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Abstract

PURPOSE:
Sorafenib, an oral multikinase inhibitor, is a recommended treatment option available for patients with Barcelona Clinic Liver Cancer (BCLC)-C stage hepatocellular carcinoma (HCC). This study aimed to evaluate the performance of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) for predicting tumour progression during sorafenib treatment.

METHODS:
We formed a retrospective cohort comprising patients treated with sorafenib for at least 30 days and undergoing 18F-FDG PET/CT within 1 month before treatment. For statistical analyses, the tumour-to-liver standardised uptake value (SUV) ratio (TLR) of the most hypermetabolic lesion was measured.

RESULTS:
Among a total of 35 patients, two obtained partial remission, and 11 showed stable disease after the first response evaluation. Patients with a TLR ≥ 2.9 (n = 17) had a median overall survival (OS) of 3.7 months after sorafenib treatment, whereas patients with a TLR < 2.9 (n = 18) had median OS of 12.2 months (P < 0.001), although the disease control rate was not significantly different between the two groups. Pretreatment TLR ≥ 2.9 (hazard ratio [HR] = 6.318, P = 0.002) and Child-Pugh class B (HR = 4.316, P = 0.044) were poor prognostic factors for OS, and a TLR ≥ 2.9 (HR = 2.911, P = 0.024) was the only poor prognostic factor for progression-free survival in a multivariate analysis.

CONCLUSION:
Pretreatment tumour metabolic activity assessed by 18F-FDG PET is an independent prognostic factor for survival in patientswith BCLC-C stage HCC receiving sorafenib monotherapy, although it may not predict tumour response to the treatment.
KEYWORDS:
18F–FDG pet; Prognosis; Sorafenib; Time to progression; Tumour response

Author information

Sung PS1, Park HL2, Yang K1, Hwang S1, Song MJ1, Jang JW1, Choi JY1, Yoon SK1, Yoo IR3, Bae SH4.

1 Division of Hepatology, Department of Internal Medicine, The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, #505 Banpo-dong, Seocho-gu, Seoul, 06591, South Korea.
2 Division of Nuclear Medicine, Department of Radiology, College of Medicine, The Catholic University of Korea, #505 Banpo-dong, Seocho-gu, Seoul, 06591, South Korea.
3 Division of Nuclear Medicine, Department of Radiology, College of Medicine, The Catholic University of Korea, #505 Banpo-dong, Seocho-gu, Seoul, 06591, South Korea. iryoo@catholic.ac.kr.
4 Division of Hepatology, Department of Internal Medicine, The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, #505 Banpo-dong, Seocho-gu, Seoul, 06591, South Korea. baesh@catholic.ac.kr.