title: 18F-FDG PET/CT predicts survival after90Y transarterial radioembolization in unresectable hepatocellular carcinoma.
abstract: OBJECTIVE
  To compare the value of pretreatment functional and morphological imaging parameters for predicting survival in patients undergoing transarterial radioembolization using yttrium-90 (90Y-TARE) for unresectable hepatocellular carcinoma (uHCC).
  
  
  METHODS
  We analysed data from 48 patients in our prospective database undergoing90Y-TARE treatment for uHCC (31 resin, 17 glass). All patients underwent18F-FDG PET/CT and morphological imaging (CT and MRI scans) as part of a pretherapeutic work-up. Patients did not receive any treatment between these imaging procedures and90Y-TARE. Kaplan-Meier estimates of progression-free survival (PFS) and overall survival (OS) were used to assess the prognostic value of18F-FDG PET/CT metabolic parameters, including SUVmax, tumour-to-liver (T/L) uptake ratio and SUVmeanof healthy liver, and morphological data, including number and size of lesions, portal-venous infiltration (PVI). Relevant prognostic factors for HCC including Child-Pugh class, Barcelona Clinic Liver Cancer (BCLC) stage, tumour size, PVI and serum AFP level were compared with metabolic parameters in univariate and multivariate analyses.
  
  
  RESULTS
  The median follow-up in living patients was 16.2 months (range 11.4-50.1 months). Relapse occurred in 34 patients (70.8%) at a median of 7.4 months (range 1.4-27.9 months) after90Y-TARE, and relapse occurred in 24 of 34 patients (70.8%) who died from their disease at a median of 8.1 months (range 2.2-35.2 months). Significant prognostic markers for PFS were the mean and median lesion SUVmax(both P = 0.01; median PFS 10.2 vs. 7.4 months), and significant prognostic markers for OS were the first quarter (Q1) cut-off values for lesion SUVmaxand T/L uptake ratio (both P = 0.02; median OS 30.9 vs. 9 months). The multivariate analysis confirmed that lesion SUVmaxand T/L uptake ratio were independent negative predictors of PFS (hazard ratio, HR, 2.7, 95% CI 1.2-6.1, P = 0.02, for mean SUVmax; HR 2.6, 95% CI 1.1-5.9, P = 0.02, for median SUVmax:) and OS (HR 3.2, 95% CI 1-10.9, P = 0.04 for Q1 SUVmax; HR 3.7, 95% CI 1.1-12.2, P = 0.03, for Q1 T/L uptake ratio), respectively, when testing with either the BCLC staging system or serum AFP level.
  
  
  CONCLUSIONS
  Lesion SUVmaxand T/L uptake ratio as assessed by18F-FDG PET/CT, but not morphological imaging, were predictive markers of survival in patients undergoing90Y-TARE for uHCC.
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
authors.forename: Mario
authors.initials: M
authors.lastname: Jreige
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
authors.forename: Periklis
authors.initials: P
authors.lastname: Mitsakis
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
authors.forename: Axel
authors.initials: A
authors.lastname: Van Der Gucht
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Pomoni
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
authors.forename: Marina
authors.initials: M
authors.lastname: Silva-Monteiro
authors.affiliation: Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Silvano
authors.initials: S
authors.lastname: Gnesin
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
authors.forename: Ariane
authors.initials: A
authors.lastname: Boubaker
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
authors.forename: Marie
authors.initials: M
authors.lastname: Nicod-Lalonde
authors.affiliation: Department of Radiodiagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Rafael
authors.initials: R
authors.lastname: Duran
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
authors.forename: John O
authors.initials: JO
authors.lastname: Prior
authors.affiliation: Department of Radiodiagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Alban
authors.initials: A
authors.lastname: Denys
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland. niklaus.schaefer@chuv.ch.
authors.forename: Niklaus
authors.initials: N
authors.lastname: Schaefer
mesh_terms: D000368:Aged; D001158:Arteries; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000601:surgery; D018572:Disease-Free Survival; D004621:Embolization, Therapeutic; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography; D016019:Survival Analysis; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D015021:Yttrium Radioisotopes; D019788:Fluorodeoxyglucose F18
keywords: FDG PET/CT; Hepatocellular carcinoma; Imaging; Survival; TARE