Evidence-Based Medicine
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2015; 21(10): 3049-3054
Published online Mar 14, 2015. doi: 10.3748/wjg.v21.i10.3049
Prognostic value of 18F-FDG PET/CT in liver transplantation for hepatocarcinoma
Olivier Detry, Laurence Govaerts, Arnaud Deroover, Morgan Vandermeulen, Nicolas Meurisse, Serge Malenga, Noella Bletard, Charles Mbendi, Anne Lamproye, Pierre Honoré, Paul Meunier, Jean Delwaide, Roland Hustinx
Olivier Detry, Arnaud Deroover, Morgan Vandermeulen, Nicolas Meurisse, Pierre Honoré, Department of Abdominal Surgery and Transplantation, CHU Liege, B4000 Liege, Belgium
Laurence Govaerts, Roland Hustinx, Department of Nuclear Medicine, CHU Liege, University of Liege, ULg CHU, B4000 Liege, Belgium
Serge Malenga, Paul Meunier, Department of Radiology, CHU Liege, University of Liege, ULg CHU, B4000 Liege, Belgium
Noella Bletard, Department of Pathology, CHU Liege, University of Liege, ULg CHU, B4000 Liege, Belgium
Charles Mbendi, Anne Lamproye, Jean Delwaide, Department of Hepato-Gastroenterology, CHU Liege, University of Liege, ULg CHU, B4000 Liege, Belgium
Author contributions: Detry O wrote the manuscript; Govaerts L and Hustinx R collected the data and analyzed the results; Bletard N reviewed the pathology of the explanted livers; all authors significantly contributed to the conception and design of the study, and to the interpretation of the data; all authors actively reviewed the manuscript, and approved its last version.
Supported by An unrestricted research grant from Astellas Belgium; SM and CM are PhD fellows with grants from the Académie de Recherche et d’Enseignement Supérieur (ARES) of the Wallonia-Brussels Federation.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Olivier Detry, Department of Abdominal Surgery and Transplantation, CHU Liege, Sart Tilman B35, B4000 Liege, Belgium. olivier.detry@transplantation.be
Telephone: +32-3667645 Fax: +32-43667069
Received: June 2, 2014
Peer-review started: June 3, 2014
First decision: July 21, 2014
Revised: August 29, 2014
Accepted: September 29, 2014
Article in press: September 30, 2014
Published online: March 14, 2015
Processing time: 286 Days and 21 Hours
Abstract

AIM: To evaluate the prognostic value of pretreatment FDG positron emission tomography computed tomography (PET-CT) in patients with hepatocarcinoma treated by liver transplantation (LT).

METHODS: The authors retrospectively analyzed the data of 27 patients (mean age 58 ± 9 years) who underwent FDG PET-CT before LT for hepatocarcinoma. Mean follow-up was 26 ± 18 mo. The FDG PET/CT was performed according to a standard clinical protocol: 4 MBqFDG/kg body weight, uptake 60 min, low-dose non-enhanced CT. The authors measured the SUVmax and SUVmean of the tumor and the normal liver. The tumor/liver activity ratios (RSUVmax and RSUVmean) were tested as prognostic factors and compared to the following conventional prognostic factors: MILAN, CLIP, OKUDA, TNM stage, alphafoetoprotein level, portal thrombosis, size of the largest nodule, tumor differentiation, microvascular invasion, underlying cirrhosis and liver function.

RESULTS: Overall and recurrence free survivals were 80.7% and 67.4% at 3 years, and 70.6% and 67.4% at 5 years, respectively. According to a multivariate Cox model, only FDG PET/CT RSUVmax predicted recurrence free survival. Even though the MILAN criteria alone were not predictive, it is worth noting that none of the patients outside the MILAN criteria and with RSUVmax < 1.15 relapsed.

CONCLUSION: FDG PET/CT with an RSUVmax cut-off value of 1.15 is a strong prognostic factor for recurrence and death in patients with HCC treated by LT in this retrospective series. Further prospective studies should test whether this metabolic index should be systematically included in the preoperative assessment.

Keywords: Cancer; Hepatoma; Hepatocellular cancer; Liver transplantation

Core tip: Patients suffering from hepatocarcinoma are selected for liver transplantation (LT) according to the Milan criteria that were established two decades ago. The aggressiveness of the tumor has also a particular importance, but there is still no ideal way of predicting the risk of recurrence according to pretransplant tumor metabolism. This study confirms that FDG positron emission tomography computed tomography with a tumor/liver activity ratios (RSUVmax) cut-off value of 1.15 is a strong prognostic factor for recurrence and death in patients with hepatocellular cancer (HCC) treated by LT. In addition, in this series, none of the patients outside the MILAN criteria with RSUVmax < 1.15 suffered from recurrence in the follow-up. Further prospective studies should test whether this metabolic index should be systematically included in the pretransplant assessment of HCC patients.