The role of (18)F-FDG-PET imaging for the selection of liver transplantation candidates among hepatocellular carcinoma patients

Liver Transpl. 2006 Nov;12(11):1655-60. doi: 10.1002/lt.20861.

Abstract

Positron emission tomography (PET) using F-18 fluoro-2-deoxy-d-glucose ((18)F-FDG) is now well established as a noninvasive diagnostic tool for the detection of a variety of malignant tumors. However, in the case of hepatocellular carcinoma (HCC), several investigators have reported controversial conclusions and an inadequate sensitivity for PET (50-55%). Nevertheless, a high positive rate of (18)F-FDG accumulation has been reported in patients with high-grade HCC and in those with markedly elevated alpha-fetoprotein (AFP) levels. Here, we retrospectively reviewed 38 HCC cases that received liver transplantation (LT) at our center between November 2000 and July 2004 and underwent whole-body PET imaging. (18)F-FDG uptake was assessed in the liver, and its prognostic significance was investigated. Of 38 patients enrolled, 13 patients had positive PET scans for a liver tumor. When we analyzed the association between tumor factors and PET+ (greater PET lesion uptake) in the liver, preoperative AFP level and vascular invasion were found to be significantly associated with PET+ (P = 0.003 and P < 0.001, respectively). However, the association between histological grade and PET+ findings did not reach statistical significant difference (P = 0.074). Moreover, the 2-year recurrence-free survival rate of PET- patients was significantly higher than that of PET+ patients (85.1% vs. 46.1%) (P = 0.0005). Of 6 PET+ patients who met the Milan criteria, 4 patients (66.7%) had recurrence, but all 20 PET- patients who met the Milan criteria were recurrence free. Thus, PET imaging could be a good preoperative tool for estimating the post-LT risk of tumor recurrence, because histological grade and vascular invasion cannot be determined preoperatively. Importantly, our results indicate that tumor recurrence can be highly anticipated for PET-imaging-positive HCC patients who satisfy the Milan criteria. We advise that PET+ HCC patients be selected cautiously for LT.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Blood Vessels / pathology
  • Carcinoma, Hepatocellular / blood
  • Carcinoma, Hepatocellular / diagnostic imaging
  • Carcinoma, Hepatocellular / pathology
  • Carcinoma, Hepatocellular / surgery*
  • Female
  • Fluorodeoxyglucose F18*
  • Humans
  • Liver / blood supply
  • Liver / pathology
  • Liver Neoplasms / blood
  • Liver Neoplasms / diagnostic imaging
  • Liver Neoplasms / pathology
  • Liver Neoplasms / surgery*
  • Liver Transplantation*
  • Male
  • Middle Aged
  • Neoplasm Invasiveness
  • Neoplasm Recurrence, Local
  • Patient Selection*
  • Positron-Emission Tomography*
  • Prognosis
  • Radiopharmaceuticals*
  • Retrospective Studies
  • Survival Analysis
  • alpha-Fetoproteins / metabolism

Substances

  • Radiopharmaceuticals
  • alpha-Fetoproteins
  • Fluorodeoxyglucose F18