title: Prognostic implication of (18)F FDG-PET in patients with extrahepatic metastatic hepatocellular carcinoma undergoing systemic treatment, a retrospective cohort study.
abstract: OBJECTIVE
  The role of (18)F FDG-PET in hepatocellular carcinoma (HCC) has not been firmly established. We conducted this study to investigate the clinical implication of SUVmax on (18)F FDG-PET as a prognostic factor in patients with HCC, especially in the metastatic setting.
  
  
  METHODS
  HCC patients with extrahepatic metastatic lesions were enrolled that were evaluated by (18)F FDG-PET before palliative systemic therapy, between January 2002 and December 2009 at the Seoul National University Hospital. We retrospectively analyzed the clinical outcome and the value of the SUVmax.
  
  
  RESULTS
  A total of 25 patients (men, 88.0%) were enrolled. The response rate and disease control rate was 18.2% (95% CI: 2.1-34.3) and 32.0% (95% CI: 16.3-56.5), respectively. The progression-free survival (PFS) and overall survival (OS) were 2.3 months (95% CI: 1.1-3.4) and 14.2 months (95% CI: 9.1-19.2), respectively. The univariate analysis of OS showed that SUVmax and alphafetoprotein (AFP) were significant prognostic factors (P = 0.023 and P = 0.006, respectively). The multivariate analysis of OS showed that SUVmax and AFP were significant prognostic factors (P = 0.008 and P = 0.006, respectively). SUVmax and AFP were independent prognostic factors for PFS, too (P = 0.010 and P = 0.016, respectively). When the patients were divided according to the SUVmax and AFP, the patients with an SUVmax < 4.9 and an AFP ≤ 400 ng/ml showed longer OS and PFS than the patients with SUVmax ≥ 4.9 or AFP > 400 ng/ml (26.7 months vs. 9.3 months, P < 0.001 and 5.6 months vs. 1.7 months, P = 0.012, respectively).
  
  
  CONCLUSIONS
  The SUVmax of the (18)F FDG-PET has a prognostic value for OS and PFS in patients with metastatic HCC undergoing systemic therapy. The combined analysis of the SUVmax with AFP might provide more detailed prognostic information.
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehagro, Chongno-gu, Seoul 110-744, Korea.
authors.forename: Dong-Yeop
authors.initials: DY
authors.lastname: Shin
authors.forename: Sae-Won
authors.initials: SW
authors.lastname: Han
authors.forename: Do-Youn
authors.initials: DY
authors.lastname: Oh
authors.forename: Seock-Ah
authors.initials: SA
authors.lastname: Im
authors.forename: Tae-You
authors.initials: TY
authors.lastname: Kim
authors.forename: Yung-Jue
authors.initials: YJ
authors.lastname: Bang
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000556:secondary* / Q000628:therapy; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000628:therapy; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000628:therapy; D010166:Palliative Care; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011379:Prognosis; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18