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Abstract

This study aimed to assess the prognostic value of(18)F-FDG uptake in hepatocellular carcinoma (HCC) patients who had transarterial chemoembolization (TACE) or concurrent intraarterial chemotherapy with external-beam radiotherapy (CCRT) and to compare the prognosis between patients treated with TACE and those with CCRT according to(18)F-FDG uptake.

METHODS:

Two hundred fourteen intermediate-to-advanced-stage HCC patients without extrahepatic metastasis who underwent staging(18)F-FDG PET/CT before TACE (153 patients) or CCRT (61 patients) were recruited from 7 hospitals. Progression-free survival (PFS) and overall survival (OS) were compared using an optimal cutoff value for tumor-to-normal liver uptake ratio (TLR). Further, PFS and OS were compared according to treatment modalities (TACE vs. CCRT) using the same TLR cutoff value.

RESULTS:

On multivariate analysis, age and TLR were independent prognostic factors for PFS (P< 0.050). For OS, Child-Pugh classification and TLR were independent prognostic factors (P< 0.050). When the TLR was greater than 2.0, patients treated with CCRT showed significantly better PFS and OS than those treated with TACE after adjusting for tumor size and number (P= 0.014, for all). In contrast, there was no significant difference in PFS and OS between patients treated with TACE or CCRT when the TLR was 2.0 or less.

CONCLUSION:

(18)F-FDG uptake was an independent prognostic factor for PFS and OS in HCC patients treated with TACE or CCRT. Especially, in HCCs with high(18)F-FDG uptake, patients treated with CCRT showed better survival than those treated with TACE.(18)F-FDG PET/CT may help determine the treatment modality for intermediate-to-advanced-stage HCCs. 

Author information

Lee JW1, Oh JK2, Chung YA2, Na SJ3, Hyun SH4, Hong IK5, Eo JS6, Song BI7, Kim TS8, Kim do Y9, Kim SU9, Moon DH10, Lee JD11, Yun M12.

1Department of Nuclear Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea.

2Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.

3Department of Radiology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

4Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

5Department of Nuclear Medicine, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, Seoul, Korea.

6Department of Nuclear Medicine, Korea University Guro Hospital, Seoul, Korea.

7Department of Nuclear Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.

8Department of Nuclear Medicine, National Cancer Center Research Institute and Hospital, Gyeonggi-do, Korea.

9Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.

10Department of Nuclear Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

11Department of Radiology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea; and yunmijin@yuhs.ac jdlee@ish.or.kr.

12Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Korea yunmijin@yuhs.ac jdlee@ish.or.kr.