18F-fluorodeoxyglucose uptake on positron emission tomography as a prognostic predictor in locally advanced hepatocellular carcinoma

Authors

  • Beom Kyung Kim MD,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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  • Won Jun Kang MD,

    1. Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Korea
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  • Ja Kyung Kim MD,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Yonsei Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, Seoul, Korea
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  • Jinsil Seong MD,

    1. Yonsei Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
    2. Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
    3. Brain Korea 21 Project for Medical Science, Seoul, Korea
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  • Jun Yong Park MD,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Yonsei Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, Seoul, Korea
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  • Do Young Kim MD,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, Seoul, Korea
    3. Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
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  • Sang Hoon Ahn MD,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Yonsei Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, Seoul, Korea
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  • Do Youn Lee MD,

    1. Yonsei Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
    2. Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
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  • Kwang Hoon Lee MD,

    1. Yonsei Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
    2. Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
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  • Jong Doo Lee MD,

    1. Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Brain Korea 21 Project for Medical Science, Seoul, Korea
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  • Kwang-Hyub Han MD

    Corresponding author
    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Yonsei Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, Seoul, Korea
    4. Brain Korea 21 Project for Medical Science, Seoul, Korea
    • Department of Internal Medicine, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, Korea, 120-752
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    • Fax: (011) 82-2-393-6884


Abstract

BACKGROUND:

Metabolic activity assessed by 18F-fluorodeoxyglocuse-positron emission tomography (18F-FDG-PET) reflects biological aggressiveness and prognoses in various tumors. The authors present a correlation between tumor metabolic activity and clinical outcomes in patients with hepatocellular carcinoma (HCC).

METHODS:

Over a 3-year period (2005-2008), 135 locally advanced HCC patients were treated with localized concurrent chemoradiotherapy (CCRT; external beam radiotherapy at 45 grays for 5 weeks plus concurrent hepatic arterial infusion of 5-fluorouracil during the first and fifth week) followed by repetitive hepatic arterial infusional chemotherapy with 5-fluorouracil and cisplatin. Among them, the authors studied 107 who received 18F-FDG-PET before CCRT. Maximal standardized uptake values (SUVs) of tumors were calculated.

RESULTS:

The median maximal tumor SUV was 6.1 (range, 2.4-∼19.2). Patients with low maximal tumor SUVs (<6.1) had a higher disease control rate than those with high maximal tumor SUVs (≥6.1) (86.8% vs 68.5%, respectively, P = .023). Both median progression-free survival (PFS; 8.4 vs 5.2 months; P = .003) and overall survival (OS; 17.9 vs 11.3 months; P = .013) were significantly longer in the low maximal tumor SUV group than in the high maximal tumor SUV group, respectively. In multivariate analysis, low maximal tumor SUV and objective responses to CCRT remained significant for PFS and OS. The high maximal tumor SUV group was more likely to have extrahepatic metastasis within 6 months than the low maximal tumor SUV group (58.1% vs 26.8%, respectively; P < .001). Similar results were obtained for the maximal tumor SUV/normal liver maximal SUV ratio (<2 vs ≥2) concerning progression, death, and extrahepatic metastasis.

CONCLUSIONS:

Metabolic activity may be useful not only in predicting prognosis and treatment responses, but also in establishing optimal treatment plans in locally advanced HCC. Cancer 2011;. © 2011 American Cancer Society.

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