18F-FDG-Uptake of Hepatocellular Carcinoma on PET Predicts Microvascular Tumor Invasion in Liver Transplant Patients |
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| Authors: | A. Kornberg ,M. Freesmeyer,E. Bä rthel,K. Jandt,K. Katenkamp,J. Steenbeck,A. Sappler,O. Habrecht, D. Gottschild |
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| Affiliation: | Department of General, Visceral and Vascular Surgery;Department of Nuclear Medicine;Institute of Pathology, Friedrich-Schiller-University, Jena, Germany |
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| Abstract: | Vascular invasion of hepatocellular carcinoma (HCC) is a major risk factor for poor outcome after liver transplantation (LT). The aim of this retrospective analysis was to assess the value of preoperative positron emission tomography (PET) using 18F-fluorodeoxyglucose (18F-FDG) in liver transplant candidates with HCC for predicting microvascular tumor invasion (MVI) and posttransplant tumor recurrence.
Forty-two patients underwent LT for HCC after PET evaluation. Sixteen patients had an increased 18F-FDG tumor uptake on preoperative PET scans (PET +), while 26 recipients revealed negative PET findings (PET−) pre-LT. PET− recipients demonstrated a significantly better 3-year recurrence-free survival (93%) than PET + patients (35%, p < 0.001). HCC recurrence rate was 50% in the PET + group, and 3.8% in the PET—population (p < 0.001). PET + status was identified as independent predictor of MVI [hazard ratio: 13.4]. Patients with advanced PET negative tumors and patients with HCC meeting the Milan criteria had a comparable 3-year-recurrence-free survival (80% vs. 94%, p = 0.6).
Increased 18F-FDG uptake on PET is predictive for MVI and tumor recurrence after LT for HCC. Its application may identify eligible liver transplant candidates with tumors beyond the Milan criteria. |
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| Keywords: | Hepatocellular carcinoma liver transplantation microvascular invasion Milan criteria positron emission tomography tumor biology |
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