ORIGINAL ARTICLE   

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

DOI: 10.23736/S1824-4785.22.03485-9

Copyright © 2022 EDIZIONI MINERVA MEDICA

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