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Hwang SH, Hong HS, Kim D, Kim GM, Lee HW, Lee M, Kim DY, Park MA, Yun M. Total Lesion Glycolysis on 18F-FDG PET/CT Is a Better Prognostic Factor Than Tumor Dose on 90Y PET/CT in Patients With Hepatocellular Carcinoma Treated With 90Y Transarterial Radioembolization. Clin Nucl Med 2022; 47:e437-e443. [PMID: 35384891 DOI: 10.1097/rlu.0000000000004128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE This study aimed to evaluate the prognostic value of metabolic parameters on 18F-FDG PET/CT and tumor dose (TD) on posttreatment 90Y PET/CT in patients with hepatocellular carcinoma (HCC) who underwent 90Y transarterial radioembolization (TARE). PATIENTS AND METHODS Forty-seven HCC patients treated with 90Y TARE were retrospectively enrolled between January 2013 and October 2018. 18F-FDG PET/CT was performed before treatment. Maximum tumor SUV-to-mean normal liver SUV ratio (TLR), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were measured for each patient. Voxel dosimetry was performed on 90Y PET/CT images to measure TD. The prognostic significance of metabolic parameters on 18F-FDG PET/CT, TD on 90Y PET/CT, and clinical factors for overall survival (OS) was evaluated. In addition, TD on 90Y PET/CT was analyzed in relation to the administered dose of 90Y-labeled microspheres and metabolic parameters on 18F-FDG PET/CT. RESULTS The median patient age was 57 years, and 37 patients (78.7%) were men. During the follow-up period, 25 patients (53.2%) died. In univariable analysis, Barcelona Clinic Liver Cancer stage C, Child-Pugh score, TD on 90Y PET/CT, TLR, MTV, and TLG were significant prognostic factors affecting OS (P < 0.05). In multivariable analysis, Barcelona Clinic Liver Cancer stage C and high TLG on 18F-FDG PET/CT were independent prognostic factors for OS (P < 0.05). The 1-year OS rates were 72.9% in patients with low TLG and 33.3% in patients with high TLG (P < 0.05). We also found that TD on 90Y PET/CT was not correlated with the administered dose of 90Y-labeled microspheres, but negatively correlated with TLG on pretreatment 18F-FDG PET/CT (P < 0.05). CONCLUSIONS TLG, a parameter incorporating both the degree of 18F-FDG uptake and amount of metabolically active tumor volume on pretreatment 18F-FDG PET/CT, is a better prognostic factor than TD on 90Y PET/CT for predicting OS in HCC patients treated with 90Y TARE.
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Affiliation(s)
- Sang Hyun Hwang
- From the Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Hye-Suk Hong
- Department of Radiology, National Cancer Center, Goyang
| | - Dongwoo Kim
- From the Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Gyoung Min Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science
| | - Hye Won Lee
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Misu Lee
- Division of Life Sciences, College of Life Science and Bioengineering, Incheon National University, Incheon, South Korea
| | - Do Young Kim
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Mi-Ae Park
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | - Mijin Yun
- From the Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul
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Kim DY, Lee HW, Kang W, Kim GM, Won JY, Yun M. Metabolic activity assessment by 18 F-fluorodeoxyglucose positron emission tomography in patients with hepatocellular carcinoma undergoing Yttrium-90 transarterial radioembolization. J Gastroenterol Hepatol 2021; 36:1679-1684. [PMID: 33226706 DOI: 10.1111/jgh.15357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) is a functional image technique that can inform clinical decisions related to prognosis. We investigated the predictive role of 18 F-fluorodeoxyglucose PET/CT in patients with hepatocellular carcinoma (HCC) undergoing Yttrium-90 (Y-90) transarterial radioembolization (TARE). METHODS Patients with HCC treated with TARE and pre-TARE PET/CT scan were recruited between 2009 and 2013. Maximum standardized uptake value and tumor-to-non-tumorous liver uptake ratio (TLR) were measured. Tumor response was evaluated in accordance with modified RECIST criteria at 3-month intervals after Y-90 TARE. RESULTS Forty patients were included in the final analysis. The median age was 56.5 years and male predominant. Disease control in treated lesion was achieved in 82.5% (n = 33) of patients. During median 18.3-month follow-up, 27.5% (n = 11) of patients achieved progression-free survival. The cutoff of TLR, which was related to the median value, did not affect disease control rate, progression-free survival, and overall survival in patients with Y-90 TARE. CONCLUSIONS The TLR-based stratification may be a simple method, but our study did not show the usefulness in predicting prognosis in HCC patients with Y-90 TARE. Further studies with large number of patients are needed.
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Affiliation(s)
- Do Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Won Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Wonseok Kang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Gyoung Min Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong Yun Won
- Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea
| | - Mijin Yun
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, South Korea
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Cui L, Xue H, Wen Z, Lu Z, Liu Y, Zhang Y. Prognostic roles of metabolic reprogramming-associated genes in patients with hepatocellular carcinoma. Aging (Albany NY) 2020; 12:22199-22219. [PMID: 33188160 PMCID: PMC7695384 DOI: 10.18632/aging.104122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/08/2020] [Indexed: 02/07/2023]
Abstract
Metabolic reprogramming for adaptation to the tumor microenvironment is recognized as a hallmark of cancer. Although many altered metabolic genes have been reported to be associated with tumor pathological processes, systematic analysis of metabolic genes implicated in hepatocellular carcinoma prognosis remains rare. The aim of this study was to identify key metabolic genes related to hepatocellular carcinoma, and to explore their clinical significance. We downloaded mRNA expression profiles and clinical hepatocellular carcinoma data from The Cancer Genome Atlas database to explore the prognostic roles of metabolic genes. Five prognosis-associated metabolic genes, including POLA1, UCK2, ACYP1, ENTPD2, and TXNRD1, were screened via univariate Cox regression analysis and a LASSO Cox regression model, which divided patients into high- and low-risk groups. Furthermore, gene set enrichment analysis revealed that significantly-enriched gene ontology terms and pathways involving high-risk patients were focused on regulation of nucleic and fatty acid metabolism. Taken together, our study identified five metabolic genes related to survival, which can be used to predict the prognosis of patients with hepatocellular carcinoma. These genes may play essential roles in metabolic microenvironment regulation, and represent potentially important candidate targets in metabolic therapy.
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Affiliation(s)
- Lijuan Cui
- Department of Pharmacology, School of Basic Medicine, Shanxi Medical University, Taiyuan 030001, China
| | - Huan Xue
- Department of Pharmacology, School of Basic Medicine, Shanxi Medical University, Taiyuan 030001, China
| | - Zhitong Wen
- Department of Pharmacology, School of Basic Medicine, Shanxi Medical University, Taiyuan 030001, China
| | - Zhihong Lu
- Department of Pharmacology, School of Basic Medicine, Shanxi Medical University, Taiyuan 030001, China
| | - Yunfeng Liu
- Department of Endocrinology, The First Affiliated Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Yi Zhang
- Department of Pharmacology, School of Basic Medicine, Shanxi Medical University, Taiyuan 030001, China
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Vinorelbine Augments Radiotherapy in Hepatocellular Carcinoma. Cancers (Basel) 2020; 12:cancers12040872. [PMID: 32260169 PMCID: PMC7226273 DOI: 10.3390/cancers12040872] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/02/2020] [Accepted: 04/02/2020] [Indexed: 12/24/2022] Open
Abstract
There is a need to improve the effectiveness of radiotherapy (RT) in hepatocellular carcinoma (HCC). Therefore, the purpose of this study was to explore the efficacy and toxicity of the anti-microtubule agent Vinorelbine as a radiosensitizer in HCC. The radio sensitivity of 16 HCC patient-derived xenograft (PDX) models was determined by quantifying the survival fraction following irradiation in vitro, and Vinorelbine radio sensitization was determined by clonogenic assay. Ectopic HCC xenografts were treated with a single dose of 8 Gy irradiation and twice-weekly 3 mg/kg Vinorelbine. Tumor growth and changes in the proteins involved in DNA repair, angiogenesis, tumor cell proliferation, and survival were assessed, and the 3/16 (18.75%), 7/16 (43.75%), and 6/16 (37.5%) HCC lines were classified as sensitive, moderately sensitive, and resistant, respectively. The combination of RT and Vinorelbine significantly inhibited tumor growth, DNA repair proteins, angiogenesis, and cell proliferation, and promoted more apoptosis compared with RT or Vinorelbine treatment alone. Vinorelbine improved HCC tumor response to standard irradiation with no increase in toxicity. HCC is prevalent in less developed parts of the world and is mostly unresectable on presentation. Vinorelbine and conventional radiotherapy are cost-effective, well-established modalities of cancer treatment that are readily available. Therefore, this strategy can potentially address an unmet clinical need, warranting further investigation in early-phase clinical trials.
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Lee SH, Hwang HK, Lee WJ, Yun M, Kang CM. Preoperative Metabolic Tumor Volume 2.5 Associated with Early Systemic Metastasis in Resected Pancreatic Cancer: A Transcriptome-Wide Analysis. Gut Liver 2020; 13:356-365. [PMID: 30602217 PMCID: PMC6529162 DOI: 10.5009/gnl18242] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/19/2018] [Accepted: 10/01/2018] [Indexed: 12/14/2022] Open
Abstract
Background/Aims 18F-fluorodeoxyglucose-positron emission tomography (18F-FDG-PET) reflects biological aggressiveness and predicts prognoses in various tumors. Evaluating the oncologic significance of the preoperative metabolic phenotype might be necessary for planning the surgical strategy in resectable pancreatic cancers. Methods From January 2010 to December 2015, a total of 93 patients with pathologic T3 (pT3) pancreatic cancer were included in this study. Clinicopathological parameters and PET parameters were evaluated, and transcriptome-wide analysis was performed to identify the oncologic impact and molecular landscape of the metabolic phenotype of resectable pancreatic cancers. Results Preoperative metabolic tumor volume (MTV)2.5 was significantly higher in the pN1 group compared to the pN0 group (11.1±11.2 vs 6.5±7.8, p=0.031). Higher MTV2.5 values (MTV2.5 ≥4.5) were associated with multiple lymph node metastasis (p=0.003), and the lymph node ratio was also significantly higher in resected pT3 pancreatic cancer with MTV2.5 ≥4.5 compared to those with MTV2.5 <4.5 (0.12±0.13 vs 0.05±0.08, p=0.001). Disease-specific survival of patients with MTV2.5 <4.5 was better than that of patients with MTV2.5 ≥4.5 (mean, 28.8 months; 95% confidence interval [CI], 40.1 to 57.0 vs mean, 32.6 months; 95% CI, 25.5 to 39.7; p=0.026). Patients with MTV2.5 ≥4.5 who received postoperative adjuvant chemotherapy showed better survival outcomes than patients with MTV2.5 ≥4.5 who did not receive adjuvant treatment in resected pT3 pancreatic cancers (p<0.001). Transcriptome-wide analysis revealed that tumors with MTV2.5 ≥4.5 demonstrated significantly different expression of cancer-related genes reflecting aggressive tumor biology. Conclusions Resectable pancreatic cancer with high MTV2.5 is not only associated with lymph node metastasis but also early systemic metastasis. The molecular background of resectable pancreatic cancer with high MTV2.5 may be associated with aggressive biologic behavior, which might need to be considered when managing resectable pancreatic cancers. Further study is mandatory.
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Affiliation(s)
- Sung Hwan Lee
- Department of Systems Biology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Kyoung Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| | - Woo Jung Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| | - Mijin Yun
- Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea.,Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Moo Kang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
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Liu GM, Xie WX, Zhang CY, Xu JW. Identification of a four-gene metabolic signature predicting overall survival for hepatocellular carcinoma. J Cell Physiol 2019; 235:1624-1636. [PMID: 31309563 DOI: 10.1002/jcp.29081] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 06/21/2019] [Indexed: 01/27/2023]
Abstract
While hundreds of consistently altered metabolic genes had been identified in hepatocellular carcinoma (HCC), the prognostic role of them remains to be further elucidated. Messenger RNA expression profiles and clinicopathological data were downloaded from The Cancer Genome Atlas-Liver Hepatocellular Carcinoma and GSE14520 data set from the Gene Expression Omnibus database. Univariate Cox regression analysis and lasso Cox regression model established a novel four-gene metabolic signature (including acetyl-CoA acetyltransferase 1, glutamic-oxaloacetic transaminase 2, phosphatidylserine synthase 2, and uridine-cytidine kinase 2) for HCC prognosis prediction. Patients in the high-risk group shown significantly poorer survival than patients in the low-risk group. The signature was significantly correlated with other negative prognostic factors such as higher α-fetoprotein. The signature was found to be an independent prognostic factor for HCC survival. Nomogram including the signature shown some clinical net benefit for overall survival prediction. Furthermore, gene set enrichment analyses revealed several significantly enriched pathways, which might help explain the underlying mechanisms. Our study identified a novel robust four-gene metabolic signature for HCC prognosis prediction. The signature might reflect the dysregulated metabolic microenvironment and provided potential biomarkers for metabolic therapy and treatment response prediction in HCC.
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Affiliation(s)
- Gao-Min Liu
- Department of Hepatobiliary Surgery, Meizhou People's Hospital, Meizhou, China.,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou, China
| | - Wen-Xuan Xie
- Department of Liver Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Cai-Yun Zhang
- Department of Hepatobiliary Surgery, Meizhou People's Hospital, Meizhou, China.,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou, China
| | - Ji-Wei Xu
- Department of Hepatobiliary Surgery, Meizhou People's Hospital, Meizhou, China.,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou, China
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7
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Lee SM, Kim HS, Lee S, Lee JW. Emerging role of 18F-fluorodeoxyglucose positron emission tomography for guiding management of hepatocellular carcinoma. World J Gastroenterol 2019; 25:1289-1306. [PMID: 30918424 PMCID: PMC6429342 DOI: 10.3748/wjg.v25.i11.1289] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/25/2019] [Accepted: 03/02/2019] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of major causes of cancer mortality worldwide. For decades, 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has been widely used for staging, predicting prognosis, and detecting cancer recurrence in various types of malignant diseases. Due to low sensitivity of FDG PET for detecting intrahepatic HCC lesions, the clinical value of FDG PET in HCC patients has been limited. However, recent studies with diverse analytic methods have shown that FDG PET has promising role in aiding management of HCC patients. In this review, we will discuss the clinical role of FDG PET for staging, predicting prognosis, and evaluating treatment response in HCC. Further, we will focus on recent clinical studies regarding implication of volumetric FDG PET parameters, the significance of FDG uptake in HCC for selecting treatment and predicting treatment response, and the use of radiomics of FDG PET in HCC.
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Affiliation(s)
- Sang Mi Lee
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Chungcheongnam-do 31151, South Korea
| | - Hong Soo Kim
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Chungcheongnam-do 31151, South Korea
| | - Sangheun Lee
- Division of Hepatology, Department of Internal medicine, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Incheon 22711, South Korea
- Institute for Health and Life Science, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Incheon 22711, South Korea
| | - Jeong Won Lee
- Department of Nuclear Medicine, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Incheon 22711, South Korea
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Kornberg A, Friess H. 18F-fludeoxyglucose positron emission tomography for diagnosis of HCC: implications for therapeutic strategy in curative and non-curative approaches. Therap Adv Gastroenterol 2019; 12:1756284819836205. [PMID: 30915167 PMCID: PMC6429646 DOI: 10.1177/1756284819836205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 02/15/2019] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a global health issue with increasing incidence and high mortality rate. Depending on the tumor load and extent of underlying liver cirrhosis, aggressive surgical treatment by hepatectomy or liver transplantation (LT) may lead to cure, whereas different modalities of liver-directed locoregional or systemic tumor treatments are currently available for a noncurative approach. Apart from tumor burden and grade of liver dysfunction, assessment of prognostic relevant biological tumor aggressiveness is vitally important for establishing a promising multimodal therapeutic strategy and improving the individual treatment-related risk/benefit ratio. In recent years, an increasing body of clinical evidence has been presented that 18F-fludeoxyglucose (18F-FDG) positron emission tomography (PET), which is a standard nuclear imaging device in oncology, may serve as a powerful surrogate for tumor invasiveness and prognosis in HCC patients and, thereby, impact individual decision making on most appropriate therapy concept. This review describes the currently available data on the prognostic value of 18F-FDG PET in patients with early and advanced HCC stages and the resulting implications for treatment strategy.
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Affiliation(s)
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technical University, Munich, Germany
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9
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Park JH, Kim DH, Kim SH, Kim MY, Baik SK, Hong IS. The Clinical Implications of Liver Resection Margin Size in Patients with Hepatocellular Carcinoma in Terms of Positron Emission Tomography Positivity. World J Surg 2018; 42:1514-1522. [PMID: 29026966 DOI: 10.1007/s00268-017-4275-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The positivity of positron emission tomography (PET) in hepatocellular carcinoma (HCC) correlates with aggressive tumor factors and poor survival. Adequate resection margin size is still a topic of debate. We analyzed the clinical implications of resection margin size in patients with HCC in terms of PET positivity. METHODS We retrospectively reviewed the medical records of 92 patients who underwent liver resection from March 2012 to October 2015. We investigated prognostic factors for recurrence and survival. We analyzed the correlation of resection margin size and PET positivity. Resection margins were classified as less than 1 cm and more than 1 cm. RESULTS Twenty six (31.3%) patients had PET-positive HCC. Multivariate analysis showed PET, satellite nodules, microvessel invasion, and multicentric occurrence were significant prognostic factors for HCC recurrence. Multivariate analysis also showed satellite nodules and microscopic portal vein invasion were significant prognostic factors for overall survival (OS). Resection margin size did not affect disease-free survival (DFS) (p = 0.681) or OS (p = 0.301) in patients with PET-negative HCC, but showed a difference in DFS [<1 cm at 11 months vs. ≥1 cm at 41 months (p = 0.188)] and OS [<1 cm at 28 months vs. ≥1 cm at 48 months (p < 0.001)] in patients with PET-positive HCC. CONCLUSIONS PET has low sensitivity for HCC. However, it is useful to predict treatment outcomes after liver resection or liver transplantation for HCC. Although the extent of liver resection must be decided based on liver function, a resection margin size >1 cm may improve DFS and OS in patients with PET-positive HCC.
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Affiliation(s)
- Jae Hyun Park
- Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 162, Ilsan-dong, Wonju, 220-701, Kangwon-do, Korea
| | - Dong Hwi Kim
- Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 162, Ilsan-dong, Wonju, 220-701, Kangwon-do, Korea
| | - Sung Hoon Kim
- Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 162, Ilsan-dong, Wonju, 220-701, Kangwon-do, Korea.
| | - Moon Young Kim
- Department of Internal medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Soon Koo Baik
- Department of Internal medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - In Su Hong
- Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
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10
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ACR Appropriateness Criteria ® Chronic Liver Disease. J Am Coll Radiol 2017; 14:S391-S405. [DOI: 10.1016/j.jacr.2017.08.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 02/07/2023]
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11
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Horowitz JM, Kamel IR, Arif-Tiwari H, Asrani SK, Hindman NM, Kaur H, McNamara MM, Noto RB, Qayyum A, Lalani T. ACR Appropriateness Criteria ® Chronic Liver Disease. J Am Coll Radiol 2017; 14:S103-S117. [DOI: 10.1016/j.jacr.2017.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 02/01/2017] [Accepted: 02/02/2017] [Indexed: 02/07/2023]
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12
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Rhee WJ, Hwang SH, Byun HK, Yun M, Han KH, Seong J. Risk stratification for locally advanced hepatocellular carcinoma using pretreatment alpha-foetoprotein and 18 F-fluoro-2-deoxyglucose positron emission tomography. Liver Int 2017; 37:592-599. [PMID: 27804192 DOI: 10.1111/liv.13297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 10/25/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS We investigated the significance of 18 F-fluoro-2-deoxyglucose positron emission tomography (18 F-FDG PET) parameters and alpha-foetoprotein (AFP) levels in patients with locally advanced hepatocellular carcinoma (LA-HCC). METHODS We retrospectively analysed data of 228 patients with LA-HCC who underwent pretreatment 18 F-FDG PET between January 2003 and December 2013. All patients were treated using liver-directed therapy involving radiotherapy. The maximum standardized uptake values (SUVs) and tumour-to-extratumoural liver SUV ratios were calculated, and pretreatment AFP values were obtained. RESULTS Patients were divided into high and low maximum SUV (SUVmax) groups according to a SUV cut-off of 4.825 determined via receiver-operating characteristic analysis. High AFP level (>550 ng/mL) and high SUVmax were significant predictors of overall and progression-free survival. Better treatment responses and longer median progression-free and overall survival were observed in the low SUVmax group, compared to the high SUVmax group. Similar results were obtained for SUV ratio-based (cut-off value: 2.355) and AFP-based analyses (cut-off value: 550 ng/mL). Three risk groups were identified using the double biomarkers of SUVmax and AFP value as strong prognosticators predictive of survival outcomes. This risk stratification was identified as a prognosticator of survival outcomes, even after subgroup analyses. Furthermore, in high risk group, significantly high extrahepatic failure was shown while in low risk group, significantly low intrahepatic failure. CONCLUSIONS Clinical significance of double biomarkers, SUV and AFP, could be translated into risk stratification for LA-HCC. It could be a valuable tool for survival outcome prediction.
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Affiliation(s)
- Woo Joong Rhee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Sang Hyun Hwang
- Department of Nuclear Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Hwa Kyung Byun
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Mijin Yun
- Department of Nuclear Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Kwang-Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Jinsil Seong
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
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Abstract
PURPOSE Metabolic activity, as defined by F-FDG uptake on PET, is a prognostic marker for multiple malignancies; however, no study has examined the prognostic value of imaging with FDG PET in stage I and II pancreatic cancer. We examined the value of PET FDG uptake in early-stage pancreatic cancer patients. METHODS We identified patients with early-stage pancreatic cancer (I-II) who had FDG PET scan performed as part of their preoperative evaluation. The patients were divided into either high or low FDG uptake according to the median primary tumor standard uptake value (SUVmax). Our primary end points were overall survival (OS) and recurrence-free survival (RFS). Kaplan-Meier estimate was used for survival analysis. Pathologic data were compared using the Fisher exact and χ tests. RESULTS One hundred five patients were identified: 51 patients with low FDG uptake and 54 patients with high FDG uptake. Eighty-five patients (81%) had PET avid tumors, whereas 20 (19%) patients did not. High FDG uptake correlated with pathologic stage (P = 0.012). Patients with low FDG uptake had significantly better median OS than patients with high FDG uptake (28 vs. 16 months; P = 0.036). Patients with low-FDG uptake had significantly longer median RFS than patients with high FDG uptake (14 vs. 12 months; P = 0.049). CONCLUSIONS Low FDG uptake in PET scans in patients with stage I and II pancreatic cancer correlates with improved OS and RFS. This supports the concept that glucose metabolic pathways are important in pancreatic cancer biology and that PET scan activity can be used as a prognostic biomarker after pancreatectomy.
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Ohri N, Dawson LA, Krishnan S, Seong J, Cheng JC, Sarin SK, Kinkhabwala M, Ahmed MM, Vikram B, Coleman CN, Guha C. Radiotherapy for Hepatocellular Carcinoma: New Indications and Directions for Future Study. J Natl Cancer Inst 2016; 108:djw133. [PMID: 27377923 DOI: 10.1093/jnci/djw133] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 04/18/2016] [Indexed: 12/12/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer death worldwide; its incidence is increasing in the United States. Depending on disease extent and underlying liver status, patients may be treated with local, locoregional, and/or systemic therapy. Recent data indicates that radiotherapy (RT) can play a meaningful role in the management of HCC. Here, we review published experiences using RT for HCC, including the use of radiosensitizers and stereotactic RT. We discuss methods for performing preclinical studies of RT for HCC and biomarkers of response. As a part of the HCC Working Group, an informal committee of the National Cancer Institute's Radiation Research Program, we suggest how RT should be implemented in the management of HCC and identify future directions for the study of RT in HCC.
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Affiliation(s)
- Nitin Ohri
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Laura A Dawson
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Sunil Krishnan
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jinsil Seong
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jason C Cheng
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Shiv K Sarin
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Milan Kinkhabwala
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Mansoor M Ahmed
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Bhadrasain Vikram
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - C Norman Coleman
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Chandan Guha
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD.
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Increased 18F-FDG Uptake on PET/CT is Associated With Poor Arterial and Portal Perfusion on Multiphase CT. Clin Nucl Med 2016; 41:296-301. [PMID: 26756099 DOI: 10.1097/rlu.0000000000001105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To correlate 18F-FDG uptake on PET/CT with patterns of arterial and portal perfusion on multi-detector CT (MDCT) in patients with hepatocellular carcinoma (HCC) and to assess the value of variables from PET/CT and MDCT in predicting histological grades and overall survival. METHODS We retrospectively analyzed MDCT and PET/CT of 66 patients with HCC who underwent surgical treatment. Tumor peak standard uptake value (SUV) was divided by the mean liver SUV (T/LSUV). The mean tumor Hounsfield unit (HU) to mean liver HU was calculated for arterial (T/LHU-A) and portal phases (T/LHU-P). All patients were divided into three groups: I, T/LHU-A ≤l and T/LHU-P <1; II, T/LHU-A >1 and T/LHU-P <1; and III, T/LHU-A >1 and T/LHU-P ≥1. The relationships between the CT perfusion groups and T/LSUV were assessed. Multivariate logistic regression analyses were performed using clinical and imaging parameters for predicting histological grade. Overall survival curves stratified by T/LSUV and CT perfusion groups were estimated using the Kaplan-Meier method. RESULTS Statistically significant differences in T/LSUV were noted between groups I and II (2.29 [range 1.74-3.60] vs. 1.20 [range 1.07-1.58], P < 0.001) and groups I and III (2.29 [range 1.74-3.60] vs. 1.30 [range 1.07-1.43], P < 0.001). In multivariate analysis, a T/LSUV cutoff of >1.46 was the only independent predictor of tumor grade, with an odds ratio of 8.462 (95% confidence interval 1.799-39.803). Kaplan-Meier curves showed significant differences in OS according to T/LSUV >1.62, group I perfusion pattern, and T/LSUV >1.62 plus group I perfusion pattern (P = 0.04, P = 0.021, and P = 0.002, respectively). CONCLUSION 18F-FDG PET/CT is not commonly used for detecting HCC due to its limited sensitivity. We found that increased 18F-FDG uptake is associated with decreased arterial and portal perfusion on MDCT. This can be used to preselect patients who would benefit the most from PET/CT. Meanwhile, 18F-FDG uptake remained as the only independent predictor of histological grade, and higher 18F-FDG uptake and lower perfusion pattern on MDCT were significantly related to shorter OS.
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16
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Lee JW, Oh JK, Chung YA, Na SJ, Hyun SH, Hong IK, Eo JS, Song BI, Kim TS, Kim DY, Kim SU, Moon DH, Lee JD, Yun M. Prognostic Significance of ¹⁸F-FDG Uptake in Hepatocellular Carcinoma Treated with Transarterial Chemoembolization or Concurrent Chemoradiotherapy: A Multicenter Retrospective Cohort Study. J Nucl Med 2016; 57:509-16. [PMID: 26742711 DOI: 10.2967/jnumed.115.167338] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 11/20/2015] [Indexed: 12/12/2022] Open
Abstract
UNLABELLED 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.
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Affiliation(s)
- Jeong Won Lee
- Department of Nuclear Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Jin Kyoung Oh
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Yong An Chung
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Sae Jung Na
- Department of Radiology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Seung Hyup Hyun
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Il Ki Hong
- Department of Nuclear Medicine, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Jae Seon Eo
- Department of Nuclear Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Bong-Il Song
- Department of Nuclear Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Tae-sung Kim
- Department of Nuclear Medicine, National Cancer Center Research Institute and Hospital, Gyeonggi-do, Korea
| | - Do Young Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Up Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Hyuk Moon
- Department of Nuclear Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong Doo Lee
- Department of Radiology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea; and
| | - Mijin Yun
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Korea
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17
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Prognostic significance of parameters from pretreatment (18)F-FDG PET in hepatocellular carcinoma: a meta-analysis. Abdom Radiol (NY) 2016; 41:33-41. [PMID: 26830609 DOI: 10.1007/s00261-015-0603-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE The prognostic value of (18)F-deoxyglucose positron emission tomography ((18)F-FDG PET) on hepatocellular carcinoma (HCC) remains inconclusive. This study aims to investigate the prognostic role of pretreatment (18)F-FDG PET on HCC patients by meta-analysis. METHODS PubMed, Embase, Cochrane library, and Wanfang databases were searched until June 2015. Hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) were synthesized by Stata 10.0, and the combined results were used as effective values. RESULTS Twenty-two studies containing a total of 1721 patients were identified. According to random-effect model, meta-analysis results showed that high Tumor SUV/Liver SUV (Tsuv/Lsuv) ratio was significantly associated with poorer overall survival (OS) (HR = 2.04; 95% CI 1.50-2.79; P = 0.000) and poorer disease-free survival (HR = 7.17; 95% CI 3.58-14.36; P = 0.000); and high Tumor SUV (Tsuv) value was also correlated with poor OS (HR = 1.53; 95% CI 1.26-1.87; P = 0.000). Meanwhile, subgroup analysis results showed that the significant association above was not altered by study sample size, parameter cutoff value, analytic method, and follow-up period, but there was no significant association between Tsuv/Lsuv ratio and OS in patients who underwent resection (HR = 1.71; 95% CI 1.00-2.92; P = 0.052). CONCLUSIONS Both high Tsuv/Lsuv ratio and high Tsuv value are associated with poor prognosis in HCC patients. Therefore, pretreatment (18)F-FDG PET is a useful tool in predicting the prognosis of HCC patients. More studies with explicit treatment modalities are required to investigate the prognostic value of pretreatment (18)F-FDG PET on HCC patients.
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18
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Kim BK, Shim JH, Kim SU, Park JY, Kim DY, Ahn SH, Kim KM, Lim YS, Han KH, Lee HC. Risk prediction for patients with hepatocellular carcinoma undergoing chemoembolization: development of a prediction model. Liver Int 2016; 36:92-9. [PMID: 25950442 DOI: 10.1111/liv.12865] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 05/01/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUNDS & AIMS We aimed to generate and validate a novel risk prediction model for patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE). METHODS Patients receiving TACE as the first-line therapy between 2006 and 2009 were selected from the databases of two major tertiary hospitals in Korea. This study population was randomly assigned into training (n = 340) and validation (n = 145) sets. From a multivariate Cox-regression model for overall survival (OS), tumour Size, tumour Number, baseline Alpha-foetoprotein level, Child-Pugh class and Objective radiological Response after the first TACE session were selected and then scored to generate a 10-point risk prediction model (named as "SNACOR" model) in the training set. Thereafter, the prognostic performance was assessed in the validation set. RESULTS In the training set, the time-dependent areas under receiver-operating characteristic curves (AUROCs) for OS at 1-, 3- and 6-years were 0.756, 0.754 and 0.742 respectively. According to the score of the SNACOR model, patients were stratified into three groups; low- (score 0-2), intermediate- (score 3-6) and high-risk group (score 7-10) respectively. The low-risk group had the longest median OS (49.8 months), followed by intermediate- (30.7 months) and high-risk group (12.4 months) (log-rank test, P < 0.001). Compared with the low-risk group, the intermediate-risk (hazard ratio [HR] 2.13, P < 0.001) and high-risk group (HR 6.17, P < 0.001) retained significant risks of death. Similar results were obtained in the validation set. CONCLUSION A simple-to-use SNACOR model for patients with HCC treated with TACE might be helpful in appropriate prognostification and guidance for decision of further treatment strategies.
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Affiliation(s)
- Beom Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Ju Hyun Shim
- Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Up Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Yong Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Do Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hoon Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.,Brain Korea 21 Project for Medical Science, Seoul, Korea
| | - Kang Mo Kim
- Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Suk Lim
- Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kwang-Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.,Brain Korea 21 Project for Medical Science, Seoul, Korea
| | - Han Chu Lee
- Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Ahn SY, Lee JM, Joo I, Lee ES, Lee SJ, Cheon GJ, Han JK, Choi BI. Prediction of microvascular invasion of hepatocellular carcinoma using gadoxetic acid-enhanced MR and (18)F-FDG PET/CT. ACTA ACUST UNITED AC 2015; 40:843-51. [PMID: 25253426 DOI: 10.1007/s00261-014-0256-0] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To identify the gadoxetic acid-enhanced MR and the (18)F-fludeoxyglucose (FDG) PET/CT findings associated with microvascular invasion (MVI) of hepatocellular carcinoma (HCC) in patients who are undergoing liver transplantation (LT). METHODS Fifty-one patients with 78 HCCs underwent LT. Preoperative MRI and (18)F-FDG PET/CT findings were retrospectively analyzed and the association of the imaging findings with MVI was assessed. RESULTS Univariate analysis revealed that hypointensity seen on T1WI (OR = 4.329, p = 0.011), peritumoral enhancement (OR = 7.000, p = 0.008), inhomogeneity on arterial phase (OR = 4.321, p = 0.011), delayed phase (OR = 4.519, p = 0.009) or hepatobiliary phase (OR = 3.564, p = 0.032), and the large tumor size (>5 cm) (OR = 12.091, p = 0.001) showed statistically significant associations with MVI. The ratio of tumor maximum standardized uptake value (SUV) to normal liver mean SUV (TSUVmax/LSUVmean) (2.05 ± 1.43 vs. 1.08 ± 0.37) revealed significantly higher value in the MVI-positive group. Multivariate analysis revealed that peritumoral enhancement and a TSUVmax/LSUVmean of 1.2 or greater had a statistically significant association with MVI, with odds ratios of 10.648 (p = 0.016) and 14.218 (p = 0.001), respectively. CONCLUSIONS Preoperative imaging findings such as peritumoral enhancement seen on gadoxetic acid-enhanced MR and a TSUVmax/LSUVmean of 1.2 or more on (18)F-FDG PET/CT, may suggest the presence of MVI in HCC patients.
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Affiliation(s)
- Su Yeon Ahn
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea
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20
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¹⁸F-FDG PET/CT in hepatocellular carcinoma: detection of bone metastasis and prediction of prognosis. Nucl Med Commun 2015; 36:226-33. [PMID: 25460306 DOI: 10.1097/mnm.0000000000000246] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the diagnostic accuracy and prognostic value of 18F-fluorodeoxyglucose PET/computed tomography (CT) in bone metastases from hepatocellular carcinoma (HCC). PATIENTS AND METHODS Of 3912 consecutive HCC patients, 67 patients who had undergone both PET/CT and bone scintigraphy (BS) within a 3-month interval were evaluated. RESULTS Bone metastases were most frequently found in the pelvis (20%), followed by the lumbar spine (14%) and long bones (13%). PET/CT was significantly more sensitive than BS in region-based analyses, with 273 confirmed bone metastases (96.7 vs. 52.7%, respectively; P<0.001), and in patient-based analyses (99 vs. 85%; P=0.042). The median survival period was 5 (range, 0.4-18) months. On univariate analysis, poor prognostic factors included age (<60 years), multiple bone metastases, lymph node metastasis, high serum α-fetoprotein (≥400 IU/ml), Child-Pugh class B, and high maximum standardized uptake value (SUVmax) of bone metastasis (>5.0). Large metabolic volume (≥200 cm3) of bone metastasis was another poor prognostic factor. On Cox regression analysis, high α-fetoprotein was the only poor prognostic factor with statistical significance. CONCLUSION PET/CT was more sensitive than BS in bone metastasis from HCC by both patient-based and region-based analyses, and offered additional information on survival. PET/CT can be helpful in early diagnosis and opportune treatment of bone metastasis from HCC.
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21
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Kim R, Lee JM, Shin CI, Lee ES, Yoon JH, Joo I, Kim SH, Hwang I, Han JK, Choi BI. Differentiation of intrahepatic mass-forming cholangiocarcinoma from hepatocellular carcinoma on gadoxetic acid-enhanced liver MR imaging. Eur Radiol 2015; 26:1808-17. [PMID: 26373763 DOI: 10.1007/s00330-015-4005-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 08/16/2015] [Accepted: 09/02/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To determine the different imaging features of intrahepatic mass-forming cholangiocarcinoma (IMCC) from hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced magnetic resonance imaging (MRI). METHODS This retrospective study was institutional review board approved and the requirement for informed consent was waived. Patients who underwent gadoxetic acid-enhanced MRI with histologically confirmed IMCCs (n = 46) or HCCs (n = 58) were included. Imaging features of IMCCs and HCCs on gadoxetic acid-enhanced MRI including T2- and T1-weighted, diffusion weighted images, dynamic study and hepatobiliary phase (HBP) images were analyzed. Univariate and multivariate logistic regression analyses were performed to identify relevant differentiating features between IMCCs and HCCs. RESULTS Multivariate analysis revealed heterogeneous T2 signal intensity and a hypointense rim on the HBP as suggestive findings of IMCCs and the wash-in and "portal wash-out" enhancement pattern as well as focal T1 high signal intensity foci as indicative of HCCs (all, p < 0.05). When we combined any three of the above four imaging features, we were able to diagnose IMCCs with 94 % (43/46) sensitivity and 86 % (50/58) specificity. CONCLUSIONS Combined interpretation of enhancement characteristics including HBP images, morphologic features, and strict application of the "portal wash-out" pattern helped more accurate discrimination of IMCCs from HCCs. KEY POINTS • Analysis of enhancement characteristics helped accurate discrimination of IMCCs from HCCs. • Wash-out should be determined on the PVP of gadoxetic acid-enhanced MRI. • A hypointense rim on the HBP was a significant finding of IMCCs.
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Affiliation(s)
- Rihyeon Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea. .,Institute of Radiation Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea.
| | - Cheong-Il Shin
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, 102, Heukseok-ro, Dongjak-gu, Seoul, Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Seong Ho Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Inpyeong Hwang
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, 102, Heukseok-ro, Dongjak-gu, Seoul, Korea
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Abstract
Transarterial chemoembolization is a minimally invasive procedure that deprives the tumor of its blood supply, and is especially used for the treatment of unresectable hepatocellular carcinoma. Metabolic evaluation of interventional therapies such as transarterial chemoembolization in hepatocellular carcinoma is proving to be a valuable tool in choosing therapies that are better targeted to patients, especially because of its likely contribution in predicting treatment response in unresectable lesions after these therapies.
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Affiliation(s)
- Nayelli Ortega López
- Department of Nuclear Medicine, Instituto Nacional de Cancerología, Av. San Fernando, no. 22, Colonia Sección XVI, C.P. 0400, Mexico City, Mexico; PET/CT Unit, Imagenus, Advanced Diagnostics in Healthcare, Av. México-Coyoacán, no. 346, Colonia General Anaya, Mexico City 03340, Mexico.
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Gauthé M, Richard-Molard M, Cacheux W, Michel P, Jouve JL, Mitry E, Alberini JL, Lièvre A. Role of fluorine 18 fluorodeoxyglucose positron emission tomography/computed tomography in gastrointestinal cancers. Dig Liver Dis 2015; 47:443-54. [PMID: 25766918 DOI: 10.1016/j.dld.2015.02.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/06/2015] [Indexed: 12/11/2022]
Abstract
Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) has become a routine imaging modality for many malignancies and its use is currently increasing. In the present review article, we will summarize the evidence for FDG-PET/CT use in digestive cancers (excluding neuroendocrine tumours), and review the existing recommendations. While PET/CT is nowadays considered to be an important tool in the initial workup of oesophageal and anal cancers, new data are emerging regarding its use in assessing therapeutic efficacy, radiotherapy treatment planning, and detection of recurrence in case of isolated tumour marker elevation. Moreover, PET/CT may help decision making by detecting distant metastatic sites especially in potentially resectable metastatic colorectal cancer and, to a lesser extent, in localized gastric and pancreatic cancers. Finally, incidental focal colonic FDG uptakes require exploration by colonoscopy, as they are often associated with premalignant or malignant lesions.
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Affiliation(s)
- Mathieu Gauthé
- Institut Curie, René Huguenin Hospital, Department of Nuclear Medicine, Saint-Cloud, France; Department of Nuclear Medicine, Centre Oscar Lambret, Lille, France.
| | - Marion Richard-Molard
- Institut Curie, René Huguenin Hospital, Department of Radiation Therapy, Saint-Cloud, France
| | - Wulfran Cacheux
- Institut Curie, Department of Medical Oncology, Paris, France
| | - Pierre Michel
- Department of Gastroenterology, Rouen University Hospital, France; University of Rouen, Rouen, France
| | - Jean-Louis Jouve
- Department of Gastroenterology, Dijon University Hospital, University of Burgundy, INSERM U866, Dijon, France
| | - Emmanuel Mitry
- Institut Curie, René Huguenin Hospital, Department of Medical Oncology, Saint-Cloud, France; University of Versailles Saint Quentin, Faculty of Health Sciences, Montigny-Le-Bretonneux, France
| | - Jean-Louis Alberini
- Institut Curie, René Huguenin Hospital, Department of Nuclear Medicine, Saint-Cloud, France; University of Versailles Saint Quentin, Faculty of Health Sciences, Montigny-Le-Bretonneux, France
| | - Astrid Lièvre
- Institut Curie, René Huguenin Hospital, Department of Medical Oncology, Saint-Cloud, France; University of Versailles Saint Quentin, Faculty of Health Sciences, Montigny-Le-Bretonneux, France
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Hayano K, Lee SH, Sahani DV. Imaging for assessment of treatment response in hepatocellular carcinoma: Current update. Indian J Radiol Imaging 2015; 25:121-8. [PMID: 25969635 PMCID: PMC4419421 DOI: 10.4103/0971-3026.155835] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Morphologic methods such as the Response Evaluation Criteria in Solid Tumors (RECIST) are considered as the gold standard for response assessment in the management of cancer. However, with the increasing clinical use of antineoplastic cytostatic agents and locoregional interventional therapies in hepatocellular carcinoma (HCC), conventional morphologic methods are confronting limitations in response assessment. Thus, there is an increasing interest in new imaging methods for response assessment, which can evaluate tumor biology such as vascular physiology, fibrosis, necrosis, and metabolism. In this review, we discuss various novel imaging methods for response assessment and compare them with the conventional ones in HCC.
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Affiliation(s)
- Koichi Hayano
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sang Ho Lee
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dushyant V Sahani
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
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25
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Kim MJ, Kim YS, Cho YH, Jang HY, Song JY, Lee SH, Jeong SW, Kim SG, Jang JY, Kim HS, Kim BS, Lee WH, Park JM, Lee JM, Lee MH, Choi DL. Use of (18)F-FDG PET to predict tumor progression and survival in patients with intermediate hepatocellular carcinoma treated by transarterial chemoembolization. Korean J Intern Med 2015; 30:308-15. [PMID: 25995661 PMCID: PMC4438285 DOI: 10.3904/kjim.2015.30.3.308] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 06/27/2014] [Accepted: 08/25/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND/AIMS (18)F-Fluorodeoxyglucose positron-emission tomography ((18)F-FDG PET) has been used to assess the biological behavior of hepatocellular carcinoma (HCC). In this study, we investigated the usefulness of (18)F-FDG PET for predicting tumor progression and survival in patients with intermediate Barcelona Clinic Liver Cancer (BCLC) intermediate-stage HCC treated by transarterial chemoembolization (TACE). METHODS From February 2006 to March 2013, 210 patients treated with TACE, including 77 patients with BCLC intermediate-stage HCC, underwent examination by (18)F-FDG PET. (18)F-FDG uptake was calculated based on the tumor maximum (Tmax) standardized uptake value (SUV), the liver mean (Lmean) SUV, and the ratio of the Tmax SUV to the Lmean SUV (Tmax/Lmean). RESULTS The mean follow-up period for the 77 patients (52 males, 25 females; average age, 63.3 years) was 22.2 months. The median time to progression of HCC in patients with a low Tmax/Lmean (< 1.83) and high Tmax/Lmean (≥ 1.83) was 17 and 6 months, respectively (p < 0.001). The median overall survival time of patients with a low and high Tmax/Lmean was 44 and 14 months, respectively (p = 0.003). Multivariate analysis revealed that the Tmax/Lmean was an independent predictor of overall survival (hazard ratio [HR], 1.96; 95% confidence interval [CI], 1.210 to 3.156; p = 0.006) and tumor progression (HR, 2.05; 95% CI, 1.264 to 3.308; p = 0.004). CONCLUSIONS (18)F-FDG uptake calculated by the Tmax/Lmean using PET predicted tumor progression and survival in patients with BCLC intermediate-stage HCC treated by TACE.
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Affiliation(s)
- Min Jin Kim
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Young Seok Kim
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Youn Hee Cho
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Hee Yoon Jang
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jeong-Yeop Song
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sae Hwan Lee
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Soung Won Jeong
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sang Gyune Kim
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jae Young Jang
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Hong Su Kim
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Boo Sung Kim
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Won Hyung Lee
- Department of Nuclear Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jung Mi Park
- Department of Nuclear Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jae Myung Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Min Hee Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Deuk Lin Choi
- Department of Radiology, Soonchunhyang University Hospital, Seoul, Korea
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26
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Predictability of preoperative 18F-FDG PET for histopathological differentiation and early recurrence of primary malignant intrahepatic tumors. Nucl Med Commun 2015; 36:319-27. [DOI: 10.1097/mnm.0000000000000254] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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27
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Choi JY, Lee JM, Sirlin CB. CT and MR imaging diagnosis and staging of hepatocellular carcinoma: part II. Extracellular agents, hepatobiliary agents, and ancillary imaging features. Radiology 2015; 273:30-50. [PMID: 25247563 DOI: 10.1148/radiol.14132362] [Citation(s) in RCA: 356] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Computed tomography (CT) and magnetic resonance (MR) imaging play critical roles in the diagnosis and staging of hepatocellular carcinoma (HCC). The second article of this two-part review discusses basic concepts of diagnosis and staging, reviews the diagnostic performance of CT and MR imaging with extracellular contrast agents and of MR imaging with hepatobiliary contrast agents, and examines in depth the major and ancillary imaging features used in the diagnosis and characterization of HCC.
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Affiliation(s)
- Jin-Young Choi
- From the Department of Radiology, Research Institute of Radiological Science, Yonsei University Health System, Seoul, Korea (J.Y.C.); Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea (J.M.L.); and Liver Imaging Group, Department of Radiology, University of California-San Diego Medical Center, 408 Dickinson St, San Diego, CA 92103-8226 (C.B.S.)
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28
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Flamen P. Optimizing the use of PET with selective internal radiation therapy. Future Oncol 2014; 10:73-5. [DOI: 10.2217/fon.14.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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29
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She WH, Cheung TT, Yau TCC, Chan ACY, Chok KSH, Chu FSK, Liu RKY, Poon RTP, Chan SC, Fan ST, Lo CM. Survival analysis of transarterial radioembolization with yttrium-90 for hepatocellular carcinoma patients with HBV infection. Hepatobiliary Surg Nutr 2014; 3:185-93. [PMID: 25202695 DOI: 10.3978/j.issn.2304-3881.2014.07.09] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 07/22/2014] [Indexed: 12/13/2022]
Abstract
INTRODUCTION For patients with resectable hepatocellular carcinoma (HCC), hepatectomy remains one of the best treatment options to provide long-term survival. However, more than 50% of the patients have unresectable disease upon diagnosis even though there are no distant metastases. Transarterial chemoembolization (TACE) is a well-established treatment option that offers a palliative survival benefit for this group of patients. A better treatment for unresectable HCC has been sought after. There is some evidence that transarterial radioembolization (TARE) with the agent yttrium-90 produces encouraging outcomes, especially in patients with portal vein tumor thrombus. This study aims to analyze the outcomes of TARE at our center. METHODS From August 2009 to April 2013, 16 patients underwent TARE at our center. Sixteen patients with similar tumor characteristics were selected to undergo TACE alone for comparison. A retrospective analysis of the prospectively collected data of the patients was conducted. Only patients with newly diagnosed primary tumors were included in this study. RESULTS The median survival for patients having TARE was 19.9 versus 14.0 months in the TACE group (P=0.615). There was no difference in terms of tumor response according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST) (P=0.632). The 1-, 2- and 3-year survival rates in the TARE group were 80.0%, 30.5% and 20.3% respectively. The 1-year survival in the TACE group was 58.3% (P=0.615). For patients who had major vascular invasion (eight in each group), the 1- and 2-year survival rates in the TARE group were 62.5% and 15.6% respectively, while the 1-year survival in the TACE group was 35.0% (P=0.664). CONCLUSIONS The two groups showed similar results in terms of tumor response and overall survival benefit. TARE might provide a survival benefit for patients with major vessel invasion.
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Affiliation(s)
- Wong Hoi She
- 1 Department of Surgery, 2 Department of Diagnostic Radiology, 3 Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
| | - Tan To Cheung
- 1 Department of Surgery, 2 Department of Diagnostic Radiology, 3 Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
| | - Thomas C C Yau
- 1 Department of Surgery, 2 Department of Diagnostic Radiology, 3 Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
| | - Albert C Y Chan
- 1 Department of Surgery, 2 Department of Diagnostic Radiology, 3 Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
| | - Kenneth S H Chok
- 1 Department of Surgery, 2 Department of Diagnostic Radiology, 3 Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
| | - Ferdinand S K Chu
- 1 Department of Surgery, 2 Department of Diagnostic Radiology, 3 Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
| | - Rico K Y Liu
- 1 Department of Surgery, 2 Department of Diagnostic Radiology, 3 Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
| | - Ronnie T P Poon
- 1 Department of Surgery, 2 Department of Diagnostic Radiology, 3 Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
| | - See Ching Chan
- 1 Department of Surgery, 2 Department of Diagnostic Radiology, 3 Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
| | - Sheung Tat Fan
- 1 Department of Surgery, 2 Department of Diagnostic Radiology, 3 Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
| | - Chung Mau Lo
- 1 Department of Surgery, 2 Department of Diagnostic Radiology, 3 Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
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Cho Y, Lee DH, Lee YB, Lee M, Yoo JJ, Choi WM, Cho YY, Paeng JC, Kang KW, Chung JK, Yu SJ, Lee JH, Yoon JH, Lee HS, Kim YJ. Does 18F-FDG positron emission tomography-computed tomography have a role in initial staging of hepatocellular carcinoma? PLoS One 2014; 9:e105679. [PMID: 25153834 PMCID: PMC4143262 DOI: 10.1371/journal.pone.0105679] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 07/22/2014] [Indexed: 12/16/2022] Open
Abstract
Background and Aim The utility of fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET/CT) in initial staging of hepatocellular carcinoma (HCC) has yet to be fully explored. We assessed the usefulness of 18F-FDG PET/CT in initial staging of HCC. Methods A total of 457 consecutive patients initially diagnosed with HCC at Seoul National University Hospital between 2006 and 2012 were evaluated retrospectively to assess the impact of 18F-FDG PET/CT on staging and compliancy with Milan criteria, relative to dynamic CT of liver and chest x-ray. Results Seven among the 457 patients studied showed a shift in Barcelona Clinic Liver Cancer [BCLC] stage (A→C: 6 patients; B→C: 1 patient) and 5 patients who had originally met Milan criteria no longer qualified. 18F-FDG PET/CT had value in initial staging of early (stage A) or intermediate (stage B) HCC, as determined by dynamic CT of liver and BCLC or AJCC classifications, whereas BCLC stage 0 and stage C tumors were unchanged (P<0.001). 18F-FDG PET/CT disclosed additional metastases in patients with American Joint Committee on Cancer [AJCC] T2 (2.7%), T3a (5.3%), and T3b (4.8%) classifications. Conclusions In initial staging of HCC, 18F-FDG PET/CT provided additional information, impacting the patients with BCLC (stages A and B) and AJCC (T2 and T3) classifications. Its use might be thus appropriate for these patient subsets, especially if hepatic resection or liver transplantation is planned.
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Affiliation(s)
- Yuri Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong Hyeon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yun Bin Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Minjong Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong-ju Yoo
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Won-mook Choi
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Youn Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Chul Paeng
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Keon Wook Kang
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - June-Key Chung
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Su Jong Yu
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyo-Suk Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoon Jun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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Donswijk ML, Hess S, Mulders T, Lam MGEH. [18F]Fluorodeoxyglucose PET/Computed Tomography in Gastrointestinal Malignancies. PET Clin 2014; 9:421-41, v-vi. [PMID: 26050945 DOI: 10.1016/j.cpet.2014.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This article discusses the current state-of-the-art application of 2-deoxy-2-[(18)F]fluoro-d-glucose (FDG)-PET and FDG-PET/computed tomography (CT) in the management of patients with gastrointestinal malignancies. Gastrointestinal malignancies include many different cell types, several common malignancies of which may be imaged by FDG-PET/CT. This review focuses on gastric carcinoma, pancreatic carcinoma, hepatocellular carcinoma, cholangiocarcinoma, colorectal carcinoma, and stroma cell tumors. The role of FDG-PET/CT in staging these malignancies is discussed, in addition to (re)staging, detection of recurrent disease, patient selection/prognostication, and response assessment, using the currently available literature.
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Affiliation(s)
- Maarten L Donswijk
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands; Department of Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Søren Hess
- Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark
| | - Ties Mulders
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands; Department of Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Marnix G E H Lam
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands; Department of Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands.
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Simoneau E, Hassanain M, Madkhali A, Salman A, Nudo CG, Chaudhury P, Metrakos P. (18)F-Fluorodeoxyglucose positron-emission tomography could have a prognostic role in patients with advanced hepatocellular carcinoma. ACTA ACUST UNITED AC 2014; 21:e551-6. [PMID: 25089106 DOI: 10.3747/co.21.1959] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION We set out to evaluate the prognostic value of (18)F-fluorodeoxyglucose positron-emission tomography (pet) in patients with advanced (non-transplant-eligible) hepatocellular carcinoma (hcc) and to evaluate the correlation between standardized uptake values (suvs) and survival outcomes. METHODS We identified patients with hcc who, from 2005 to 2013, underwent pet imaging before any treatment. This retrospective study from our hcc database obtained complete follow-up data for the 63 identified patients. RESULTS Of the 63 patients, 10 underwent surgical resection, and 59 underwent locoregional therapy. In this cohort, 28 patients were pet-positive (defined as any lesion with a suv ≥ 4.0) before any therapy was given, and 35 patients were pet negative (all lesions with a suv < 4.0). On survival analysis, median survival was greater for the pet-negative than for the pet-positive patients: 29 months (range: 16.3-41.1 months) versus 12 months (range: 4.0-22.1 months) respectively, p = 0.0241. The pet-positive patients more often had large tumours (≥5 cm), poor differentiation, and extrahepatic disease, reflecting more aggressive tumours. On multivariate analysis, only pet positivity was associated with poor survival (p = 0.049). CONCLUSIONS Compared with pet-positive patients, pet-negative patients with hcc experienced longer survival. Imaging by pet can be of value in early prognostication for patients with hcc, especially patients receiving locoregional therapy for whom pathologic tumour differentiation is rarely available. This potential role for pet requires further validation in a prospective study.
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Affiliation(s)
- E Simoneau
- Department of Surgery, McGill University Health Centre, Hepatopancreaticobiliary Research Unit, Montreal, QC
| | - M Hassanain
- Department of Oncology, McGill University Health Centre, Montreal, QC. ; Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - A Madkhali
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - A Salman
- Department of Surgery, McGill University Health Centre, Hepatopancreaticobiliary Research Unit, Montreal, QC
| | - C G Nudo
- Department of Gastroenterology, Division of Hepatology, McGill University Health Centre, Montreal, QC
| | - P Chaudhury
- Department of Surgery, McGill University Health Centre, Hepatopancreaticobiliary Research Unit, Montreal, QC. ; Department of Oncology, McGill University Health Centre, Montreal, QC
| | - P Metrakos
- Department of Surgery, McGill University Health Centre, Hepatopancreaticobiliary Research Unit, Montreal, QC. ; Departments of Pathology and Anatomy and Cell Biology, McGill University Health Centre, Montreal, QC
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Ezziddin S, Adler L, Sabet A, Pöppel TD, Grabellus F, Yüce A, Fischer HP, Simon B, Höller T, Biersack HJ, Nagarajah J. Prognostic Stratification of Metastatic Gastroenteropancreatic Neuroendocrine Neoplasms by 18F-FDG PET: Feasibility of a Metabolic Grading System. J Nucl Med 2014; 55:1260-6. [DOI: 10.2967/jnumed.114.137166] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 04/01/2014] [Indexed: 02/07/2023] Open
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Kim KA, Park MS, Ji HJ, Park JY, Han KH, Kim MJ, Kim KW. Diffusion and perfusion MRI prediction of progression-free survival in patients with hepatocellular carcinoma treated with concurrent chemoradiotherapy. J Magn Reson Imaging 2013; 39:286-92. [PMID: 24302545 DOI: 10.1002/jmri.24161] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 03/12/2013] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To assess whether MR perfusion and diffusion parameters taken before concurrent chemoradiotherapy (CCRT) are useful imaging biomarkers for predicting progression-free survival (PFS) in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS Twenty patients with locally advanced HCC who had no treatment before CCRT underwent dynamic contrast-enhanced (DCE) and diffusion-weighted MRI. Mean values of the volume transfer constant (K(trans) ), reflex constant (Kep ), extravascular extracellular volume fraction (Ve ) and the apparent diffusion coefficient (ADC) were estimated on a region of interest. The best cutoff value for each factor was assessed to differentiate between patients who had PFS shorter or longer than the median PFS. Patients were dichotomized in terms of the cutoff value. The survival outcome of the two groups and the predictive ability of each factor on PFS were evaluated. RESULTS Median time to PFS was 179 days. The best cutoff values for ADC, K(trans) , Kep , and Ve was 1.008 × 10(-3) mm(2) s(-1) , 0.108 min(-1) , 0.570 min(-1) , and 0.298%. Patients with higher ADC had significantly longer PFS than those with lower ADC(P < 0.0001). CONCLUSION The ADC of HCC acquired before CCRT correlated with PFS and was valuable in the prediction of the clinical outcome of HCC treated with CCRT.
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Affiliation(s)
- Kyung Ah Kim
- Department of Radiology, St. Vincent's Hospital, The Catholic University of Korea, Gyeonggi-do, South Korea
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Lee S, Kim BK, Kim SU, Park Y, Chang S, Park JY, Kim DY, Ahn SH, Chon CY, Han KH. Efficacy of sorafenib monotherapy versus sorafenib-based loco-regional treatments in advanced hepatocellular carcinoma. PLoS One 2013; 8:e77240. [PMID: 24155932 PMCID: PMC3796498 DOI: 10.1371/journal.pone.0077240] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 08/31/2013] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Although sorafenib is accepted as the standard of care in advanced hepatocellular carcinoma (HCC), its therapeutic benefit is marginal. Here, we aimed to compare the efficacy and safety of sorafenib monotherapy (S-M) and sorafenib-based loco-regional treatments (S-LRTs) in advanced HCC. METHODS From 2007 to 2012, 290 patients with advanced HCC (Barcelona Clinic Liver Cancer stage C) with S-M (n = 226) or S-LRTs (n = 64) were reviewed retrospectively. Survival outcomes and treatment-related toxicities between two groups were analyzed. RESULTS Variables related to tumor burden and liver function were similar between the groups (all P > 0.05). Within the entire population, the S-LRTs group had both longer median overall survival (OS) (8.5 vs 5.5 months, P = 0.001) and progression-free survival (PFS) (5.3 vs 3.0 months, P = 0.002) than the S-M group. Furthermore, the S-LRTs group had longer Os than the S-M group in a subgroup with neither extrahepatic spread (EHS) nor regional nodal involvement (RNI) (18.0 vs 7.8 months, P = 0.019) and in a subgroup with EHS and/or RNI (8.3 vs 4.8 months, P = 0.028). In addition, the S-LRTs group had longer PFS than the S-M group in the subgroup with neither EHS nor RNI (9.6 vs 3.2 months, P = 0.027). TREATMENT Related toxicity was similar between two groups. CONCLUSION Combined use of sorafenib and LRTs may provide better treatment outcomes without significantly increasing treatment-related toxicities, even in patients with EHS and/or RNI. Therefore, addition of active LRTs might be considered, if feasible.
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Affiliation(s)
- Sangheun Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Beom Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Up Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Republic of Korea
- Liver Cirrhosis Clinical Research Center, Seoul, Republic of Korea
- * E-mail: (SUK); (KHH)
| | - Yehyun Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sooyun Chang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun Yong Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Republic of Korea
- Liver Cirrhosis Clinical Research Center, Seoul, Republic of Korea
| | - Do Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Republic of Korea
- Liver Cirrhosis Clinical Research Center, Seoul, Republic of Korea
| | - Sang Hoon Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Republic of Korea
- Liver Cirrhosis Clinical Research Center, Seoul, Republic of Korea
- Brain Korea Project for Medical Science, Seoul, Republic of Korea
| | - Chae Yoon Chon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Republic of Korea
- Liver Cirrhosis Clinical Research Center, Seoul, Republic of Korea
| | - Kwang-Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Republic of Korea
- Liver Cirrhosis Clinical Research Center, Seoul, Republic of Korea
- Brain Korea Project for Medical Science, Seoul, Republic of Korea
- * E-mail: (SUK); (KHH)
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Gonzalez-Guindalini FD, Botelho MPF, Harmath CB, Sandrasegaran K, Miller FH, Salem R, Yaghmai V. Assessment of Liver Tumor Response to Therapy: Role of Quantitative Imaging. Radiographics 2013; 33:1781-800. [DOI: 10.1148/rg.336135511] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Yoon HJ, Paeng JC, Kwak C, Park YH, Kim TM, Lee SH, Chung JK, Edmund Kim E, Lee DS. Prognostic implication of extrarenal metabolic tumor burden in advanced renal cell carcinoma treated with targeted therapy after nephrectomy. Ann Nucl Med 2013; 27:748-55. [DOI: 10.1007/s12149-013-0742-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 05/30/2013] [Indexed: 10/26/2022]
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Shao YY, Hsu CH, Cheng AL. Predictive biomarkers of antiangiogenic therapy for advanced hepatocellular carcinoma: where are we? Liver Cancer 2013; 2:93-107. [PMID: 24159601 PMCID: PMC3740718 DOI: 10.1159/000343845] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Antiangiogenic therapy, especially treatment with sorafenib, is the primary treatment for patients with advanced hepatocellular carcinoma (HCC). However, the efficacy of such therapy is modest, with low objective response rates and limited prolongation of survival times. Several researchers have investigated predictive biomarkers to help identify patients who can benefit most from antiangiogenic therapy. The largest study on this topic to date was based on the pivotal phase III study of sorafenib (the SHARP study) and did not find any plasma markers that could predict the efficacy of sorafenib. Other studies based on single-arm phase II clinical trials found some potential predictive markers, such as early alpha-fetoprotein response, the serum insulin-like growth factor-1 level at baseline, and the volume transfer constants of dynamic contrast-enhanced magnetic resonance imaging. These findings require validation by further studies. Identifying predictive biomarkers of antiangiogenic therapy for HCC remains challenging and warrants further investigations.
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Affiliation(s)
- Yu-Yun Shao
- Departments of Oncology, National Taiwan University Hospital, Taiwan, ROC,Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taiwan, ROC
| | - Chih-Hung Hsu
- Departments of Oncology, National Taiwan University Hospital, Taiwan, ROC,Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taiwan, ROC
| | - Ann-Lii Cheng
- Departments of Oncology, National Taiwan University Hospital, Taiwan, ROC,Internal Medicine, National Taiwan University Hospital, Taiwan, ROC,Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taiwan, ROC,*Departments of Oncology and Internal Medicine, National Taiwan University Hospital,7 Chung-Shan South Road, Taipei, Taiwan 10002 (ROC), Tel. +886 2 23123456 ext. 67251, E-mail
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Kinetic analysis of FDG in rat liver: effect of dietary intervention on arterial and portal vein input. Nucl Med Biol 2013; 40:537-46. [PMID: 23454249 DOI: 10.1016/j.nucmedbio.2013.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 01/14/2013] [Accepted: 01/23/2013] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Dietary conditions may affect liver [(18)F]FDG kinetics due to arterial and portal vein (PV) input. The purpose of this study was to evaluate kinetic models of [(18)F]FDG metabolism under a wide range of dietary interventions taking into account variations in arterial (HA) and portal vein (PV) input. METHODS The study consisted of three groups of rats maintained under different diet interventions: 12 h fasted, 24 h fasted and those fed with high fructose diet. [(15)O]H₂O PET imaging was used to characterize liver flow contribution from HA and PV to the liver's dual input function (DIF). [(18)F]FDG PET imaging was used to characterize liver metabolism. Differences in [(18)F]FDG kinetics in HA, PV and liver under different diet interventions were investigated. An arterial to PV Transfer Function (TF) was optimized in all three dietary states to noninvasively estimate PV activity. Finally, two compartment 3-parameter (2C3P), two compartment 4-parameter (2C4P), two compartment 5-parameter (2C5P), and three compartment 5-parameter (3C5P) models were evaluated and compared to describe the kinetics of [(18)F]FDG in the liver across diet interventions. Sensitivity of the compartmental models to ratios of HA to PV flow fractions was further investigated. RESULTS Differences were found in HA and PV [(18)F]FDG kinetics across 12h fasted, 24h fasted and high fructose fed diet interventions. A two exponential TF model was able to estimate portal activity in all the three diet interventions. Statistical analysis suggests that a 2C3P model configuration was adequate to describe the kinetics of [(18)F]FDG in the liver under wide ranging dietary interventions. The net influx of [(18)F]FDG was lowest in the 12h fasted group, followed by 24 h fasted group, and high fructose diet. CONCLUSIONS A TF was optimized to non-invasively estimate PV time activity curve in different dietary states. Several kinetic models were assessed and a 2C3P model was sufficient to describe [(18)F]FDG liver kinetics despite differences in HA and PV kinetics across wide ranging dietary interventions. The observations have broader implications for the quantification of liver metabolism in metabolic disorders and cancer, among others.
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Song MJ, Bae SH, Lee SW, Song DS, Kim HY, Yoo IR, Choi JI, Lee YJ, Chun HJ, Lee HG, Choi JY, Yoon SK. 18F-fluorodeoxyglucose PET/CT predicts tumour progression after transarterial chemoembolization in hepatocellular carcinoma. Eur J Nucl Med Mol Imaging 2013; 40:865-73. [PMID: 23436073 DOI: 10.1007/s00259-013-2366-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 02/04/2013] [Indexed: 12/11/2022]
Abstract
PURPOSE (18)F-FDG PET monitoring of FDG uptake may be a useful tool for assessment of the biological behaviour of hepatocellular carcinoma (HCC). We evaluated the correlation between FDG uptake on (18)F-FDG PET and clinical characteristics and prognosis. METHODS In total, 58 HCC patients undergoing (18)F-FDG PET before transarterial chemoembolization (TACE) between May 2007 and May 2010 at Seoul St. Mary's Hospital were evaluated retrospectively. The predictive value of the ratio of maximal tumour standardized uptake value (SUV) to mean liver SUV (T(SUVmax)/L(SUVmean)) was tested. Primary endpoints were the clinical characteristics and treatment response according to T(SUVmax)/L(SUVmean). The secondary endpoint was time to progression (TTP). RESULTS A high SUV ratio (cutoff value 1.70) correlated significantly with tumour size (≥5 cm) and serum AFP level (≥400 ng/mL). Objective response rates were significantly different between those with a ratio above (15.7 %) and those with a ratio below (66.6 %) the cutoff value (P = 0.023). Patients in the low SUV ratio group had a median TTP of 16.8 months compared with 8.1 months in the high SUV ratio group (P = 0.011). Overall survival in the high SUV ratio group was worse than in the low SUV ratio group (median 56.5 vs. 23.3 months), although the difference was not statistically significant in a multivariate analysis. CONCLUSION Tumour metabolic activity (T(SUVmax)/L(SUVmean)), assessed by PET/CT, is an independent predictor of response to TACE in patients with intermediate-stage HCC. T(SUVmax)/L(SUVmean) can be used to predict tumour progression. Thus, (18)F-FDG PET can provide valuable information for prediction of prognosis and aid in decisions regarding treatment strategy.
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Affiliation(s)
- Myeong Jun Song
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Tsai CL, Koong AC, Hsu FM, Graber M, Chen IS, Cheng JCH. Biomarker studies on radiotherapy to hepatocellular carcinoma. Oncology 2013; 84 Suppl 1:64-8. [PMID: 23428861 DOI: 10.1159/000345892] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Radiotherapy (RT) has been gradually integrated into the multimodality treatment for hepatocellular carcinoma (HCC). The various patterns of failure in HCC patients undergoing RT drive the need of effective biomarkers to guide treatment decisions. Limited numbers of biomarkers have been investigated in HCC, with even fewer of them for patients treated by RT. Serum or plasma biomarkers measured by enzyme-linked immunosorbent assay were the most common practice. Of particular interest are those biomarkers that are detectable early in the course of radiotherapy which correlated with ultimate clinical outcome. Functional magnetic resonance imaging (MRI) is increasingly used to evaluate the imaging pattern indicative of disease control following RT. Positron emission tomography shows that pre-RT standard uptake values associate with various types of recurrence after treatment. Proximity ligation assay (PLA) is evolving with the unique features of dual-probe identification, ligation and amplification to allow the small volume of serum/plasma samples for evaluating multiple biomarkers. We demonstrate the screening work of biomarkers by PLA with pre- and post-RT serum samples from HCC patients undergoing RT. Efforts are being made to search for the potential biomarkers for HCC patients treated by RT.
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Affiliation(s)
- Chiao-Ling Tsai
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan, ROC
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Kim TM, Paeng JC, Chun IK, Keam B, Jeon YK, Lee SH, Kim DW, Lee DS, Kim CW, Chung JK, Kim IH, Heo DS. Total lesion glycolysis in positron emission tomography is a better predictor of outcome than the International Prognostic Index for patients with diffuse large B cell lymphoma. Cancer 2012; 119:1195-202. [PMID: 23212736 DOI: 10.1002/cncr.27855] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 05/02/2012] [Accepted: 06/07/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study was undertaken to evaluate the prognostic value of quantitative metabolic parameters in [(18) F]2-fluoro-2-deoxyglucose (FDG)-positron emission tomography (PET) for diffuse large B cell lymphoma (DLBCL). METHODS A total of 140 DLBCL patients underwent FDG-PET scans before rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) chemotherapy. The maximal standardized uptake value (SUVmax ) and total lesion glycolysis (TLG) were calculated, with the margin thresholds as 25%, 50%, and 75% of SUVmax of all lesions. Treatment outcomes were compared between groups according to metabolic parameters and the International Prognostic Index (IPI). RESULTS After a median follow-up of 28.5 months (range, 5-81 months), the 2-year progression-free survival (PFS) and overall survival (OS) were 83% and 87%, respectively. Among metabolic parameters, TLG at the threshold of 50% (TLG50 ) was significantly associated with treatment outcomes. High TLG50 values (>415.5) were associated with reduced survivals compared with low TLG50 values (≤415.5) (2-year PFS of 73% versus 92%, P = .007; and 2-year OS of 81% versus 93%, P = .031). High IPI score (≥3) significantly reduced OS (2-year OS of 79% versus 90%, P = .049). Ann Arbor stage III/IV adversely affected PFS (P = .013). However, high IPI score and Ann Arbor stage of III/V did not significantly shorten PFS (P = .200) and OS (P = .921), respectively. High TLG50 values independently predicted survivals by multivariate analysis (hazard ratio = 4.4; 95% confidence interval = 1.5-13.1; P = .008 for PFS and hazard ratio = 3.1; 95% confidence interval = 1.0-9.6; P = .049 for OS). CONCLUSIONS Combined assessment of volume and metabolism (ie, TLG) is predictive of survivals in DLBCL patients who are treated with R-CHOP. Cancer 2013. © 2012 American Cancer Society.
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Affiliation(s)
- Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Novel antiangiogenic therapies against advanced hepatocellular carcinoma (HCC). Clin Transl Oncol 2012; 14:564-74. [PMID: 22855137 DOI: 10.1007/s12094-012-0842-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 04/13/2012] [Indexed: 12/12/2022]
Abstract
Angiogenesis is a cornerstone in the process of hepatocarcinogenesis. In the sorafenib era, other antiangiogenic targeted drugs, such as monoclonal antibodies and a new generation of tyrosine kinase inhibitors, have been shown in phase II trials to be safe and effective in the treatment of advanced hepatocellular carcinoma. Several currently active phase III trials are testing these drugs, both in first- and second-line settings. Strategies to overcome primary and acquired resistance to antiangiogenic therapy are urgently needed. Novel biomarkers may help in improving the efficacy of drugs targeting angiogenesis.
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Song MJ, Bae SH, Yoo IR, Park CH, Jang JW, Chun HJ, Choi BG, Lee HG, Choi JY, Yoon SK. Predictive value of 18F-fluorodeoxyglucose PET/CT for transarterial chemolipiodolization of hepatocellular carcinoma. World J Gastroenterol 2012; 18:3215-22. [PMID: 22783045 PMCID: PMC3391758 DOI: 10.3748/wjg.v18.i25.3215] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Revised: 04/27/2012] [Accepted: 05/26/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the correlation of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) with clinical features and the prediction of treatment response.
METHODS: A total of 83 hepatocellular carcinoma (HCC) patients undergoing 18F-FDG PET before transarterial chemolipiodolization with systemic chemo-infusion between October, 2006 and May, 2009 were retrospectively enrolled. The patients included 68 men and 15 women (mean age, 60 ± 10.7 years). The effect of 18F-FDG-monitored PET uptake on clinical features and on the evaluated treatment response was ascertained with modified Response Evaluation Criteria in Solid Tumors. The PET parameters of maximal standardized uptake value of the tumor (Tsuvmax), the ratio of the tumor maximal standardized uptake value (SUV) to the liver maximal SUV (Tsuvmax/Lsuvmax) and the ratio of tumor maximal SUV to the liver mean SUV (Tsuvmax/Lsuvmean) were tested as predictive factors.
RESULTS: Among the 3 SUV parameters, the Tsuvmax/Lsuvmean ratio (cutoff value of 1.90) was significantly associated with tumor burden including tumor size, tumor number, α-fetoprotein levels and tumor stage (P < 0.001, P = 0.008, P = 0.011, P < 0.001, respectively). The objective response rates in patients with a high SUV ratio (≥ 1.90) were significantly better than those with a low SUV ratio (< 1.90) (P = 0.020). The overall survival rates of patients exhibiting a low Tsuvmax/Lsuvmean ratio (< 1.90) and those with a high SUV ratio (≥ 1.90) was 38.2 and 10.3 mo, respectively (P < 0.01). However, the time to progression showed no significant difference between the groups (P = 0.15).
CONCLUSION: 18F-FDG PET can be an important predictor of HCC treatment. In particular, the Tsuvmax/Lsuvmean ratio (cutoff value of 1.90) can provide useful information in treatment prognosis for HCC patients treated with locoregional therapy.
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Park JC, Lee JH, Cheoi K, Chung H, Yun MJ, Lee H, Shin SK, Lee SK, Lee YC. Predictive value of pretreatment metabolic activity measured by fluorodeoxyglucose positron emission tomography in patients with metastatic advanced gastric cancer: the maximal SUV of the stomach is a prognostic factor. Eur J Nucl Med Mol Imaging 2012; 39:1107-16. [PMID: 22526958 DOI: 10.1007/s00259-012-2116-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 03/11/2012] [Indexed: 12/11/2022]
Abstract
PURPOSE Few studies have evaluated metabolic activity by (18)F-FDG PET as a prognostic factor in advanced gastric cancer (AGC). We investigated its prognostic role in metastatic AGC. METHODS We enrolled 82 patients with metastatic AGC, who were treatment-naive and underwent pretreatment (18)F-FDG PET/CT scanning. In each patient, the maximal standardized uptake value (SUVmax) was measured in each target lesion. Stomach(SUVmax) was defined as SUVmax in the stomach, while Total(SUVmax) was defined as the highest SUVmax among all the target lesions. RESULTS The stomach was the organ most frequently displaying the highest SUVmax among all the target lesions (in 67.1% of patients). A Total(SUVmax) value of 11.5 was the value with the maximum sum of sensitivity and specificity from receiver-operating characteristic curves for progression-free survival (PFS). PFS was significantly longer in patients with a Total(SUVmax) value <11.5 than in those with a Total(SUVmax) value ≥11.5 (P = 0.023); however, overall survival (OS) was not (P = 0.055). A Stomach(SUVmax) value of 6.0 was derived by similar methods. PFS and OS were significantly longer in those with a Stomach(SUVmax) value <6.0 than in those with a Stomach(SUVmax) value ≥6.0 (P = 0.001 and P = 0.006, respectively). Furthermore, those with a low Total(SUVmax) and those with a low Stomach(SUVmax) showed better chemotherapeutic responses (P = 0.016 and P = 0.034, respectively). Among patients with histologically undifferentiated carcinomas, those with lower Total(SUVmax) and those with lower Stomach(SUVmax) showed longer median PFS (P = 0.027 and P = 0.005, respectively) and OS (P = 0.009 and P <0.001, respectively). Multivariate analysis demonstrated Stomach(SUVmax) as an independent predictor of PFS (P = 0.002) and OS (P = 0.038). CONCLUSION Pretreatment metabolic activity may be a useful prognostic marker in patients with metastatic AGC undergoing palliative chemotherapy. Notably, Stomach(SUVmax) was the single, most robust factor predicting prognosis.
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Affiliation(s)
- Jun Chul Park
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 120-752, Korea
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