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European Radiology
Published in: European Radiology 11/2019

01-11-2019 | Liver Transplantation | Nuclear Medicine

Composite criteria using clinical and FDG PET/CT factors for predicting recurrence of hepatocellular carcinoma after living donor liver transplantation

Authors: Yeon-koo Kang, Joon Young Choi, Jin Chul Paeng, Yong-il Kim, Hyun Woo Kwon, Gi Jeong Cheon, Kyung-Suk Suh, Choon Hyuck David Kwon, Dong Soo Lee, Keon Wook Kang

Published in: European Radiology | Issue 11/2019

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Abstract

Objectives

Fluorodeoxyglucose (FDG) PET/CT is effective for predicting recurrence of hepatocellular carcinoma after liver transplantation. This study aimed to design composite criteria for predicting post-transplantation recurrence using clinical and FDG PET/CT factors.

Methods

We retrospectively enrolled 239 patients who underwent living donor transplantation in two independent centers between 2005 and 2013. On PET, maximum tumor-to-background ratio (TBRmax) was measured. Significant predictors for recurrence were selected by logistic regression and survival analyses. With varying cutoff values for the selected factors, composite criteria were designed to maximize the predictive performance for recurrence, and tenfold cross-validation was performed. Predictive values were compared between the composite criteria and the conventional recipient selection criteria.

Results

Tumor size, number, alpha-fetoprotein, and TBRmax were selected as significant predictors in both logistic regression and multivariate survival analyses. In combination of these factors, the highest diagnostic performance was sensitivity of 75.7% and specificity of 88.5% with cutoff values of tumor size < 6.0 cm, tumor number < 8, alpha-fetoprotein < 465 ng/mL, and TBRmax < 2.8. The composite criteria exhibited the highest performance for predicting recurrence and recurrence-free survival among the tested criteria including conventional ones.

Conclusions

The composite criteria adding FDG PET findings to clinical factors are effective in selecting appropriate liver cancer patients who are candidates for liver transplantation.

Key Points

• In patients with HCC, tumor uptake on FDG PET/CT, tumor size, number, and serum AFP level are recognized individual predictors for tumor recurrence after LT.
• A composite criterion set, combining tumor size, number, serum AFP level, and maximum tumor-to-background ratio (TBR max ), predicts post-LT recurrence most effectively when compared with conventional criteria sets in selecting candidates for living donor LT.
Appendix
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Metadata
Title
Composite criteria using clinical and FDG PET/CT factors for predicting recurrence of hepatocellular carcinoma after living donor liver transplantation
Authors
Yeon-koo Kang
Joon Young Choi
Jin Chul Paeng
Yong-il Kim
Hyun Woo Kwon
Gi Jeong Cheon
Kyung-Suk Suh
Choon Hyuck David Kwon
Dong Soo Lee
Keon Wook Kang
Publication date
01-11-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 11/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06239-z

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