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Risk stratification for locally advanced hepatocellular carcinoma using pretreatment alpha-foetoprotein and 18F-fluoro-2-deoxyglucose positron emission tomography

 Woo Joong Rhee  ;  Sang Hyun Hwang  ;  Hwa Kyung Byun  ;  Mijin Yun  ;  Kwang-Hyub Han  ;  Jinsil Seong 
 Liver International, Vol.37(4) : 592-599, 2017 
Journal Title
 Liver International 
Issue Date
alpha‐foetoprotein ; FDG‐PET ; hepatocellular carcinoma ; survival ; tumour aggressiveness
Background & Aims : We investigated the significance of 18F-fluoro-2-deoxyglucose positron emission tomography (18F-FDG PET) parameters and alpha-foetoprotein (AFP) levels in patients with locally advanced hepatocellular carcinoma (LA-HCC). Methods : We retrospectively analysed data of 228 patients with LA-HCC who underwent pretreatment 18F-FDG PET between January 2003 and December 2013. All patients were treated using liver-directed therapy involving radiotherapy. The maximum standardized uptake values (SUVs) and tumour-to-extratumoural liver SUV ratios were calculated, and pretreatment AFP values were obtained. Results : Patients were divided into high and low maximum SUV (SUVmax) groups according to a SUV cut-off of 4.825 determined via receiver-operating characteristic analysis. High AFP level (>550 ng/mL) and high SUVmax were significant predictors of overall and progression-free survival. Better treatment responses and longer median progression-free and overall survival were observed in the low SUVmax group, compared to the high SUVmax group. Similar results were obtained for SUV ratio-based (cut-off value: 2.355) and AFP-based analyses (cut-off value: 550 ng/mL). Three risk groups were identified using the double biomarkers of SUVmax and AFP value as strong prognosticators predictive of survival outcomes. This risk stratification was identified as a prognosticator of survival outcomes, even after subgroup analyses. Furthermore, in high risk group, significantly high extrahepatic failure was shown while in low risk group, significantly low intrahepatic failure. Conclusions : Clinical significance of double biomarkers, SUV and AFP, could be translated into risk stratification for LA-HCC. It could be a valuable tool for survival outcome prediction.
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Nuclear Medicine (핵의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
변화경(Byun, Hwa Kyung) ORCID logo https://orcid.org/0000-0002-8964-6275
성진실(Seong, Jin Sil) ORCID logo https://orcid.org/0000-0003-1794-5951
윤미진(Yun, Mi Jin) ORCID logo https://orcid.org/0000-0002-1712-163X
한광협(Han, Kwang-Hyub) ORCID logo https://orcid.org/0000-0003-3960-6539
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