Risk stratification for locally advanced hepatocellular carcinoma using pretreatment alpha-foetoprotein and18F-fluoro-2-deoxyglucose positron emission tomography.
We investigated the significance of18F-fluoro-2-deoxyglucose positron emission tomography (18F-FDG PET) parameters and alpha-foetoprotein (AFP) levels in patients with locally advanced hepatocellular carcinoma (LA-HCC).



We retrospectively analysed data of 228 patients with LA-HCC who underwent pretreatment18F-FDG PET between January 2003 and December 2013. All patients were treated using liver-directed therapy involving radiotherapy. The maximum standardized uptake values (SUVs) and tumour-to-extratumoural liver SUV ratios were calculated, and pretreatment AFP values were obtained.



Patients were divided into high and low maximum SUV (SUVmax) groups according to a SUV cut-off of 4.825 determined via receiver-operating characteristic analysis. High AFP level (>550 ng/mL) and high SUVmax were significant predictors of overall and progression-free survival. Better treatment responses and longer median progression-free and overall survival were observed in the low SUVmax group, compared to the high SUVmax group. Similar results were obtained for SUV ratio-based (cut-off value: 2.355) and AFP-based analyses (cut-off value: 550 ng/mL). Three risk groups were identified using the double biomarkers of SUVmax and AFP value as strong prognosticators predictive of survival outcomes. This risk stratification was identified as a prognosticator of survival outcomes, even after subgroup analyses. Furthermore, in high risk group, significantly high extrahepatic failure was shown while in low risk group, significantly low intrahepatic failure.



Clinical significance of double biomarkers, SUV and AFP, could be translated into risk stratification for LA-HCC. It could be a valuable tool for survival outcome prediction.
Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
Woo Joong
WJ
Rhee
Department of Nuclear Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
Sang Hyun
SH
Hwang
Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
Hwa Kyung
HK
Byun
Department of Nuclear Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
Mijin
M
Yun
Department of Internal Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
Kwang-Hyub
KH
Han
Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
Jinsil
J
Seong
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000000981:diagnostic imaging*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D055815:Young Adult; D000509:alpha-Fetoproteins / Q000032:analysis*
D015415:Biomarkers; D019275:Radiopharmaceuticals; D000509:alpha-Fetoproteins; D019788:Fluorodeoxyglucose F18
FDG-PET; alpha-foetoprotein; hepatocellular carcinoma; survival; tumour aggressiveness