Measuring total liver function on sulfur colloid SPECT/CT for improved risk stratification and outcome prediction of hepatocellular carcinoma patients.

Stephen R Bowen,Joshua Borgman,Smith Apisarnthanarax,Paul E Kinahan,Robert S Miyaoka,Tobias R Chapman,Matthew J Nyflot,Iris W Liou,Hubert J Vesselle,George A Sandison

doi:10.1186/s13550-016-0212-9

Stephen R Bowen, Joshua Borgman + Show 8 more

Open Access

https://doi.org/10.1186/s13550-016-0212-9

Copy DOI

Journal: EJNMMI research	Publication Date: Jun 27, 2016
Citations: 24	License type: CC BY 4.0

Affiliation: University of Washington, Seattle University

Abstract

BackgroundAssessment of liver function is critical in hepatocellular carcinoma (HCC) patient management. We evaluated parameters of [99mTc] sulfur colloid (SC) SPECT/CT liver uptake for association with clinical measures of liver function and outcome in HCC patients.MethodsThirty patients with HCC and variable Child-Turcotte-Pugh scores (CTP A5-C10) underwent [99mTc]SC SPECT/CT scans for radiotherapy planning. Gross tumor volume (GTV), anatomic liver volume (ALV), and spleen were contoured on CT. SC SPECT image parameters include threshold-based functional liver volumes (FLV) relative to ALV, mean liver-to-spleen uptake ratio (L/Smean), and total liver function (TLF) ratio derived from the product of FLV and L/Smean. Optimal SC uptake thresholds were determined by ROC analysis for maximizing CTP classification accuracy. Image metrics were tested for rank correlation to composite scores and clinical liver function parameters. Image parameters of liver function were tested for association to overall survival with Cox proportional hazard regression.ResultsOptimized thresholds on SC SPECT were 58 % of maximum uptake for FLV, 38 % for L/Smean, and 58 % for TLF. TLF produced the highest CTP classification accuracy (AUC = 0.93) at threshold of 0.35 (sensitivity = 0.88, specificity = 0.86). Higher TLF was associated with lower CTP score: TLFA = 0.6 (0.4–0.8) versus TLFB = 0.2 (0.1–0.3), p < 10−4. TLF was rank correlated to albumin and bilirubin (|R| > 0.63). Only TLF >0.30 was independently associated with overall survival when adjusting for CTP class (HR = 0.12, 95 % CI = 0.02–0.58, p = 0.008).ConclusionsSC SPECT/CT liver uptake correlated with differential liver function. TLF was associated with improved overall survival and may aid in personalized oncologic management of HCC patients.

Highlights

Assessment of liver function is critical in hepatocellular carcinoma (HCC) patient management
The accurate assessment of liver function is of critical importance in the management of patients with hepatocellular carcinoma (HCC) [1]
Other prognostic models of cirrhosis have been designed, including the model for end-stage liver disease (MELD) score [11, 12] and its derivatives [10], that are utilized for prioritization of liver transplantation

Summary

Introduction

Assessment of liver function is critical in hepatocellular carcinoma (HCC) patient management. Staging systems that incorporate both tumor and liver function parameters for HCC patients include the Barcelona Clinic Liver Cancer (BCLC), Cancer of the Liver Italian Program (CLIP), and Japan Integrated Scoring system (JIS) [14]. All of these classification systems and models (including CTP and MELD) still rely on traditional measures of liver function, only provide a global assessment of liver function, and/or do not take into account spatial variations in liver function [15]. Knowledge of this patient-specific liver function heterogeneity may be valuable in the local therapeutic management of HCC patients [16, 17]

Methods

Results

Conclusion