Top

European Journal of Nuclear Medicine and Molecular Imaging

Published in:

01-03-2018 | Original Article

¹⁸F–fluorodeoxyglucose uptake of hepatocellular carcinoma as a prognostic predictor in patients with sorafenib treatment

Authors: Pil Soo Sung, Hye Lim Park, Keungmo Yang, Seawon Hwang, Myeong Jun Song, Jeong Won Jang, Jong Young Choi, Seung Kew Yoon, Ie Ryung Yoo, Si Hyun Bae

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 3/2018

Abstract

Purpose

Sorafenib, an oral multikinase inhibitor, is a recommended treatment option available for patients with Barcelona Clinic Liver Cancer (BCLC)-C stage hepatocellular carcinoma (HCC). This study aimed to evaluate the performance of ¹⁸F–fluorodeoxyglucose positron emission tomography (¹⁸F–FDG PET) for predicting tumour progression during sorafenib treatment.

Methods

We formed a retrospective cohort comprising patients treated with sorafenib for at least 30 days and undergoing ¹⁸F–FDG PET/CT within 1 month before treatment. For statistical analyses, the tumour-to-liver standardised uptake value (SUV) ratio (TLR) of the most hypermetabolic lesion was measured.

Results

Among a total of 35 patients, two obtained partial remission, and 11 showed stable disease after the first response evaluation. Patients with a TLR ≥ 2.9 (n = 17) had a median overall survival (OS) of 3.7 months after sorafenib treatment, whereas patients with a TLR < 2.9 (n = 18) had median OS of 12.2 months (P < 0.001), although the disease control rate was not significantly different between the two groups. Pretreatment TLR ≥ 2.9 (hazard ratio [HR] = 6.318, P = 0.002) and Child-Pugh class B (HR = 4.316, P = 0.044) were poor prognostic factors for OS, and a TLR ≥ 2.9 (HR = 2.911, P = 0.024) was the only poor prognostic factor for progression-free survival in a multivariate analysis.

Conclusion

Pretreatment tumour metabolic activity assessed by ¹⁸F–FDG PET is an independent prognostic factor for survival in patients with BCLC-C stage HCC receiving sorafenib monotherapy, although it may not predict tumour response to the treatment.

Available only for authorised users

Llovet JM, Zucman-Rossi J, Pikarsky E, Sangro B, Schwartz M, Sherman M, et al. Hepatocellular carcinoma. Nat Rev Dis Primers. 2016;2:16018. https://doi.org/10.1038/nrdp.2016.18.CrossRefPubMed

Bruix J, Reig M, Sherman M. Evidence-based diagnosis, staging, and treatment of patients with Hepatocellular carcinoma. Gastroenterology. 2016;150:835–53. https://doi.org/10.1053/j.gastro.2015.12.041.CrossRefPubMed

Na SJ, Oh JK, Hyun SH, Lee JW, Hong IK, Song BI, et al. 18F-FDG PET/CT can predict survival of advanced hepatocellular carcinoma patients: a multicenter retrospective cohort study. J Nucl Med. 2016. https://doi.org/10.2967/jnumed.116.182022.

Kim DY, Kim HJ, Han KH, Han SY, Heo J, Woo HY, et al. Real-life experience of Sorafenib treatment for Hepatocellular carcinoma in Korea: from GIDEON data. Cancer Res Treat. 2016;48:1243–52. https://doi.org/10.4143/crt.2015.278.CrossRefPubMedPubMedCentral

Yu SJ. A concise review of updated guidelines regarding the management of hepatocellular carcinoma around the world: 2010-2016. Clin Mol Hepatol. 2016;22:7–17. https://doi.org/10.3350/cmh.2016.22.1.7.CrossRefPubMedPubMedCentral

Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008;359:378–90. https://doi.org/10.1056/NEJMoa0708857.CrossRefPubMed

Cheng AL, Kang YK, Chen Z, Tsao CJ, Qin S, Kim JS, et al. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol. 2009;10:25–34. https://doi.org/10.1016/S1470-2045(08)70285-7.CrossRefPubMed

Shao YY, Hsu CH, Cheng AL. Predictive biomarkers of sorafenib efficacy in advanced hepatocellular carcinoma: are we getting there? World J Gastroenterol. 2015;21:10336–47. https://doi.org/10.3748/wjg.v21.i36.10336.CrossRefPubMedPubMedCentral

Lee JH, Park JY, Kim DY, Ahn SH, Han KH, Seo HJ, et al. Prognostic value of 18F-FDG PET for hepatocellular carcinoma patients treated with sorafenib. Liver Int. 2011;31:1144–9. https://doi.org/10.1111/j.1478-3231.2011.02541.x.CrossRefPubMed

10.

Sugiyama M, Sakahara H, Torizuka T, Kanno T, Nakamura F, Futatsubashi M, et al. 18F-FDG PET in the detection of extrahepatic metastases from hepatocellular carcinoma. J Gastroenterol. 2004;39:961–8. https://doi.org/10.1007/s00535-004-1427-5.CrossRefPubMed

11.

Hong CM, Ahn BC, Jang YJ, Jeong SY, Lee SW, Lee J. Prognostic value of metabolic parameters of 18F-FDG PET/CT and apparent diffusion coefficient of MRI in Hepatocellular carcinoma. Clin Nucl Med. 2017;42:95–9. https://doi.org/10.1097/rlu.0000000000001478.CrossRefPubMed

12.

Hyun SH, Eo JS, Lee JW, Choi JY, Lee KH, Na SJ, et al. Prognostic value of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with Barcelona clinic liver cancer stages 0 and a hepatocellular carcinomas: a multicenter retrospective cohort study. Eur J Nucl Med Mol Imaging. 2016;43:1638–45. https://doi.org/10.1007/s00259-016-3348-y.CrossRefPubMed

13.

Eo JS, Paeng JC, Lee DS. Nuclear imaging for functional evaluation and theragnosis in liver malignancy and transplantation. World J Gastroenterol. 2014;20:5375–88. https://doi.org/10.3748/wjg.v20.i18.5375.CrossRefPubMedPubMedCentral

14.

Lee JW, Paeng JC, Kang KW, Kwon HW, Suh KS, Chung JK, et al. Prediction of tumor recurrence by 18F-FDG PET in liver transplantation for hepatocellular carcinoma. J Nucl Med. 2009;50:682–7. https://doi.org/10.2967/jnumed.108.060574.CrossRefPubMed

15.

Kitamura K, Hatano E, Higashi T, Seo S, Nakamoto Y, Yamanaka K, et al. Preoperative FDG-PET predicts recurrence patterns in hepatocellular carcinoma. Ann Surg Oncol. 2012;19:156–62. https://doi.org/10.1245/s10434-011-1990-y.CrossRefPubMed

16.

Kornberg A, Kupper B, Thrum K, Katenkamp K, Steenbeck J, Sappler A, et al. Increased 18F-FDG uptake of hepatocellular carcinoma on positron emission tomography independently predicts tumor recurrence in liver transplant patients. Transplant Proc. 2009;41:2561–3. https://doi.org/10.1016/j.transproceed.2009.06.115.CrossRefPubMed

17.

Lee JW, Yun M, Cho A, Han KH, Kim DY, Lee SM, et al. The predictive value of metabolic tumor volume on FDG PET/CT for transarterial chemoembolization and transarterial chemotherapy infusion in hepatocellular carcinoma patients without extrahepatic metastasis. Ann Nucl Med. 2015;29:400–8. https://doi.org/10.1007/s12149-015-0956-8.CrossRefPubMed

18.

Kim MJ, Kim YS, Cho YH, Jang HY, Song JY, Lee SH, et al. Use of (18)F-FDG PET to predict tumor progression and survival in patients with intermediate hepatocellular carcinoma treated by transarterial chemoembolization. Korean J Intern Med. 2015;30:308–15. https://doi.org/10.3904/kjim.2015.30.3.308.CrossRefPubMedPubMedCentral

19.

Lee JW, Oh JK, Chung YA, Na SJ, Hyun SH, Hong IK, et al. Prognostic significance of (1)(8)F-FDG uptake in Hepatocellular carcinoma treated with Transarterial Chemoembolization or concurrent Chemoradiotherapy: a multicenter retrospective cohort study. J Nucl Med. 2016;57:509–16. https://doi.org/10.2967/jnumed.115.167338.CrossRefPubMed

20.

Lee JW, Hwang SH, Kim DY, Han KH, Yun M. Prognostic value of FDG uptake of portal vein tumor thrombosis in patients with locally advanced Hepatocellular carcinoma. Clin Nucl Med. 2017;42:e35–40. https://doi.org/10.1097/rlu.0000000000001422.CrossRefPubMed

21.

Song MJ, Bae SH, Lee SW, Song DS, Kim HY, Yoo Ie R, et al. 18F-fluorodeoxyglucose PET/CT predicts tumour progression after transarterial chemoembolization in hepatocellular carcinoma. Eur J Nucl Med Mol Imaging. 2013;40:865–73. https://doi.org/10.1007/s00259-013-2366-2.CrossRefPubMed

22.

Jreige M, Mitsakis P, Van Der Gucht A, Pomoni A, Silva-Monteiro M, Gnesin S, et al. 18F-FDG PET/CT predicts survival after 90Y transarterial radioembolization in unresectable hepatocellular carcinoma. Eur J Nucl Med Mol Imaging 2017. https://doi.org/10.1007/s00259-017-3653-0.

23.

Hartenbach M, Weber S, Albert NL, Hartenbach S, Hirtl A, Zacherl MJ, et al. Evaluating treatment response of Radioembolization in intermediate-stage Hepatocellular carcinoma patients using 18F-Fluoroethylcholine PET/CT. J Nucl Med. 2015;56:1661–6. https://doi.org/10.2967/jnumed.115.158758.CrossRefPubMed

24.

Sabet A, Ahmadzadehfar H, Bruhman J, Sabet A, Meyer C, Wasmuth JC, et al. Survival in patients with hepatocellular carcinoma treated with 90Y-microsphere radioembolization. Prediction by 18F-FDG PET. Nuklearmedizin. 2014;53:39–45. https://doi.org/10.3413/Nukmed-0622-13-09.CrossRefPubMed

25.

Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis. 2010;30:52–60. https://doi.org/10.1055/s-0030-1247132.CrossRefPubMed

26.

Upadhyay M, Samal J, Kandpal M, Singh OV, Vivekanandan P. The Warburg effect: insights from the past decade. Pharmacol Ther. 2013;137:318–30. https://doi.org/10.1016/j.pharmthera.2012.11.003.CrossRefPubMed

27.

Pimiento JM, Davis-Yadley AH, Kim RD, Chen DT, Eikman EA, Berman CG, et al. Metabolic activity by 18F-FDG-PET/CT is prognostic for stage I and II pancreatic cancer. Clin Nucl Med. 2016;41:177–81. https://doi.org/10.1097/RLU.0000000000001098.CrossRefPubMedPubMedCentral

28.

Song DS, Song MJ, Bae SH, Chung WJ, Jang JY, Kim YS, et al. A comparative study between sorafenib and hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis. J Gastroenterol. 2015;50:445–54. https://doi.org/10.1007/s00535-014-0978-3.CrossRefPubMed

29.

Edeline J, Boucher E, Rolland Y, Vauleon E, Pracht M, Perrin C, et al. Comparison of tumor response by response evaluation criteria in solid Tumors (RECIST) and modified RECIST in patients treated with sorafenib for hepatocellular carcinoma. Cancer. 2012;118:147–56. https://doi.org/10.1002/cncr.26255.CrossRefPubMed

Title: 18F–fluorodeoxyglucose uptake of hepatocellular carcinoma as a prognostic predictor in patients with sorafenib treatment
Authors: Pil Soo Sung
Hye Lim Park
Keungmo Yang
Seawon Hwang
Myeong Jun Song
Jeong Won Jang
Jong Young Choi
Seung Kew Yoon
Ie Ryung Yoo
Si Hyun Bae
Publication date: 01-03-2018
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 3/2018
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-017-3871-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

¹⁸F–fluorodeoxyglucose uptake of hepatocellular carcinoma as a prognostic predictor in patients with sorafenib treatment

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2018

Prognostic value of 18F–choline PET/CT metabolic parameters in patients with metastatic castration-resistant prostate cancer treated with abiraterone or enzalutamide

177Lu-PSMA-617 radioligand therapy in mCRPC: ready for phase III trial?

Founder of EJNM passed away

Is the whole larger than the sum of the parts? Integrated PET/MRI as a tool for response prediction

Head to head comparison of [18F] AV-1451 and [18F] THK5351 for tau imaging in Alzheimer’s disease and frontotemporal dementia

Absolute number of new lesions on 18F-FDG PET/CT is more predictive of clinical response than SUV changes in metastatic melanoma patients receiving ipilimumab