Predicting the Recurrence of Hepatocellular Carcinoma after Primary Living Donor Liver Transplantation Using Metabolic Parameters Obtained from 18F-FDG PET/CT.

Sungmin Kang,Dong Lak Choi,Byungwook Choi,Joo Dong Kim

doi:10.3390/jcm11020354

Abstract

This study evaluated the prognostic value of metabolic parameters based on the standardized uptake value (SUV) normalized by total body weight (bwSUV) and by lean body mass (SUL) measured on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for predicting tumor recurrence after primary living donor liver transplantation (LDLT) in patients with hepatocellular carcinoma (HCC) without transplantation locoregional therapy. This retrospective study enrolled 49 patients with HCC. The maximum tumor bwSUV (T-bwSUVmax) and SUL (T-SULmax) were measured on PET. The maximum bwSUV (L-bwSUVmax), mean bwSUV (L-bwSUVmean), maximum SUL (L-SULmax), and mean SUL (L-SULmean) were measured in the liver. All metabolic parameters were evaluated using survival analyses and compared to clinicopathological factors. Tumor recurrence occurred in 16/49 patients. Kaplan–Meier analysis revealed that all metabolic parameters were significant (p < 0.05). Univariate analysis revealed that prothrombin-induced by vitamin K absence or antagonist-II; T-stage; tumor number; tumor size; microvascular invasion; the Milan criteria, University of California, San Francisco (UCSF), and up-to-seven criteria; T-bwSUVmax/L-bwSUVmean; T-SULmax; T-SULmax/L-SULmax; and T-SULmax/L-SULmean were significant predictors. Multivariate analysis revealed that the T-SULmax/L-SULmean (hazard ratio = 115.6; p = 0.001; cut-off, 1.81) and UCSF criteria (hazard ratio = 172.1; p = 0.010) were independent predictors of tumor recurrence. SUL-based metabolic parameters, especially T-SULmax/L-SULmean, were significant, independent predictors of HCC recurrence post-LDLT.

Highlights

The incidence of hepatocellular carcinoma (HCC), which accounts for the majority of primary liver cancer and occurs mostly in the setting of chronic liver disease and cirrhosis, has risen in recent years [1]
A total of 49 patients (40 men and 9 women; mean age 54 ± 6 years, range 41–65 years) were enrolled in this study. Their clinicopathological characteristics are summarized in Table 1. 18F-FDG PET/CT was performed 22.2 ± 15.4 days before living donor liver transplantation (LT) (LDLT)
HCC recurred in 16 patients (32.7%) after 18.6 ± 14.6 months (5–54 months) of LDLT; 5 patients experienced recurrence within 12 months of LDLT, 7 patients between 12–24 months, and 4 patients between 24–60 months

Summary

Introduction

The incidence of hepatocellular carcinoma (HCC), which accounts for the majority of primary liver cancer and occurs mostly in the setting of chronic liver disease and cirrhosis, has risen in recent years [1]. The current selection criteria including the Milan criteria; University of California, San Francisco (UCSF); and up-to-seven criteria that utilize the number and size of the tumor have been proposed for the selection of HCC patients for LT, and have demonstrated excellent long-term outcomes comparable to those for LT in non-malignant disease [10,11,12]. These histopathological prognostic factors can reliably assess only the explanted liver and not the clinical features available before LT. The evaluation of the number and size of the tumor with pre-LT radiographic imaging studies is limited by the high risk of the under- and overestimation of the tumor burden [13,14,15]

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Discussion

Conclusion