Research ArticleClinical Investigations

Prognostic Significance of 18F-FDG Uptake in Hepatocellular Carcinoma Treated with Transarterial Chemoembolization or Concurrent Chemoradiotherapy: A Multicenter Retrospective Cohort Study

Jeong Won Lee, Jin Kyoung Oh, Yong An Chung, Sae Jung Na, Seung Hyup Hyun, Il Ki Hong, Jae Seon Eo, Bong-Il Song, Tae-sung Kim, Do Young Kim, Seung Up Kim, Dae Hyuk Moon, Jong Doo Lee and Mijin Yun
Journal of Nuclear Medicine April 2016, 57 (4) 509-516; DOI: https://doi.org/10.2967/jnumed.115.167338

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Flowchart of patient selection.

  • FIGURE 2.
    FIGURE 2.

    Maximal-intensity-projection image (A) and transaxial fused image (C) of 18F-FDG PET/CT and a contrast-enhanced liver CT (B) image of a 65-y-old man with BCLC stage B HCC. Contrast-enhanced CT image (B) shows enhanced HCC lesion with internal necrosis in right lobe of liver (arrow). PET/CT image (C) shows intensely increased 18F-FDG uptake in mass, with TLR of 6.6 (arrow). Patient underwent TACE, and cancer progressed with pulmonary metastases 2.0 mo after TACE. Patient died 8.2 mo after initial treatment.

  • FIGURE 3.
    FIGURE 3.

    Maximal-intensity-projection image (A) and transaxial fused image (C) of 18F-FDG PET/CT and contrast-enhanced liver CT (B) image of a 54-y-old man with HCC. On contrast-enhanced CT image (B), infiltrative HCC is shown (arrow). HCC reveals mildly increased 18F-FDG uptake, with TLR of 1.6 (arrow). Patient was diagnosed at BCLC stage C due to portal vein tumor thrombosis on CT images and underwent CCRT. HCC progressed with intrahepatic metastases 15.6 mo after CCRT, and patient died 19.8 mo after initial treatment.

  • FIGURE 4.
    FIGURE 4.

    Cumulative PFS (A) and OS (B) curves according to TLR of HCC.

  • FIGURE 5.
    FIGURE 5.

    Cumulative PFS (A) and OS (B) curves in patients treated with TACE or CCRT.

  • FIGURE 6.
    FIGURE 6.

    Cumulative PFS (A) and OS (B) curves in patients with TLR greater than 2.0 according to treatment (TACE or CCRT).

Tables

  • TABLE 1

    Patient Characteristics

    CharacteristicTotal (n = 214)TACE (n = 153)CCRT (n = 61)P
    Age (y)*58 (27–88)59 (27–88)60 (39–80)0.400
    Sex0.738
     Men180 (84.1%)130 (85.0%)50 (82.0%)
     Women34 (15.9%)23 (15.0%)11 (18.0%)
    Diabetes mellitus58 (27.1%)39 (25.5%)19 (31.1%)0.503
    Etiology0.388
     HBV152 (71.0%)110 (71.9%)42 (68.9%)
     HCV17 (7.9%)12 (7.8%)5 (8.2%)
     Alcohol19 (8.9%)16 (10.5%)3 (4.9%)
     Other26 (12.1%)15 (9.8%)11 (18.0%)
    Child–Pugh classification0.266
     A182 (85.0%)127 (83.0%)55 (90.2%)
     B32 (15.0%)26 (17.0%)6 (9.8%)
    Tumor size (cm)*8.0 (1.3–20.0)6.3 (1.3–17.6)10.0 (2.5–20.0)<0.001
    Tumor number<0.001
     Single76 (35.5%)39 (25.5%)37 (60.7%)
     Multiple138 (64.5%)114 (74.5%)24 (39.3%)
    Portal vein tumor thrombosis0.003
     Absence106 (49.5%)86 (56.2%)20 (32.8%)
     Presence108 (50.5%)67 (43.8%)41 (67.2%)
    Serum AFP (ng/dL)*427.3 (1.6–435,220.0)325.7 (2.7–435,220.0)1,059.0 (1.6–120,000.0)0.853
    TLR*2.6 (1.1–11.6)2.2 (1.1–9.8)3.3 (1.3–11.6)0.007

    • ↵* Data are median value, with range in parentheses.

    • HBV = hepatitis B virus; HCV = hepatitis C virus.

  • TABLE 2

    Median Survival Time and Significance of Prognostic Factors for PFS

    UnivariateMultivariate
    VariablePMedian (mo)PHazard ratio (95% confidence interval)
    Age (y)0.002
     ≤606.8
     >6010.20.0010.59 (0.42–0.81)
    Sex0.568
     Men7.2
     Women7.7
    Etiology0.198
     HBV7.2
     HCV11.8
     Alcohol21.2
     Other7.5
    Child–Pugh classification0.902
     A7.5
     B7.9
    Treatment0.054
     TACE7.2
     CCRT9.1
    Tumor size (cm)0.022
     ≤6.08.8
     >6.06.50.356
    Tumor number0.144
     Single7.7
     Multiple7.2
    Portal vein thrombosis0.029
     Absence9.2
     Presence6.50.313
    Serum AFP (ng/dL)0.969
     ≤500.07.2
     >500.07.7
    TLR0.014
     ≤2.09.8
     >2.06.20.0091.55 (1.12–2.15)

    • HBV = hepatitis B virus; HCV = hepatitis C virus.

  • TABLE 3

    Median Survival Time and Significance of Prognostic Factors for OS

    UnivariateMultivariate with TLR
    VariablePMedian (mo)PHazard ratio (95% confidence interval)
    Age (y)0.779
     ≤6013.3
     >6011.4
    Sex0.583
     Men12.4
     Women11.4
    Etiology0.274
     HBV10.7
     HCV14.8
     Alcohol12.6
     Other23.8
    Child-Pugh classification0.026
     A13.3
     B7.70.0181.60 (1.06–2.40)
    Treatment0.280
     TACE11.8
     CCRT13.7
    Tumor size (cm)0.006
     ≤6.022.9
     >6.010.00.257
    Tumor number0.890
     Single10.7
     Multiple13.3
    Portal vein thrombosis0.012
     Absence21.0
     Presence9.90.248
    Serum AFP (ng/dL)0.004
     ≤500.021.0
     >500.09.90.197
    TLR<0.001
     ≤2.023.8
     >2.09.1<0.0011.97 (1.43–2.72)

    • HBV = hepatitis B virus; HCV = hepatitis C virus.

  • TABLE 4

    Median Survival for Patients Treated with CCRT and TACE According to TLR

    Median PFSMedian OS
    TLRTACECCRTPTACECCRTP
    ≤2.0 (n = 80; TACE = 69, CCRT = 11)0.1870.927
     Median (mo)8.917.725.219.8
     95% confidence interval7.1–14.76.6–44.221.7–27.610.0–37.6
    >2.0 (n = 134; TACE = 84, CCRT = 50)0.0180.009
     Median (mo)5.67.57.911.4
     95% confidence interval3.8–7.25.1–13.56.5–10.38.8–24.8

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