The role of preoperative [18F]fluorodeoxyglucose positron emission tomography in predicting early recurrence after curative resection of hepatocellular carcinomas

Abstract

Purpose 18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) scan reflects tumor differentiationand predicts clinical outcome in patients with hepatocellular carcinoma (HCC). We investigated the correlation of PETscanswith tumor differentiation and early tumor recurrence (time-to-recurrence <1 year).Methods We reviewed the medical records of 93 patients with HCC who underwent curative resection at our hospitalfrom August 2004 through December 2008. PET scans were performed preoperatively, and the maximumstandardized uptake value of the tumor (SUVtumor) and the tumor-to-non-tumor SUV ratio (TNR) were calculatedfrom FDG uptake.Results Twenty-six (27.9%) had recurrences and 12 of them (46.2%) had early recurrences. SUVtumor and TNR correlatedstrongly with tumor differentiation (p<0.001). Early recurrence-free and the overall survival rates in the low TNR group(TNR <2.0) were higher than in the high TNR group (TNR ≥2.0) (p=0.015, p=0.013). According to univariate analysis,predictors of early tumor recurrence were large tumor size (≥5 cm), high TNR (≥2), high SUVtumor (≥4), and highEdmoson–Steiner grade. However, on multivariate analysis, none of the examined factors were statistically significantindependent predictor.Conclusion PET scans reflect tumor differentiation in HCCs. Because high TNR (TNR ≥2) and SUVtumor (SUV ≥4) werethese cutoff point significant predictors in univariate analysis, future studies with more statistical power are needed to assessthe significance.