为了提高双（18F-FDG/18F-胆碱）PET/CT 在肝细胞癌管理中的应用价值：一项三级中心研究。
Towards refining the utility of dual (18F-FDG / 18F-Choline) PET/CT for the management of hepatocellular carcinoma: a tertiary center study.
机构信息
Department of Hepatobiliary Surgery, Hepato-Biliary Center, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Villejuif, France -
Department of Biophysics and Nuclear Medicine-Molecular Imaging, Paris-Saclay University Hospital, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France.
出版信息
Q J Nucl Med Mol Imaging. 2023 Sep;67(3):206-214. doi: 10.23736/S1824-4785.22.03485-9. Epub 2022 Nov 7.
BACKGROUND
The role of positron emission tomography/computed tomography (PET/CT) in hepatocellular carcinoma (HCC) management is not clearly defined. Our objective was to analyze the utility of dual-PET/CT (F-FDG + F-Choline) imaging findings on the BCLC staging and treatment decision for HCC patients.
METHODS
Between January 2011 and April 2019, 168 consecutive HCC patients with available baseline dual-PET/CT imaging data were retrospectively analyzed. To identify potential refinement criteria for surgically-treated patients, survival Kaplan-Meier curves of various standard-of-care and dual-PET/CT baseline parameters were estimated. Finally, multivariate cox proportional hazard ratios of the most relevant clinico-biological and/or PET parameters were estimated.
RESULTS
Dual-PET/CT findings increased the score of BCLC staging in 21 (12.5%) cases. In 24.4% (N.=41) of patients, the treatment strategy was modified by the PET findings. Combining AFP levels at a threshold of 10 ng/mL with F-FDG or F-Choline N status significantly impacted DFS (P<0.05). In particular, the combined criteria of the N status assessed by F-Choline with AFP threshold of 10 ng/mL provided a highly predictive composite parameter for estimation of DFS according to multivariate analysis (HR=10.6, P<0.05).
CONCLUSIONS
The F-Choline / AFP composite parameter appears promising, and further prospective studies are mandatory to validate its oncological impact.
背景
正电子发射断层扫描/计算机断层扫描（PET/CT）在肝细胞癌（HCC）管理中的作用尚未明确界定。我们的目的是分析双 PET/CT（F-FDG+F-胆碱）成像在 HCC 患者 BCLC 分期和治疗决策中的作用。
方法
回顾性分析了 2011 年 1 月至 2019 年 4 月期间 168 例 HCC 患者的双 PET/CT 基线影像学数据。为了确定适用于手术治疗患者的潜在细化标准，我们对各种标准治疗和双 PET/CT 基线参数的生存 Kaplan-Meier 曲线进行了估计。最后，我们还对最相关的临床生物学和/或 PET 参数的多变量 Cox 比例风险比进行了估计。
结果
双 PET/CT 结果使 21 例（12.5%）患者的 BCLC 分期评分升高。在 24.4%（N=41）的患者中，PET 结果改变了治疗策略。将 AFP 水平的阈值设为 10ng/mL 并结合 F-FDG 或 F-胆碱的 N 状态，显著影响了无复发生存率（DFS）（P<0.05）。特别是，通过 F-胆碱评估的 N 状态与 AFP 阈值为 10ng/mL 的联合标准为 DFS 的估计提供了一个具有高度预测性的复合参数，根据多变量分析（HR=10.6，P<0.05）。
结论
F-胆碱/AFP 复合参数很有前途，需要进一步的前瞻性研究来验证其对肿瘤学的影响。
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