Combination of FDG-PET and UCSF Criteria for Predicting HCC Recurrence After Living Donor Liver Transplantation.
F-18 fluorodeoxyglucose (FDG) uptake in hepatocellular carcinoma (HCC) is related to tumor biology and has predictive value for tumor recurrence after liver transplantation. This retrospective study assessed whether the degree of FDG uptake in positron emission tomography (PET) can be used to predict HCC recurrence after living donor liver transplantation (LDLT).



One hundred forty-seven patients with HCC underwent FDG-PET studies before LDLT. The semiquantification of FDG uptake in FDG-positive HCC was done with maximum standardized uptake value (SUVmax) and tumor to nontumor ratio (TNR). Recurrence-free survivals (RFS) were calculated using the Kaplan-Meier method.



In univariable analysis, T stage, presence of microvascular invasion, being FDG-positive, SUVmax, and TNR were significant predictors for worse RFS. The optimal cutoff values of SUVmax and TNR were 4.8 and 2.0, respectively. The high FDG uptake HCC (TNR ≥ 2) was a strong predictor for worse RFS (hazard ratio, 13.52; 95% confidence interval, 4.77-38.29; P < 0.001). Using a combination of FDG-PET and University of California San Francisco (UCSF) criteria, the patients can be divided into low-risk (within UCSF criteria and FDG-negative), intermediate-risk (beyond UCSF criteria and FDG-negative; FDG-positive and TNR < 2), and high-risk (FDG-positive and TNR ≥ 2) groups. The estimated 5-year RFS in these groups were 85.5%, 83.9%, and 29.6% according to the combination of FDG-PET and clinical UCSF criteria, and 94.0%, 75.8%, and 29.6% according to the combination of FDG-PET and pathologic UCSF criteria, respectively.



Combination of FDG-PET and UCSF criteria can be used to predict the risk of HCC recurrence after LDLT.
1 Liver Transplantation Program, Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. 2 Liver Transplantation Program, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. 3 Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan. 4 Liver Transplantation Program, Department of Pathology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. 5 Liver Transplantation Program, Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Chien-Chin
CC
Hsu
Chao-Long
CL
Chen
Chih-Chi
CC
Wang
Chih-Che
CC
Lin
Chee-Chien
CC
Yong
Shih-Ho
SH
Wang
Yueh-Wei
YW
Liu
Ting-Lung
TL
Lin
Wei-Feng
WF
Lee
Yu-Hung
YH
Lin
Yi-Chia
YC
Chan
Yi-Ju
YJ
Wu
Hock-Liew
HL
Eng
Yu-Fan
YF
Cheng
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000008:administration & dosage*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D019275:Radiopharmaceuticals / Q000008:administration & dosage*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18