Kitamura Yoshiyuki, Yugawa Kyohei, Iseda Norifumi, Shimagaki Tomonari, Nagao Yoshihiro, Toshima Takeo, Harada Noboru, Kohashi Kenichi, Baba Shingo, Ishigami Kousei, Oda Yoshinao, Mori Masaki
Department of Surgery and ScienceGraduate School of Medical SciencesKyushu UniversityFukuokaJapan.
Department of Clinical RadiologyGraduate School of Medical SciencesKyushu UniversityFukuokaJapan.
Hepatol Commun. 2021 Mar 26;5(7):1278-1289. doi: 10.1002/hep4.1715. eCollection 2021 Jul.
We evaluated the prognostic value of fluorine-18 fluorodeoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT) in hepatocellular carcinoma (HCC). Their association with programmed death ligand 1 (PD-L1) expression and vascular formation was further investigated. In this retrospective study, using a database of 418 patients who had undergone F-FDG PET/CT before hepatic resection for HCC, immunohistochemical staining of PD-L1, clusters of differentiation (CD) 8, CD68, and CD34 was performed. Patients with a high maximum standardized uptake value (SUVmax) on F-FDG PET/CT showed a significantly worse recurrence-free survival (RFS) (hazard ratio [HR]: 1.500; 95% confidence interval [CI]: 1.088-2.069; = 0.0133) and overall survival (OS) (HR: 2.259; 95% CI: 1.276-4.000; = 0.0052) than patients with a low SUVmax. Logistic regression analysis showed that a high SUVmax in HCC was significantly associated with PD-L1-positive expression (odds ratio: 4.407; 95% CI: 2.265-8.575; < 0.0001). SUVmax values of HCC were associated with intratumoral CD8-positive T-cell counts ( = 0.0044) and CD68-positive macrophage counts ( = 0.0061). Stratification based on SUVmax, PD-L1 expression, and the vessels that encapsulate tumor clusters (VETC) status was also significantly associated with RFS and OS. SUVmax, VETC, and PDL1 expression were independently predictive of survival on multivariable analysis. Our large cohort study showed that a high SUVmax on F-FDG PET/CT is associated with a poor clinical outcome and PD-L1 expression in patients with HCC. Additionally, stratification of patients based on the combination of SUVmax, PD-L1 expression, and the VETC status predicts poor clinical outcome.
我们评估了氟-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）在肝细胞癌（HCC）中的预后价值。进一步研究了其与程序性死亡配体1（PD-L1）表达及血管形成的相关性。在这项回顾性研究中，利用一个包含418例在肝癌肝切除术前接受F-FDG PET/CT检查患者的数据库，对PD-L1、分化簇（CD）8、CD68和CD34进行免疫组织化学染色。F-FDG PET/CT上最大标准化摄取值（SUVmax）高的患者无复发生存期（RFS）显著更差（风险比[HR]：1.500；95%置信区间[CI]：1.088 - 2.069；P = 0.0133），总生存期（OS）也显著更差（HR：2.259；95% CI：1.276 - 4.000；P = 0.0052），而SUVmax低的患者情况较好。逻辑回归分析显示，HCC中SUVmax高与PD-L1阳性表达显著相关（比值比：4.407；95% CI：2.265 - 8.575；P < 0.0001）。HCC的SUVmax值与瘤内CD8阳性T细胞计数（P = 0.0044）和CD68阳性巨噬细胞计数（P = 0.0061）相关。基于SUVmax、PD-L1表达和包绕肿瘤簇的血管（VETC）状态进行分层，也与RFS和OS显著相关。在多变量分析中，SUVmax、VETC和PDL1表达可独立预测生存期。我们的大型队列研究表明，F-FDG PET/CT上SUVmax高与HCC患者的不良临床结局及PD-L1表达相关。此外，基于SUVmax、PD-L1表达和VETC状态的组合对患者进行分层可预测不良临床结局。
