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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2018

01-02-2018 | Hepatobiliary Tumors

Proposal of a New Preoperative Prognostic Model for Solitary Hepatocellular Carcinoma Incorporating 18F-FDG-PET Imaging with the ALBI Grade

Authors: Tomoaki Yoh, MD, Satoru Seo, MD, PhD, Satoshi Ogiso, MD, PhD, Takayuki Kawai, MD, PhD, Yukihiro Okuda, MD, PhD, Takamichi Ishii, MD, PhD, Kojiro Taura, MD, PhD, Tatsuya Higashi, MD, PhD, Yuji Nakamoto, MD, PhD, Etsuro Hatano, MD, PhD, Toshimi Kaido, MD, PhD, Shinji Uemoto, MD, PhD

Published in: Annals of Surgical Oncology | Issue 2/2018

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Abstract

Background

Existing prognostic systems were not developed using only objective variables available preoperatively, and therefore do not provide ideal prognostication for patients undergoing hepatectomy for hepatocellular carcinoma (HCC). We aimed to develop a preoperative prognostic model using objective variables involving two parameters: 18F-fluorodeoxyglucose-positron emission tomography (18F-FDG-PET) and the albumin-bilirubin (ALBI) grade.

Methods

This study included 207 consecutive patients with solitary HCC who underwent 18F-FDG-PET prior to hepatectomy. The tumor to non-tumor maximum standardized uptake value ratio (TNR) was used as an 18F-FDG PET imaging parameter.

Results

The 5-year overall survival (OS) and disease-free survival (DFS) rates were 58.6% and 28.8%, respectively. Multivariate analysis of OS identified TNR ≥ 2 (hazard ratio [HR] 1.743, 95% confidence interval [CI] 1.114–2.648, p = 0.016) and ALBI grade 2 (HR 1.966, 95% CI 1.349–2.884, p < 0.001) as the only significant prognostic factors; tumor diameter and tumor markers were not significant. Patients were divided into low- (TNR < 2 and ALBI grade 1), intermediate- (TNR < 2 and ALBI grade 2, or TNR ≥ 2 and ALBI grade 1), and high-risk (TNR ≥ 2 and ALBI grade 2) groups, which differed significantly in terms of survival (5-year OS: 75.7, 49.6, and 27.3%, respectively, p < 0.001; 5-year DFS: 37.0, 24.9, and 13.6%, respectively, p < 0.001). Compared with other staging systems, our model had the best discriminatory ability (corrected Akaike information criteria 1054.8, p < 0.001) and homogeneity (likelihood ratio Chi square value 27.6, p < 0.001).

Conclusion

A preoperative prognostic model incorporating 18F-FDG-PET imaging with the ALBI grade may be useful for estimating the prognosis of selected patients with solitary HCC.
Appendix
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Metadata
Title
Proposal of a New Preoperative Prognostic Model for Solitary Hepatocellular Carcinoma Incorporating 18F-FDG-PET Imaging with the ALBI Grade
Authors
Tomoaki Yoh, MD
Satoru Seo, MD, PhD
Satoshi Ogiso, MD, PhD
Takayuki Kawai, MD, PhD
Yukihiro Okuda, MD, PhD
Takamichi Ishii, MD, PhD
Kojiro Taura, MD, PhD
Tatsuya Higashi, MD, PhD
Yuji Nakamoto, MD, PhD
Etsuro Hatano, MD, PhD
Toshimi Kaido, MD, PhD
Shinji Uemoto, MD, PhD
Publication date
01-02-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 2/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-017-6262-z

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