18F-fluorodeoxyglucose uptake of hepatocellular carcinoma as a prognostic predictor in patients with sorafenib treatment.

Abstract

Sorafenib, an oral multikinase inhibitor, is a recommended treatment option available for patients with Barcelona Clinic Liver Cancer (BCLC)-C stage hepatocellular carcinoma (HCC). This study aimed to evaluate the performance of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) for predicting tumour progression during sorafenib treatment. We formed a retrospective cohort comprising patients treated with sorafenib for at least 30days and undergoing 18F-FDG PET/CT within 1month before treatment. For statistical analyses, the tumour-to-liver standardised uptake value (SUV) ratio (TLR) of the most hypermetabolic lesion was measured. Among a total of 35 patients, two obtained partial remission, and 11 showed stable disease after the first response evaluation. Patients with a TLR≥2.9 (n=17) had a median overall survival (OS) of 3.7months after sorafenib treatment, whereas patients with a TLR<2.9 (n=18) had median OS of 12.2months (P<0.001), although the disease control rate was not significantly different between the two groups. Pretreatment TLR≥2.9 (hazard ratio [HR]=6.318, P=0.002) and Child-Pugh class B (HR=4.316, P=0.044) were poor prognostic factors for OS, and a TLR≥2.9 (HR=2.911, P=0.024) was the only poor prognostic factor for progression-free survival in a multivariate analysis. Pretreatment tumour metabolic activity assessed by 18F-FDG PET is an independent prognostic factor for survival in patients with BCLC-C stage HCC receiving sorafenib monotherapy, although it may not predict tumour response to the treatment.