Role of pre-transplant 18F-FDG PET/CT in predicting hepatocellular carcinoma recurrence after liver transplantation

Table 1 Morphological criteria used in selection of patients with hepatocellular carcinoma for liver transplantation

Ref.	Year	Size and number
Milan[5]	1996	1 lesion ≤ 5 cm, or 2 to 3 lesions each ≤ 3
University of California San Francisco[6]	2001	1 lesion ≤ 6.5 cm, 2-3 lesions each ≤ 4.5 cm with total tumor diameter ≤ 8 cm
Tokyo University[8]	2008	Up to 5 tumors, each < 5 cm
Asan Medical Center[9]	2008	The largest tumor diameter < 5 cm, tumor number ≤ 6
Alberta[10]	2008	Total tumor volume < 115 cm
Valencia[11]	2008	Up to 3 tumors, each < 5 cm, and a cumulative tumor burden ≤ 10 cm
Up-to-seven[7]	2009	7 as the sum of the size of the largest tumor and total number of tumors

Table 2 The use of biomarkers with expanded morphological criteria

Ref.	Year	No. of patients	Criteria	Overall survival
				Within criteria	Beyond criteria
Kyoto[21]	2007	136	Up to 10 tumors, all ≤ 5 cm; DCP ≤ 400 ng/mL	87% (5-yr)	37% (5-yr)
Kyushu[22]	2007	40	Any number, tumor diameter ≤ 5 cm; DCP < 300 ng/mL	77% (3-yr)	40% (3-yr)
Seoul[23]	2007	140	Any number, tumor diameter ≤ 5 cm; AFP ≤ 400 ng/mL	87% (5-yr)	23% (5-yr)
Hangzhou[24]	2008	195	Total tumor diameter ≤ 8 cm; or total tumor diameter > 8 cm and grade I/II and AFP ≤ 400 ng/mL	71% (5-yr)	19% (5-yr)

Table 3 The criteria used for prediction of biological behavior of hepatocellular carcinoma in the pre-transplant setting

Biomarkers (AFP, DCP)[21-24]

The neutrophil-lymphocyte ratio[27]

Pre-transplant liver biopsy[12]

Response to loco-regional therapy[19]

Test of time (3-mo waiting period)[19,26]

Dynamic evaluation (tumor doubling time and change in AFP)[19]

FDG-PET scan

AFP: Alpha-fetoprotein; DCP: Des-gamma-carboxy prothrombin; FDG-PET: Fluorodeoxyglucose positron emission tomography.

Table 4 The standardized uptake values used to define clinically significant 18F-fluorodeoxyglucose positron emission tomography/computed tomography positivity for hepatocellular carcinoma

Ref.	Year	No. of patients	Study model	SUV values
				SUVmax	TSUVmax-to-LSUVmax	TSUVmax-to-LSUVmean
Lee et al[34]	2009	59	LT	3	1.15	1.35
Song et al[35]	2012	83	LRT	4	1.45	1.9
Lee et al[36]	2015	280	LDLT	4.4
Hsu et al[37]	2016	147	LDLT	4.8		2
Hong et al[38]	2016	123	LDLT		1.1
Boussouar et al[39]	2016	28	LT		1.15
Bailly et al[40]	2016	34	LT		1.15
Lin et al[41]	2017	65	LT	3.8	1.49	1.69

SUV: Standardized uptake values; TSUVmax: Tumor SUVmax; LSUVmax: Normal-liver SUVmax.

Table 5 The use of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in predicting post-transplant hepatocellular carcinoma recurrences

Ref.	Year	Follow-up (mo)	Recurrence		Disease-free survival	Risk of recurrence (95%CI)
			PET/CT (+)	PET/CT (-)
Yang et al[28]	2006	19	13/8	25/3	2-yr, 46.1% vs 85.1%	OR = 7.6 (1.9-28.9)
Kornberg et al[56]	2009	11.5	19/9	36/1	3-yr, 46.9% vs 93.3%	OR = 23.9 (2.1-268.5)
Lee et al[34]	2013	26.1	55/22	136/16	3-yr, 57.1% vs 86.8%	HR = 3.9 (1.1-13.0)
Hsu et al[37]	2016	25.8	30/9	117/9	5-yr, 68.3 vs 84.8%	HR = 13.5 (4.7-38.2)
Kornberg et al[57]	2017	74	41/24	75/5	5-yr, 38.1% vs 93.3%	HR = 22.8 (6.3-83.0)
Ye et al[63]	2017	25.7	78/46	25/7	5-yr, 21.9% vs 76%	HR = 3.6 (1.3-9.6)

PET/CT: Positron emission tomography/computed tomography.