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Refining prognosis in patients with hepatocellular carcinoma through incorporation of metabolic imaging biomarkers

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Title: Refining prognosis in patients with hepatocellular carcinoma through incorporation of metabolic imaging biomarkers
Authors: Takeuchi, Satoshi Browse this author
Rohren, Eric M. Browse this author
Abdel-Wahab, Reham Browse this author
Xiao, Lianchun Browse this author
Morris, Jeffrey S. Browse this author
Macapinlac, Homer A. Browse this author
Hassan, Manal M. Browse this author
Kaseb, Ahmed O. Browse this author
Keywords: FDG PET/CT
Hepatocellular carcinoma
CLIP scoring system
BCLC staging system
Issue Date: Jun-2017
Publisher: Springer
Journal Title: European Journal of Nuclear Medicine and Molecular Imaging
Volume: 44
Issue: 6
Start Page: 969
End Page: 978
Publisher DOI: 10.1007/s00259-016-3583-2
Abstract: Purpose: 18F-fluorodeoxyglucose positron emission tomopraphy/computed tomography (FDGPET/CT) has been proven to be useful for imaging many types of cancer; however, its role is not well defined in hepatocellular carcinoma (HCC). We assessed the prognostic value of metabolic imaging biomarkers as established by baseline pretreatment FDG PET/CT in patients with HCC. Methods: We retrospectively analyzed the records of patients with HCC who underwent FDG PET/CT before initial treatment from May 2013 through May 2014. Four PET/CT parameters were measured: maximum standardized uptake value (SUVmax), total lesion glycolysis (TLG), metabolic tumor volume (MTV), and tumor-to-normal-liver SUV ratio (TNR). Optimal cut-off values for the PET/CT parameters to stratify patients in terms of overall survival (OS) were determined. Multivariate analysis was performed to determine whether the PET/CT parameters could add to the prognostic value of the Cancer of the Liver Italian Program (CLIP) scoring system and the Barcelona-Clinic Liver Cancer (BCLC) staging system. Results: The analysis included 56 patients. Univariate analysis of the association between OS and continuous variables, including the PET/CT parameters SUVmax, TLG, tumor size, total bilirubin level, and alkaline phosphatase level were significant predictors of OS. SUVmax ≥ 11.7, TLG ≥ 1,341, MTV ≥ 230 mL, and TNR ≥ 4.8 were identified as cut-off values. Multivariate analysis revealed that SUVmax ≥ 11.7 and TNR ≥ 4.8 were independent factors predicting a poor prognosis in both the CLIP scoring system and the BCLC staging system, as was TLG in the BCLC staging system. Conclusion: Pretreatment FDG PET/CT in patients with HCC can add to the prognostic value of standard clinical measures. Incorporation of imaging biomarkers derived from FDG PET/CT into HCC staging systems should be considered.
Rights: The final publication is available at
Type: article (author version)
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 竹内 啓

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