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

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 <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. Median progression-free survival (8.4 vs 5.2 months; P =.003), overall survival (17.9 vs 11.3 months; P =.013), and extrahepatic metastasis-free survival (13.8 vs 5.7 months; P <6.1) than in those with high maximal tumor SUVs (≥6.1), in patients with locally advanced hepatocellular carcinoma (HCC) who underwent localized concurrent chemoradiation therapy. Similar results were obtained for the ratio of maximal tumor SUV to maximal normal liver SUV (<2 vs ≥2) concerning progression, death, and extrahepatic metastasis. Thus, tumor metabolic activity assessed by 18F- fluorodeoxyglucose uptake on positron emission tomography may be useful not only in predicting prognosis and treatment responses, but also in establishing optimal treatment plans in HCC patients. Copyright © 2011 American Cancer Society.