18F-FDG PET/CT Can Predict Survival of Advanced Hepatocellular Carcinoma Patients: A Multicenter Retrospective Cohort Study
18F-FDG PET/CT Can Predict Survival of Advanced Hepatocellular Carcinoma Patients: A Multicenter Retrospective Cohort Study
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DOI：
10.2967/jnumed.116.182022
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发表时间：
2017-05-01
影响因子：
9.3
通讯作者：
Yun, Mijin
中科院分区：
文献类型：
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作者：
Na, Sae Jung;Oh, Jin Kyoung;Yun, Mijin
巴塞罗那临床肝癌（BCLC）C期肝细胞癌（HCC）由具有广泛生存时间的异质性患者组组成，需要进一步的预后分层以促进治疗分配。我们评估了BCLC C期HCC患者在PET/CT上F-18-FDG摄取的预后价值。研究方法：从7所大学医院回顾性入组了2009年至2010年间接受F-18-FDG PET/CT分期的291例BCLC C期HCC患者。根据病变程度将患者进一步分为肝内和肝外两组。在F-18-FDG PET/CT上测量原发性肿瘤的肿瘤与肝脏SUV比率（TLR）。在单变量和多变量分析中，分析TLR和其他临床变量的预后值以预测总生存期（OS）。通过Kaplan Meier方法检查了按TLR分层的OS差异。结果：TLR升高与肝外病变相关（P = 0.018）。多因素分析显示，肝内病变组中Child-Pugh分级和TLR是独立的预后因素（P均<0.05），而肝外病变组中TLR是唯一的独立预后因素（P <0.05）。两组中TLR高者的OS均显著低于TLR低者（P <0.05）。结论：在BCLC C期HCC患者中，肝外病变患者原发肿瘤的F-18-FDG摄取显著高于肝内病变患者。此外，治疗前PET/CT上的F-18-FDG摄取对肝内和肝外疾病组的OS具有增量预后价值。
Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC) consists of a heterogeneous group of patients with a wide range of survival times, requiring further prognostic stratification to facilitate treatment allocation. We evaluated the prognostic value of F-18-FDG uptake on PET/CT at the time of presentation in patients with BCLC stage C HCC. Methods: A total of 291 patients with BCLC stage C HCC who underwent F-18-FDG PET/ CT between 2009 and 2010 for staging were retrospectively enrolled from 7 university hospitals. The patients were further divided into 2 groups according to the extent of disease, as intrahepatic or extrahepatic. Tumor-to-liver SUV ratio (TLR) of the primary tumor was measured on F-18-FDG PET/CT. Prognostic values of TLR and other clinical variables were analyzed to predict overall survival (OS) in univariate and multivariate analyses. Differences in the OS stratified by TLR were examined by the Kaplan Meier method. Results: Higher TLR was associated with extrahepatic disease (P = 0.018). On multivariate analysis, Child Pugh classification and TLR were independent prognostic factors in the intrahepatic disease group (all P < 0.05), whereas TLR was the only independent prognostic factor in the extrahepatic disease group (P < 0.05). Patients with high TLR showed a significantly worse OS than those with low TLR (P < 0.05) in both groups. Conclusion: In patients with BCLC stage C HCC, F-18-FDG uptake in the primary tumor was significantly higher in patients with extrahepatic disease than in those with intrahepatic disease. In addition, F-18-FDG uptake on pretreatment PET/CT had an incremental prognostic value for OS in both intrahepatic and extrahepatic disease groups.