Abstract
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Introduction: Patients with inoperable, advanced or multi-focal hepatocellular carcinoma (HCC) who have failed all other liver-directed treatment options are ideal candidates for Transarterial Radioembolisation (TARE) with Y90 labeled spheres. However, there is limited data regarding variables that impact the prognosis and outcome in these patients. 99mTc Macro-aggregated albumin (MAA) scan for Lung-Shunt Fraction (LSF) and 18F FDG PET/CT are performed during initial work-up. Aim: We, therefore decided to assess the prognostic impact of LSF and metabolic parameters like maximum standardized uptake value (SUV max), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in patients undergoing TARE for HCC
Methods: This is a retrospective observational study with 64 patients of HCC, deemed suitable for TARE by a Multi-Disciplinary Liver Clinic; who underwent the procedure between January 2010 to December 2016. Pre-TARE LSF on 99mTc MAA scan, and SUVmax, MTV and TLG on FDG PET CT were measured using automated software by 3-D region of interest.PET parameters were stratified using optimal cut offs derived from Receiver Operating Curve (ROC) analysis.Survival curves for the groups were estimated using the Kaplan-Meier method and were compared using the log rank test. Cox proportional hazards model was used in multivariate analysis to identify independent prognostic factors.
Results: Overall Survival (OS) was 15 months. 41 out of 64 patients (Male 40, Female 24) showed tumor SUV max higher than normal liver SUV max and was considered to have positive FDG PET scan. In univariate analysis, high LSF (greater than 7.6), MTV and TLG were statistically significant and were associated with poor overall survival (OS). In multivariate analysis, TLG (p value 0.044), MTV (p value 0.290) and LSF (p value 0.010) were independent predictors of outcome, after adjustment for significant univariate variables. However, SUV max was not statistically significant for overall survival.
Conclusions: LSF, MTV and TLG are significant independent prognostic indicators of outcome in patients undergoing TARE for HCC.