Open Access

Predicting tumor recurrence using metabolic indices of 18F‑FDG PET/CT prior to orthotopic liver transplantationfor hepatocellular carcinoma

  • Authors:
    • Enci Ding
    • Dongyan Lu
    • Lijuan Wei
    • Xuemin Feng
    • Jie Shen
    • Wengui Xu
  • View Affiliations

  • Published online on: May 28, 2020     https://doi.org/10.3892/ol.2020.11681
  • Pages: 1245-1255
  • Copyright: © Ding et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The present study analyzed the ability of metabolic burden indices from 18F‑fluorodeoxyglucose (18F‑FDG) positron emission tomography/computed tomography (PET/CT) to predict tumor recurrence following orthotopic liver transplantation (OLT) in patients with hepatocellular carcinoma (HCC). Seven major metabolic indices were measured by 18F‑FDG PET/CT in 93 patients with HCC, prior to OLT. The Mann‑Whitney U test was then used to predict the association of metabolic indices, including the maximum standardized uptake value (SUVmax), tumor‑to‑mediastinum SUV ratio, tumor‑to‑normal‑liver SUV ratio, SUV normalized to lean body mass metabolic tumor volume (MTV), total lesion glycolysis (TLG) and uptake‑volume product (UVP), with the recurrence risk. The Deauville‑like scoring system was used to quantify the recurrence risk. Univariate and multivariable Cox regression models were performed to determine survival rate. The results showed that Deauville‑like score (PET‑negative vs. ‑positive), MTV (cutoff value, 13.36), TLG (cutoff value, 62.21) and UVP (cutoff value, 66.60) had high prediction performance for tumor recurrence (P<0.05). TLG had the highest receiver operating characteristics area under the curve of 0.725. Among the clinical factors, high level of α‑fetoprotein (AFP, ≥144 ng/ml), Milan criteria, tumor number (>3), involvement of both right and left lobes, and tumor size (>5 cm) were found to be significant predictors of tumor recurrence. Patients in the low metabolic group had longer recurrence‑free survival (RFS) times compared with those in the high metabolic group, regardless of whether they met the Milan criteria or not. AFP, uptake‑volume product according the SUV mean of mediastinum (UVP‑M), Milan criteria, lymph node metastasis, and the number of tumors were significant prognostic factors for RFS (P<0.05) in both univariate and multivariate survival analyses. Additionally, the MVI was a significant prognostic factor based on univariate survival analyses. Overall, the present study demonstrated the metabolic burden indices measured by PET/CT, Deauville‑like score, MTV, TLG and UVP as significant prognostic factors in patients with HCC following OLT. The combination of metabolic indices measured by PET/CT and the existing criteria, such as the Milan criteria, may play an important role in evaluating the suitability of OLT in specific patients.

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August-2020
Volume 20 Issue 2

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APA
Ding, E., Lu, D., Wei, L., Feng, X., Shen, J., & Xu, W. (2020). Predicting tumor recurrence using metabolic indices of 18F‑FDG PET/CT prior to orthotopic liver transplantationfor hepatocellular carcinoma. Oncology Letters, 20, 1245-1255. https://doi.org/10.3892/ol.2020.11681
MLA
Ding, E., Lu, D., Wei, L., Feng, X., Shen, J., Xu, W."Predicting tumor recurrence using metabolic indices of 18F‑FDG PET/CT prior to orthotopic liver transplantationfor hepatocellular carcinoma". Oncology Letters 20.2 (2020): 1245-1255.
Chicago
Ding, E., Lu, D., Wei, L., Feng, X., Shen, J., Xu, W."Predicting tumor recurrence using metabolic indices of 18F‑FDG PET/CT prior to orthotopic liver transplantationfor hepatocellular carcinoma". Oncology Letters 20, no. 2 (2020): 1245-1255. https://doi.org/10.3892/ol.2020.11681