Significance of preoperative fluorodeoxyglucose-positron emission tomography in prediction of tumor recurrence after liver transplantation for hepatocellular carcinoma patients: a Japanese multicenter study.
BACKGROUND
In the present study, we conducted a multicenter nationwide survey to investigate the effects of preoperative fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) on the prediction of hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT).


METHODS
From 16 Japanese LT centers, data were collected on 182 recipients with HCC who underwent living donor liver transplantation (LDLT) between February 2005 and November 2013. PET-positive status was defined as increased uptake of FDG in the tumor compared to the surrounding non-tumor liver tissue. The median follow-up after LDLT was 54.5 months (range 1-125 months).


RESULTS
Postoperative HCC recurrence occurred in 23 patients. Multivariate analysis revealed that exceeding the Milan criteria (MC), alpha-fetoprotein (AFP) level ≥115 ng/ml, and PET-positive status were significant and independent risk factors for recurrence. In the over-MC group, a subgroup of patients with AFP level <115 ng/ml and PET-negative status (n = 22) had a significantly lower 5-year recurrence rate than the other patients (n = 27, 19% vs. 53%, P = 0.019).


CONCLUSIONS
These results suggest that preoperative FDG-PET status offers additional information on HCC recurrence risk after LT. Over-MC patients with PET-negative status and lower AFP level may achieve successful outcome comparable to that of within-MC patients.
Department of HBP and Breast Surgery, Ehime University Graduate School of Medicine, Ehime, Japan.
Yasutsugu
Y
Takada
Division of HBP Surgery and Transplantation, Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Toshimi
T
Kaido
Department of Hepatobiliary and Pancreatic Surgery, Gunma University, Gunma, Japan.
Ken
K
Shirabe
Department of Gastroenterological Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
Hiroaki
H
Nagano
Department of Surgery, Tokyo Women's Medical University, Tokyo, Japan.
Hiroto
H
Egawa
Department of Transplantation and Pediatric Surgery, Postgraduate School of Life Science, Kumamoto University, Kumamoto, Japan.
Yasuhiko
Y
Sugawara
Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Hokkaido, Japan.
Akinobu
A
Taketomi
Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan.
Takeshi
T
Takahara
Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Surgical Services, Ageo Central General Hospital, Saitama, Japan.
Go
G
Wakabayashi
Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Miyagi, Japan.
Chikashi
C
Nakanishi
Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Miyagi, Japan.
Naoki
N
Kawagishi
Department of Regenerative Surgery, Fukushima Medical University, Fukushima, Japan.
Akira
A
Kenjo
Department of Regenerative Surgery, Fukushima Medical University, Fukushima, Japan.
Mitsukazu
M
Gotoh
Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan.
Yoshikazu
Y
Toyoki
Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan.
Kenichi
K
Hakamada
Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Masayuki
M
Ohtsuka
Artificial Organ and Transplantation Surgery Division, Department of Surgery, The University of Tokyo, Tokyo, Japan.
Nobuhisa
N
Akamatsu
Artificial Organ and Transplantation Surgery Division, Department of Surgery, The University of Tokyo, Tokyo, Japan.
Norihiro
N
Kokudo
National Hospital Organization Yokohama Medical Center, Kanagawa, Japan.
Kazuhisa
K
Takeda
Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan.
Itaru
I
Endo
Department of Gastroenterological Surgery, Kanazawa University, Ishikawa, Japan.
Hiroyuki
H
Takamura
Division of HBP Surgery and Transplantation, Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Hideaki
H
Okajima
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
Hiroshi
H
Wada
Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
Shoji
S
Kubo
Hepato-Biliary-Pancreatic Surgery, Kobe University Hospital, Hyogo, Japan.
Kaoru
K
Kuramitsu
Hepato-Biliary-Pancreatic Surgery, Kobe University Hospital, Hyogo, Japan.
Yonson
Y
Ku
Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.
Kohei
K
Ishiyama
Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.
Hideki
H
Ohdan
Department of HBP and Breast Surgery, Ehime University Graduate School of Medicine, Ehime, Japan.
Eitaro
E
Ito
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Yoshihiko
Y
Maehara
Department of Transplantation and Pediatric Surgery, Postgraduate School of Life Science, Kumamoto University, Kumamoto, Japan.
Masaki
M
Honda
Department of Transplantation and Pediatric Surgery, Postgraduate School of Life Science, Kumamoto University, Kumamoto, Japan.
Yukihiro
Y
Inomata
Division of Gastroenterologic Surgery, Department of Surgery, Asahikawa Medical University, Hokkaido, Japan.
Hiroyuki
H
Furukawa
Division of HBP Surgery and Transplantation, Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Shinji
S
Uemoto
Second Department of Surgery, Wakayama Medical University School of Medicine, Wakayama, Japan.
Hiroki
H
Yamaue
International University of Health and Welfare, Mita Hospital, Tokyo, Japan.
Masaru
M
Miyazaki
Japanese Society of Hepato-biliary-Pancreatic Surgery, Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
Tadahiro
T
Takada
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D002423:Cause of Death; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology; D049268:Positron-Emission Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014019:Tissue Donors; D016896:Treatment Outcome
D019788:Fluorodeoxyglucose F18
Biological marker; Hepatocellular carcinoma; Liver transplantation; Selection criteria