Increased 18F-FDG Uptake of Hepatocellular Carcinoma on Positron Emission Tomography Independently Predicts Tumor Recurrence in Liver Transplant Patients

The aim of this retrospective trial was to analyze the value of preoperative F-18-fluorodeoxyglucose positron emission tomography (F-18-FDG PET) to predict parameters of tumor aggressiveness among liver transplant (OLT) patients with hepatocellular carcinoma (HCC). Fifty-five patients with HCC underwent F-18-FDG-PET during evaluation for OLT. Nineteen patients demonstrated increased F-18-FDG uptake on PET pre-OLT (PET+), and 36 patients revealed negative PET findings (PET-). PET+ patients showed a relative risk of 9.5 and 6.4 for poor differentiation and for microvascular invasion (MVI) in the HCC at explant pathology, respectively. Of the 10 patients (18.2%) who developed HCC recurrences, 9 (90%) revealed increased F-18-FDG uptake pre-OLT; only 1 (10%) showed a PET- status (P < .001). Apart from poor tumor differentiation, PET+ status was identified as an independent predictor of tumor recurrence post-OLT (odds ratio, 23.9). Our study demonstrated that F-18-FDG uptake on PET is a reliable preoperative predictor of tumor recurrence after OLT in patients with HCC, triggered by its high association with poor tumor differentiation and MVI.