Au Kin-Pan, Dai Wing-Chiu, Chi-Yan Chan Albert, Cheung Tan-To, Lo Chung-Mau, Chok Kenneth Siu-Ho
The Liver Transplant Centre, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
Transplant Direct. 2021 Sep 20;7(10):e769. doi: 10.1097/TXD.0000000000001213. eCollection 2021 Oct.
Precise staging is essential in the management of patients with recurrent hepatocellular carcinoma (HCC) after liver transplantation. There is no current consensus on the optimal staging strategy. We conducted this study to evaluate the performance of dual-tracer positron emission tomography-computed tomography (PET-CT) for this purpose and to investigate whether the results of dual-tracer PET-CT affected patient management.
A retrospective study was conducted. Patients who underwent dual-tracer PET-CT for suspected or confirmed HCC recurrence after liver transplant were included. The lesion-based sensitivity and positive predictive value of dual-tracer PET-CT were determined.
Fifty-six patients and 189 recurrent tumors were included. The lesion-based sensitivity and positive predictive value of dual-tracer PET-CT were 94.7% and 90.4%, respectively. The sensitivity of dual-tracer PET-CT was better than the standard imaging in the surveillance protocol (82.5% versus 94.7%, < 0.001), especially for detecting liver recurrence (71.0% versus 96.8%, < 0.001). Half of the dual-tracer PET-CT detected additional recurrence (n = 26, 46.4%) and one-third led to a change in management (n = 19, 33.9%). Ten patients (17.9%) with inconclusive standard imaging had metabolic recurrence confirmed on PET-CT and treatment was commenced early. Four patients (7.1%) had revised locoregional treatment, and 5 (8.9%) had to withdraw from locoregional treatment after the detection of additional metastatic disease.
Dual-tracer PET-CT is effective for staging posttransplant HCC recurrence. It often provides valuable information to guide clinical management.
精确分期对于肝移植术后复发性肝细胞癌（HCC）患者的管理至关重要。目前对于最佳分期策略尚无共识。我们开展本研究以评估双示踪剂正电子发射断层扫描-计算机断层扫描（PET-CT）在此方面的性能，并调查双示踪剂PET-CT的结果是否会影响患者管理。
进行一项回顾性研究。纳入因怀疑或确诊肝移植后HCC复发而接受双示踪剂PET-CT检查的患者。确定基于病灶的双示踪剂PET-CT的敏感性和阳性预测值。
纳入56例患者和189个复发性肿瘤。基于病灶的双示踪剂PET-CT的敏感性和阳性预测值分别为94.7%和90.4%。双示踪剂PET-CT的敏感性优于监测方案中的标准成像（82.5%对94.7%，<0.001），尤其是在检测肝内复发方面（71.0%对96.8%，<0.001）。一半的双示踪剂PET-CT检测到额外的复发（n = 26，46.4%），三分之一导致管理方式改变（n = 19，33.9%）。10例（17.9%）标准成像结果不明确的患者在PET-CT上证实有代谢复发并早期开始治疗。4例（7.1%）患者调整了局部区域治疗，5例（8.9%）在检测到额外转移病灶后不得不退出局部区域治疗。
双示踪剂PET-CT对肝移植术后HCC复发的分期有效。它通常能提供有价值的信息以指导临床管理。
