title: Clinical Impact of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Living Donor Liver Transplantation for Advanced Hepatocellular Carcinoma.
abstract: BACKGROUND
  The relevant number of patients with hepatocellular carcinoma (HCC) beyond the Milan criteria have undergone living donor liver transplantation (LDLT). However, the prognostic factors for these patients with advanced HCC remain unclear.
  
  
  METHODS
  From March 2005 to May 2013, 280 patients with HCC underwent LDLT at the National Cancer Center. Of these, patients with HCC beyond the Milan criteria were retrospectively enrolled. We analyzed the prognostic significance of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG-PET/CT) for selecting appropriate candidates.
  
  
  RESULTS
  Of the total 280 patients, 147 (52.5%) were confirmed to have HCC beyond the Milan criteria on the basis of pathological reports. The patients who met and exceeded the Milan criteria had 5-year overall survival (OS) rates of 87.2% and 64.6%, respectively (P < 0.001). Multivariable analysis for OS and disease-free survival (DFS) in patients with HCC beyond the Milan criteria revealed PET/CT positivity (hazards ratio [HR], 2.714; P = 0.013 for OS; HR, 3.803; P < 0.001 for DFS), total tumor size over 10 cm (HR, 2.333; P = 0.035 for OS; HR, 3.334, P = 0.001 for DFS), and microvascular invasion (HR, 2.917; P = 0.025 for DFS) to be significant prognostic factors. In particular, patients with HCC beyond the Milan criteria with a PET/CT-negative status and total tumor size less than 10 cm showed similar OS and DFS in comparison with those with HCC within the Milan criteria.
  
  
  CONCLUSIONS
  A PET/CT status in LDLT is a useful marker for predicting survival of patients with advanced HCC.
authors.affiliation: 1 Center for Liver Cancer, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea. 2 Department of Nuclear Medicine, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea. 3 Department of Surgery, College of Medicine, Jeju National University, Jeju-do, Republic of Korea.
authors.forename: Seung Duk
authors.initials: SD
authors.lastname: Lee
authors.forename: Seong Hoon
authors.initials: SH
authors.lastname: Kim
authors.forename: Seok-Ki
authors.initials: SK
authors.lastname: Kim
authors.forename: Young-Kyu
authors.initials: YK
authors.lastname: Kim
authors.forename: Sang-Jae
authors.initials: SJ
authors.lastname: Park
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D064847:Multimodal Imaging; D015999:Multivariate Analysis; D049268:Positron-Emission Tomography; D011379:Prognosis; D016016:Proportional Hazards Models; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18