Refining prognosis in patients with hepatocellular carcinoma through incorporation of metabolic imaging biomarkers.
Refining prognosis in patients with hepatocellular carcinoma through incorporation of metabolic imaging biomarkers.
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DOI：
10.1007/s00259-016-3583-2
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发表时间：
2017-06
影响因子：
9.1
通讯作者：
Kaseb AO
中科院分区：
文献类型：
--
作者：
Takeuchi S;Rohren EM;Abdel-Wahab R;Xiao L;Morris JS;Macapinlac HA;Hassan MM;Kaseb AO
18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDGPET/CT）已被证明是有用的成像许多类型的癌症;然而，它的作用是没有很好地定义在肝细胞癌（HCC）。我们评估了HCC患者基线治疗前FDG PET/CT建立的代谢成像生物标志物的预后价值。我们回顾性分析了2013年5月至2014年5月在初始治疗前接受FDG PET/CT的HCC患者的记录。测量四个PET/CT参数：最大标准化摄取值（SUVmax），总病变糖酵解（TLG），代谢肿瘤体积（MTV）和肿瘤与正常肝脏SUV比值（TNR）。确定PET/CT参数的最佳截止值，以根据总生存期（OS）对患者进行分层。进行多变量分析，以确定PET/CT参数是否可以增加意大利肝癌计划（CLIP）评分系统和维罗纳临床肝癌（BCLC）分期系统的预后价值。该分析包括56名患者。对OS与连续变量（包括PET/CT参数SUVmax、TLG、肿瘤大小、总胆红素水平和碱性磷酸酶水平）之间的相关性进行单变量分析，发现SUVmax ≥ 11.7、TLG ≥ 1，341、MTV ≥ 230 mL和TNR ≥ 4.8是OS的显著预测因素。多因素分析显示SUVmax ≥ 11.7和TNR ≥ 4.8是CLIP评分系统和BCLC分期系统中预后不良的独立因素，BCLC分期系统中TLG也是预后不良的独立因素。HCC患者治疗前FDG PET/CT可增加标准临床指标的预后价值。应考虑将FDG PET/CT的影像学生物标志物纳入HCC分期系统。
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. 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. 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. 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.