18F-FDG PET as novel imaging biomarker for disease progression after ablation therapy in colorectal liver metastases.
OBJECTIVE
Recurrent disease following thermal ablation therapy is a frequently reported problem. Preoperative identification of patients with high risk of recurrent disease might enable individualized treatment based on patients' risk profile. The aim of the present work was to investigate the role of metabolic parameters derived from the pre-ablation18F-FDG PET/CT as imaging biomarkers for recurrent disease in patients with colorectal liver metastases (CLM).


METHODS
Included in this retrospective study were all consecutive patients with CLM treated with percutaneous or open thermal ablation therapy who had a pre-treatment baseline18F-FDG PET/CT available. Multivariable cox regression for survival analysis was performed using different models for the metabolic parameters (SULpeak, SULmean, SULmax, partial volume corrected SULmean(cSULmean), and total lesion glycolysis (TLG)) corrected for tumour and procedure characteristics. The study endpoints were defined as local tumour progression free survival (LTP-FS), new intrahepatic recurrence free survival (NHR-FS) and extrahepatic recurrence free survival (EHR-FS). Clinical and imaging follow-up data was used as the reference standard.


RESULTS
Fifty-four patients with 90 lesions were selected. Univariable cox regression analysis resulted in eight models. Multivariable analysis revealed that after adjusting for lesion size and the approach of the procedure, none of the metabolic parameters were associated with LTP-FS or EHR-FS. Percutaneous approach was significantly associated with a shorter LTP-FS. It was demonstrated that lower values of SULpeak, SULmax, SULmean, and cSULmeanare associated with a significant better NHR-FS, independent of the lesion size and number and prior chemotherapy.


CONCLUSIONS
We found no association between the metabolic parameters on pre-ablation18F-FDG PET/CT and the LTP-FS. However, low values of the metabolic parameters were significantly associated with improved NHR-FS. The clinical implication of these findings might be the identification of high-risk patients who might benefit most from adjuvant or combined treatment strategies.
Department Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands. morsalsamim@gmail.com.|Department Radiology and Nuclear Medicine, University Medical Centre Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands. morsalsamim@gmail.com.
M
M
Samim
Department of Radiology and Nuclear Medicine, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1006 BE, Amsterdam, The Netherlands.
W
W
Prevoo
Department of Radiology and Nuclear Medicine, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1006 BE, Amsterdam, The Netherlands.
B J
BJ
de Wit-van der Veen
Department Surgical Oncology, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1006 BE, Amsterdam, The Netherlands.
K F
KF
Kuhlmann
Department Surgical Oncology, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1006 BE, Amsterdam, The Netherlands.
T
T
Ruers
Department Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
R
R
van Hillegersberg
Department Radiology and Nuclear Medicine, University Medical Centre Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
M A A J
MAAJ
van den Bosch
Department Radiology and Nuclear Medicine, University Medical Centre Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
H M
HM
Verkooijen
Department Radiology and Nuclear Medicine, University Medical Centre Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
M G E H
MGEH
Lam
Department of Radiology and Nuclear Medicine, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1006 BE, Amsterdam, The Netherlands.
M P M
MPM
Stokkel
D055011:Ablation Techniques; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism; D015179:Colorectal Neoplasms / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000556:secondary* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography; D012189:Retrospective Studies
D014408:Biomarkers, Tumor; D019788:Fluorodeoxyglucose F18
CLM; Imaging biomarker; PERCIST; RFA