Preoperative FDG-PET Predicts Recurrence Patterns in Hepatocellular Carcinoma

We investigated the usefulness of preoperative fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) as a tool for predicting recurrence patterns to select patients for liver resection as an initial surgical strategy for hepatocellular carcinoma. Sixty-three consecutive hepatocellular carcinoma patients undergoing FDG-PET were enrolled. They were classified according to the initial recurrence patterns (beyond the Milan criteria [MC], within the MC, and no recurrence) and the time intervals before initial postoperative recurrence (within 1 year, after 1 year or later, and no recurrence). The tumor-to-nontumor ratio (TNR) obtained by FDG-PET and survival rates were compared among the groups. TNR in the recurrence within the MC group (1.9 +/- A 1.6) and no recurrence group (1.3 +/- A 1.5) was significantly lower than that in the beyond the MC group (2.9 +/- A 2.6). TNR was an independent predictive factor of recurrence patterns in multivariate analysis. TNR in the groups with recurrence after 1 year or later (1.6 +/- A 0.8) and no recurrence (1.3 +/- A 0.5) were significantly lower than that in the within 1-year group (3.1 +/- A 2.7). TNR was an independent predictive factor of the interval before initial recurrence by multivariate analysis. Preoperative FDG-PET predicts hepatocellular carcinoma recurrences within the MC or no recurrence and recurrences after 1 year or later. FDG-PET may be useful for selecting appropriate patients for liver resection as an initial surgical strategy.