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18F–fluorodeoxyglucose uptake of hepatocellular carcinoma as a prognostic predictor in patients with sorafenib treatment

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Abstract

Purpose

Sorafenib, an oral multikinase inhibitor, is a recommended treatment option available for patients with Barcelona Clinic Liver Cancer (BCLC)-C stage hepatocellular carcinoma (HCC). This study aimed to evaluate the performance of 18F–fluorodeoxyglucose positron emission tomography (18F–FDG PET) for predicting tumour progression during sorafenib treatment.

Methods

We formed a retrospective cohort comprising patients treated with sorafenib for at least 30 days and undergoing 18F–FDG PET/CT within 1 month before treatment. For statistical analyses, the tumour-to-liver standardised uptake value (SUV) ratio (TLR) of the most hypermetabolic lesion was measured.

Results

Among a total of 35 patients, two obtained partial remission, and 11 showed stable disease after the first response evaluation. Patients with a TLR ≥ 2.9 (n = 17) had a median overall survival (OS) of 3.7 months after sorafenib treatment, whereas patients with a TLR < 2.9 (n = 18) had median OS of 12.2 months (P < 0.001), although the disease control rate was not significantly different between the two groups. Pretreatment TLR ≥ 2.9 (hazard ratio [HR] = 6.318, P = 0.002) and Child-Pugh class B (HR = 4.316, P = 0.044) were poor prognostic factors for OS, and a TLR ≥ 2.9 (HR = 2.911, P = 0.024) was the only poor prognostic factor for progression-free survival in a multivariate analysis.

Conclusion

Pretreatment tumour metabolic activity assessed by 18F–FDG PET is an independent prognostic factor for survival in patients with BCLC-C stage HCC receiving sorafenib monotherapy, although it may not predict tumour response to the treatment.

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Acknowledgements

This work was supported by Research Fund of Seoul St. Mary’s Hospital, The Catholic University of Korea. This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (2017R1A2B4010197).

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Author notes

  1. Pil Soo Sung and Hye Lim Park contributed equally to this work.

Authors and Affiliations

  1. Division of Hepatology, Department of Internal Medicine, The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, #505 Banpo-dong, Seocho-gu, Seoul, 06591, South Korea

    Pil Soo Sung, Keungmo Yang, Seawon Hwang, Myeong Jun Song, Jeong Won Jang, Jong Young Choi, Seung Kew Yoon & Si Hyun Bae

  2. Division of Nuclear Medicine, Department of Radiology, College of Medicine, The Catholic University of Korea, #505 Banpo-dong, Seocho-gu, Seoul, 06591, South Korea

    Hye Lim Park & Ie Ryung Yoo

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  1. Pil Soo Sung
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Correspondence to Ie Ryung Yoo or Si Hyun Bae.

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Ethics approval was provided by the Institutional Ethics Review Board of The Catholic University of Korea (KC17RESI0241).

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Sung, P.S., Park, H.L., Yang, K. et al. 18F–fluorodeoxyglucose uptake of hepatocellular carcinoma as a prognostic predictor in patients with sorafenib treatment. Eur J Nucl Med Mol Imaging 45, 384–391 (2018). https://doi.org/10.1007/s00259-017-3871-5

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