Chandra Khangembam Bangkim, Singhal Abhinav
Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.
Department of Nuclear Medicine, National Cancer Institute, All India Institute of Medical Sciences, New Delhi, India.
Nucl Med Mol Imaging. 2021 Dec;55(6):293-301. doi: 10.1007/s13139-021-00714-6. Epub 2021 Oct 4.
Hypermetabolic macrovascular invasion (MVI) and extrahepatic metastasis (EHM) occur in aggressive hepatocellular carcinoma (HCC) and carry unfavorable prognosis. [F] FDG PET/CT, despite having low sensitivity in primary HCC, is valuable in patients with aggressive HCC for detection of hypermetabolic MVI and EHM. The study aimed at identifying the parameters that could predict hypermetabolic MVI and/or EHM in treatment naive HCC patients for tailored approach to utilize [F] FDG PET/CT.
Data of 131 treatment naive HCC patients (median age, 60 years; range, 21-80 years; 90.8% males) who underwent [F] FDG PET/CT were retrospectively analyzed to determine the proportion of patients with hypermetabolic MVI and/or EHM. Logistic regression analysis was performed to define independent predictors of hypermetabolic MVI and/or EHM.
78/131 (59.5%) patients had hypermetabolic MVI and/or EHM. 52/131 (39.7%) patients had EHM. 56/131 (42.7%) patients had hypermetabolic MVI of which, 30 had concomitant EHM with majority (90%; 27/30) having distant metastasis. 26/131 (19.8%) patients had hypermetabolic MVI without EHM while 22/131 (16.8%) patients had EHM without hypermetabolic MVI of which, majority (95.5%; 21/22) had distant metastasis. Hypermetabolic MVI was associated with EHM (χ = 7.868; value = 0.007). AFP > 93.7 ng/ml, SUVmax > 3.5, and maximum tumor size > 5.0 cm were the independent predictors of hypermetabolic MVI and/or EHM.
In treatment naive HCC patients with AFP > 93.7 ng/ml or maximum tumor size > 5.0 cm, [F] FDG PET/CT can be valuable.
高代谢型大血管侵犯（MVI）和肝外转移（EHM）见于侵袭性肝细胞癌（HCC），预后不良。[F] FDG PET/CT虽然对原发性HCC的敏感性较低，但对侵袭性HCC患者检测高代谢型MVI和EHM具有重要价值。本研究旨在确定能够预测初治HCC患者高代谢型MVI和/或EHM的参数，以便采用量身定制的方法来利用[F] FDG PET/CT。
回顾性分析131例接受[F] FDG PET/CT检查的初治HCC患者（中位年龄60岁；范围21 - 80岁；90.8%为男性）的数据，以确定高代谢型MVI和/或EHM患者的比例。进行逻辑回归分析以确定高代谢型MVI和/或EHM的独立预测因素。
78/131（59.5%）例患者存在高代谢型MVI和/或EHM。52/131（39.7%）例患者有EHM。56/131（42.7%）例患者有高代谢型MVI，其中30例伴有EHM，大多数（90%；27/30）有远处转移。26/131（19.8%）例患者有高代谢型MVI但无EHM，而22/131（16.8%）例患者有EHM但无高代谢型MVI，其中大多数（95.5%；21/22）有远处转移。高代谢型MVI与EHM相关（χ = 7.868；P值 = 0.007）。甲胎蛋白（AFP）> 93.7 ng/ml、最大标准摄取值（SUVmax）> 3.5以及最大肿瘤直径> 5.0 cm是高代谢型MVI和/或EHM的独立预测因素。
在AFP > 93.7 ng/ml或最大肿瘤直径> 5.0 cm的初治HCC患者中，[F] FDG PET/CT可能具有重要价值。
