Abstract
Simple SummaryFew data are available for the use of 11C-choline positron emission tomography/computed tomography (PET/CT) in patients with hepatocellular carcinoma (HCC). The aim of the study was to analyze the clinical impact of this metabolic imaging in patients with HCC candidates for hepatectomy. Seven parameters were recorded for PET/CT in 60 patients. The Cox regression for overall survival (OS) showed that Barcelona stages (p = 0.003) and metabolic tumor volume (MTV) (p = 0.026) were the only factors independently associated with OS and furthermore, curve analysis revealed MTV ability in predicting OS. Patients with MTV ≥ 380 had worse OS (p = 0.015). The use of 11C-choline PET/CT allows for better prognostic refinement in patients undergoing hepatectomy for HCC: integration of such metabolic modality into HCC staging system should be considered.11C-choline positron emission tomography/computed tomography (PET/CT) has been used for patients with some types of tumors, but few data are available for hepatocellular carcinoma (HCC). We queried our prospective database for patients with HCC staged with 11C-choline PET/CT to assess the clinical impact of this imaging modality. Seven parameters were recorded: maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), liver standardized uptake value (SUVliver), metabolic tumor volume (MTV), photopenic area, metabolic tumor burden (MTB = MTVxSUVmean), and SUVratio (SUVmax/SUVliver). Analysis was performed to identify parameters that could be predictors of overall survival (OS). Sixty patients were analyzed: fourteen (23%) were in stage 0-A, 37 (62%) in stage B, and 9 (15%) in stage C of the Barcelona classification. The Cox regression for OS showed that Barcelona stages (HR = 2.94; 95%CI = 1.41–4.51; p = 0.003) and MTV (HR = 2.11; 95%CI = 1.51–3.45; p = 0.026) were the only factors independently associated with OS. Receiver operating characteristics curve analysis revealed MTV ability in discriminating survival (area under the curve (AUC) = 0.77; 95%CI = 0.57–097; p < 0.001: patients with MTV ≥ 380 had worse OS (p = 0.015)). The use of 11C-choline PET/CT allows for better prognostic refinement in patients undergoing hepatectomy for HCC. Incorporation of such modality into HCC staging system should be considered.
Highlights
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the third cause of cancer-related deaths worldwide [1]
The underlying liver function was globally normal as documented by the values of Bilirubin and Cholinesterases (BILCHE), Child–Pugh–Turcotte, and Model for End-stage Liver Disease MELD, scores [19,20,21,22]
Among MELD score, BILCHE score, BCLC stages, number of tumor, size of tumor, value of serum AFP, tumor grading, microvascular invasion, cirrhosis, SUVmax, SUVmean, SUVliver, metabolic tumor volume (MTV), photopenic areas, metabolic tumor burden (MTB) and SUVratio, only the BCLC stages (HR = 2.94; 95%CI = 1.41–4.51; p = 0.003) and MTV (HR = 2.11; 95%CI = 1.51–3.45; p = 0.026) were found to be independently associated with overall survival (OS)
Summary
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the third cause of cancer-related deaths worldwide [1]. Apart from liver transplantation, which is considered the standard of care for patients who satisfy specific inclusion criteria [2], most patients receive loco-regional treatments such as hepatectomy, thermo-ablation, and trans-arterial therapies. These loco-regional treatments are burdened of disease recurrence up to 70% at five years [3,4,5,6]. We previously reported the role of 11 C-choline PET/CT in the pre-therapeutic work up of patients with HCC [18]. We sought to determine whether 11 C-choline PET/CT imaging findings correlated with patient prognosis
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