title: Prognostic Significance of ¹⁸F-FDG Uptake in Hepatocellular Carcinoma Treated with Transarterial Chemoembolization or Concurrent Chemoradiotherapy: A Multicenter Retrospective Cohort Study.
abstract: This study aimed to assess the prognostic value of (18)F-FDG uptake in hepatocellular carcinoma (HCC) patients who had transarterial chemoembolization (TACE) or concurrent intraarterial chemotherapy with external-beam radiotherapy (CCRT) and to compare the prognosis between patients treated with TACE and those with CCRT according to (18)F-FDG uptake.
  
  
  
  Two hundred fourteen intermediate-to-advanced-stage HCC patients without extrahepatic metastasis who underwent staging (18)F-FDG PET/CT before TACE (153 patients) or CCRT (61 patients) were recruited from 7 hospitals. Progression-free survival (PFS) and overall survival (OS) were compared using an optimal cutoff value for tumor-to-normal liver uptake ratio (TLR). Further, PFS and OS were compared according to treatment modalities (TACE vs. CCRT) using the same TLR cutoff value.
  
  
  
  On multivariate analysis, age and TLR were independent prognostic factors for PFS (P< 0.050). For OS, Child-Pugh classification and TLR were independent prognostic factors (P< 0.050). When the TLR was greater than 2.0, patients treated with CCRT showed significantly better PFS and OS than those treated with TACE after adjusting for tumor size and number (P= 0.014, for all). In contrast, there was no significant difference in PFS and OS between patients treated with TACE or CCRT when the TLR was 2.0 or less.
  
  
  
  (18)F-FDG uptake was an independent prognostic factor for PFS and OS in HCC patients treated with TACE or CCRT. Especially, in HCCs with high (18)F-FDG uptake, patients treated with CCRT showed better survival than those treated with TACE. (18)F-FDG PET/CT may help determine the treatment modality for intermediate-to-advanced-stage HCCs.
authors.affiliation: Department of Nuclear Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea.
authors.forename: Jeong Won
authors.initials: JW
authors.lastname: Lee
authors.affiliation: Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
authors.forename: Jin Kyoung
authors.initials: JK
authors.lastname: Oh
authors.affiliation: Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
authors.forename: Yong An
authors.initials: YA
authors.lastname: Chung
authors.affiliation: Department of Radiology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
authors.forename: Sae Jung
authors.initials: SJ
authors.lastname: Na
authors.affiliation: Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Seung Hyup
authors.initials: SH
authors.lastname: Hyun
authors.affiliation: Department of Nuclear Medicine, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, Seoul, Korea.
authors.forename: Il Ki
authors.initials: IK
authors.lastname: Hong
authors.affiliation: Department of Nuclear Medicine, Korea University Guro Hospital, Seoul, Korea.
authors.forename: Jae Seon
authors.initials: JS
authors.lastname: Eo
authors.affiliation: Department of Nuclear Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
authors.forename: Bong-Il
authors.initials: BI
authors.lastname: Song
authors.affiliation: Department of Nuclear Medicine, National Cancer Center Research Institute and Hospital, Gyeonggi-do, Korea.
authors.forename: Tae-sung
authors.initials: TS
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Do Young
authors.initials: DY
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Seung Up
authors.initials: SU
authors.lastname: Kim
authors.affiliation: Department of Nuclear Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Dae Hyuk
authors.initials: DH
authors.lastname: Moon
authors.affiliation: Department of Radiology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea; and yunmijin@yuhs.ac jdlee@ish.or.kr.
authors.forename: Jong Doo
authors.initials: JD
authors.lastname: Lee
authors.affiliation: Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Korea yunmijin@yuhs.ac jdlee@ish.or.kr.
authors.forename: Mijin
authors.initials: M
authors.lastname: Yun
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000378:metabolism; D006528:Carcinoma, Hepatocellular / Q000378:metabolism* / Q000532:radiotherapy / Q000628:therapy*; D059248:Chemoradiotherapy; D015331:Cohort Studies; D018572:Disease-Free Survival; D004621:Embolization, Therapeutic; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008099:Liver / Q000378:metabolism; D008113:Liver Neoplasms / Q000378:metabolism* / Q000532:radiotherapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011237:Predictive Value of Tests; D011379:Prognosis; D019275:Radiopharmaceuticals / Q000378:metabolism*; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: 18F-FDG PET; concurrent chemoradiotherapy; hepatocellular carcinoma; prognosis; transarterial chemoembolization