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The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2023 September;67(3):206-14

DOI: 10.23736/S1824-4785.22.03485-9


lingua: Inglese

Towards refining the utility of dual (18F-FDG / 18F-Choline) PET/CT for the management of hepatocellular carcinoma: a tertiary center study

Recep Erçin SÖNMEZ 1 , Florent L. BESSON 2, 3, 4, Jerome GHİDAGLIA 2, Maïté LEWIN 5, Lea GOMEZ 2, Chady SALLOUM 1, Gabriella PITTAU 1, Oriana CIACIO 1, Marc Antoine ALLARD 1, 6, Daniel CHERQUI 1, 6, René ADAM 1, 7, Antonio SA CUNHA 1, 6, Daniel AZOULAY 1, Eric VİBERT 1, 6, Nicolas GOLSE 1, 6

1 Department of Hepatobiliary Surgery, Hepato-Biliary Center, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Villejuif, France; 2 Department of Biophysics and Nuclear Medicine-Molecular Imaging, Paris-Saclay University Hospital, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France; 3 Paris-Saclay University, CEA, CNRS, Inserm, BioMaps, Orsay, France; 4 School of Medicine, Paris-Saclay Univrsity, Le Kremlin-Bicêtre, France; 5 Department of Radiology, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France; 6 Department of Pathogenesis and Treatment of Liver Diseases, Paris-Saclay University, INSERM, UMR-S 1193, Paris, France; 7 Research Group Chronotherapy, Cancers and Transplantation, Paris-Saclay University, Paris, France

BACKGROUND: The role of positron emission tomography/computed tomography (PET/CT) in hepatocellular carcinoma (HCC) management is not clearly defined. Our objective was to analyze the utility of dual-PET/CT (18F-FDG + 18F-Choline) imaging findings on the BCLC staging and treatment decision for HCC patients.
METHODS: Between January 2011 and April 2019, 168 consecutive HCC patients with available baseline dual-PET/CT imaging data were retrospectively analyzed. To identify potential refinement criteria for surgically-treated patients, survival Kaplan-Meier curves of various standard-of-care and dual-PET/CT baseline parameters were estimated. Finally, multivariate cox proportional hazard ratios of the most relevant clinico-biological and/or PET parameters were estimated.
RESULTS: Dual-PET/CT findings increased the score of BCLC staging in 21 (12.5%) cases. In 24.4% (N.=41) of patients, the treatment strategy was modified by the PET findings. Combining AFP levels at a threshold of 10 ng/mL with 18F-FDG or 18F-Choline N status significantly impacted DFS (P<0.05). In particular, the combined criteria of the N+ status assessed by 18F-Choline with AFP threshold of 10 ng/mL provided a highly predictive composite parameter for estimation of DFS according to multivariate analysis (HR=10.6, P<0.05).
CONCLUSIONS: The 18F-Choline / AFP composite parameter appears promising, and further prospective studies are mandatory to validate its oncological impact.

KEY WORDS: Carcinoma, hepatocellular; Fluoromethylcholine; Fluorodeoxyglucose F18; Positron emission tomography computed tomography; Alpha-fetoproteins

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