Journal
JOURNAL OF NUCLEAR MEDICINE
Volume 57, Issue 4, Pages 509-516Publisher
SOC NUCLEAR MEDICINE INC
DOI: 10.2967/jnumed.115.167338
Keywords
hepatocellular carcinoma; prognosis; F-18-FDG PET; transarterial chemoembolization; concurrent chemoradiotherapy
Funding
- Korean Society of Nuclear Medicine Clinical Trial Network (KSNM CTN) working group - Korean Society of Nuclear Medicine [KSNM-CTN-2014-02-1]
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This study aimed to assess the prognostic value of F-18-FDG uptake in hepatocellular carcinoma (HCC) patients who had transarterial chemoembolization (TACE) or concurrent intraarterial chemotherapy with external-beam radiotherapy (CCRT) and to compare the prognosis between patients treated with TACE and those with CCRT according to F-18-FDG uptake. Methods: Two hundred fourteen intermediate-to-advanced-stage HCC patients without extrahepatic metastasis who underwent staging F-18-FDG PET/CT before TACE (153 patients) or CCRT (61 patients) were recruited from 7 hospitals. Progression-free survival (PFS) and overall survival (OS) were compared using an optimal cutoff value for tumor-to-normal liver uptake ratio (TLR). Further, PFS and OS were compared according to treatment modalities (TACE vs. CCRT) using the same TLR cutoff value. Results: On multivariate analysis, age and TLR were independent prognostic factors for PFS (P < 0.050). For OS, Child-Pugh classification and TLR were independent prognostic factors (P < 0.050). When the TLR was greater than 2.0, patients treated with CCRT showed significantly better PFS and OS than those treated with TACE after adjusting for tumor size and number (P = 0.014, for all). In contrast, there was no significant difference in PFS and OS between patients treated with TACE or CCRT when the TLR was 2.0 or less. Conclusion: F-18-FDG uptake was an independent prognostic factor for PFS and OS in HCC patients treated with TACE or CCRT. Especially, in HCCs with high F-18-FDG uptake, patients treated with CCRT showed better survival than those treated with TACE. F-18-FDG PET/CT may help determine the treatment modality for intermediate-to-advanced-stage HCCs.
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