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Risk stratification for locally advanced hepatocellular carcinoma using pretreatment alpha‐foetoprotein and 18 F‐fluoro‐2‐deoxyglucose positron emission tomography
Author(s) -
Rhee Woo Joong,
Hwang Sang Hyun,
Byun Hwa Kyung,
Yun Mijin,
Han KwangHyub,
Seong Jinsil
Publication year - 2017
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13297
Subject(s) - medicine , standardized uptake value , hepatocellular carcinoma , nuclear medicine , positron emission tomography , deoxyglucose , gastroenterology
Background & Aims We investigated the significance of 18 F‐fluoro‐2‐deoxyglucose positron emission tomography ( 18 F‐ 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 18 F‐ 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 ( SUV max) groups according to a SUV cut‐off of 4.825 determined via receiver‐operating characteristic analysis. High AFP level (>550 ng/mL) and high SUV max 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 SUV max group, compared to the high SUV max 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 SUV max 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.