Prognostic value of pre-treatment F-18-FDG PET-CT in patients with hepatocellular carcinoma undergoing radioembolization

Table 1 Patient, tumor, and treatment characteristics patients treated (n = 34)

		n (%)
FDG avidity	Yes	19 (56)
	No	15 (44)
ECOG-PS1	0	17 (50)
	1	14 (41)
	≥ 2	3 (9)
Gender	Female	9 (27)
	Male	25 (74)
Grade	G1	18 (53)
	G2	6 (18)
	G3	1 (3)
	Unknown	9 (27)
Presence of cirrhosis		20 (59)
Causes of cirrhosis (n = 20)	Viral hepatitis	12 (60)
	Hepatitis B	2 (10)
	Hepatitis C	10 (50)
	Alcohol	4 (20)
	NASH2	4 (20)
Prior treatment		15 (44)
Child pugh class	A	31 (91)
	B	3 (9)
BCLC stage3	A	4 (12)
	B	10 (29)
	C	19 (56)
	D	1 (3)
Tumor burden4	≤ 50%	29 (85)
	> 50%	5 (15)
Portal vein thrombosis		5 (15)
Extrahepatic disease		3 (9)
		Median (Range)
Age		68 (46-84)
PET SUVmax		4 (2-20)
Initial AFP		14 (1-186000)
Volume treated (mL)		1146 (191-2340)
Dose delivered (Gy)		126.6 (110.5-478.6)
Follow up (mo)		12 (1-63)

¹Eastern Cooperative Oncology Group Performance Status;

²Nonalcoholic Steatohepatitis;

³Barcelona Clinic Liver Cancer Staging classification;

⁴Proportional volumes of disease to whole liver based on volumetric imaging. AFP: Alpha feto protein.

Table 2 Predictive factors associated with FDG avidity

		Non-avid patients	PET-avid patients	UVA
		n (%)	n (%)	P value
ECOG-PS1	0	9 (60)	8 (40)	0.58
	1	5 (33)	9 (47)
	≥ 2	1 (7)	2 (11)
Gender	Female	1 (7)	8 (42)	0.0474
	Male	14 (93)	11 (58)
Pathology-differentiation	Well	10 (67)	8 (42)	0.311
	Moderate	1 (7)	5 (26)
	Poor	0 (0)	1 (5)
	Unknown	4 (27)	5 (26)
BCLC stage2	A	3 (20)	1 (5)	0.123
	B	6 (40)	4 (21)
	C+	6 (40)	14 (74)
Tumor burden	≤ 50%	14 (93)	15 (79)	0.3554
	> 50%	1 (7)	4 (21)
Portal vein thrombosis	No	14 (93)	15 (79)	0.24
	Yes	5 (33)	10 (53)
Extrahepatic disease	No	14 (93)	17 (90)	1.004
	Yes	1 (7)	2 (11)
Prior treatment	No	9 (60)	10 (53)	0.67
	Yes	6 (40)	9 (47)
Child-Pugh-class	A	14 (93)	17 (90)	1.004
	B	1 (7)	2 (11)
Viral hepatitis	No	8 (53)	14 (74)	0.22
	Yes	7 (47)	5 (26)
Cirrhosis	No	14 (93)	16 (84)	0.41
	Yes	10 (67)	10 (53)
		Median (Range)	Median (Range)
Age		59 (46-84)	71 (57-84)	0.10
PET SUV3		2(2-2)	6(3-20)	-
Initial AFP		12 (1-478)	16 (2-186000)	0.23
Volume treated (mL)		1260 (400-2044)	1091 (191-2340)	0.39
Dose delivered (Gy)		125.9 (111.1-478.6)	128.5 (110.5-467.5)	0.66

¹Eastern Cooperative Oncology Group Performance Status;

²Barcelona Clinic Liver Cancer Staging classification;

³Standardized uptake value;

⁴Fisher’s exact test used. AFP: Alpha feto protein.

Table 3 Univariate and multivariate analysis

Variables1	LLC (n = 38)			DLC (n = 34)			DM (n = 31)			PFS (n = 34)			OS (n = 34)
	UVA (P)	MVA (P)	HR (95%CI)	UVA (P)	MVA (P)	HR (95%CI)	UVA (P)	MVA (P)	HR (95%CI)	UVA (P)	MVA (P)	HR (95%CI)	UVA (P)	MVA (P)	HR (95%CI)
FDG Avidity (avid vs non-avid)	0.003	0.002	6.3 (2.0-20.4)	0.003	0.015	57.7 (2.2-1496.9)	< 0.001	NS		0.015	0.008	4.04 (1.4-11.3)	0.893	-
ECOG (0 vs 1 vs≥ 2)	0.120	-		0.038	NS		0.990	-		0.049	NS		0.002	NS
Gender (female vs male)	0.100	NS		0.398	-		0.596	-		0.100	NS		0.122	-
Pathology (grade 1 vs 2 vs 3 vs unknown)	0.059	NS		0.034	NS		0.048	NS		0.016	NS		0.688	-
Extrahepatic disease	< 0.001	< 0.001	38.9 (6.6-229.2)	< 0.001	NS		-	-		< 0.001	< 0.001	47 (7.7-286)	< 0.001	NS
Tumor Burden ( ≤ 50% vs > 50%)	< 0.001	NS		0.009	NS		0.990	-		0.012	NS		0.004	NS
Cirrhosis	0.477	-		0.588	-		0.732	-		0.593	-		0.065	NS
Age (yr)	0.405	-		0.405	-		0.238	-		0.232	-		0.100	NS

¹Variables tested but not significant for outcome on univariate analysis (UVA) includes: Portal vein thrombosis, prior treatment, Child-Pugh class (A vs B), viral hepatitis, initial AFP, volume treated and dose delivered. ECOG: Eastern Cooperative Oncology Group Performance Status; LLC: Local liver control; DLC: Distant liver control; DM: Distant metastases; PFS: Progression free survival; OS: Overall survival.