Preoperative FDG-PET predicts recurrence patterns in hepatocellular carcinoma

Area of Science:

• Hepatobiliary Surgery
• Oncology Imaging
• Nuclear Medicine

Background:

• Hepatocellular carcinoma (HCC) recurrence after liver resection remains a clinical challenge.
• Accurate prediction of recurrence patterns is crucial for selecting appropriate surgical candidates.
• Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) is an imaging modality with potential in oncological prognostication.

Purpose of the Study:

• To evaluate the utility of preoperative FDG-PET in predicting recurrence patterns in HCC patients.
• To determine if FDG-PET can aid in selecting patients for liver resection.
• To assess FDG-PET's role in stratifying recurrence risk and timing.

Main Methods:

• Sixty-three HCC patients undergoing preoperative FDG-PET were analyzed.
• Patients were categorized by recurrence patterns (within/beyond Milan Criteria, no recurrence) and recurrence intervals (within 1 year, after 1 year, no recurrence).
• Tumor-to-nontumor ratio (TNR) from FDG-PET was correlated with recurrence patterns and timing.

Main Results:

• Lower TNR values were observed in patients with recurrence within Milan Criteria and no recurrence compared to those beyond Milan Criteria.
• TNR was an independent predictor of recurrence patterns in multivariate analysis.
• TNR was significantly lower in patients with late recurrence (after 1 year) or no recurrence, and higher in those with early recurrence (within 1 year), also proving to be an independent predictor.

Conclusions:

• Preoperative FDG-PET, specifically TNR, can predict HCC recurrence within Milan Criteria or no recurrence.
• FDG-PET also predicts recurrence occurring after 1 year or later.
• FDG-PET shows promise as a tool for selecting optimal candidates for liver resection in HCC management.