Prognostic Significance of PET- SUVmax in Patients Undergoing Resection of Hepatocellular Carcinoma >3 cm: A Retrospective Analysis.
Hepatocellular carcinoma (HCC) >3 cm often recurs after resection, indicating a need for better risk stratification. The 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) maximum standardized uptake value (SUVmax) reflects tumor aggressiveness. We evaluated the prognostic significance of preoperative FDG-PET SUVmax in patients with resectable initial HCC >3 cm.
This retrospective analysis included 136 patients who underwent curative resection for HCC >3 cm between 2012 and 2021 with preoperative FDG-PET imaging. Patients were classified into low- and high-uptake groups based on tumor SUVmax. Associations between FDG-PET findings and clinicopathological factors were analyzed.
Patients with high SUVmax had significantly worse overall survival than those with low SUVmax (49.2% vs. 90.0%, p<0.0001). Multivariate analysis identified high SUVmax as an independent predictor of poor overall survival (hazard ratio=3.16, 95% confidence interval=1.42-7.03, p=0.0048). Furthermore, recurrence-free survival was significantly worse in the high SUVmax group (33.4% vs. 60.4%, p=0.0006). High SUVmax was strongly associated with microscopic vascular invasion (MVI). Combining SUVmax with alpha-fetoprotein improved preoperative prediction of MVI.
Preoperative FDG-PET SUVmax is an independent prognostic biomarker in HCC >3 cm and, when combined with serum alpha-fetoprotein, may enhance prediction of MVI. These findings support incorporating metabolic imaging into preoperative risk models to guide management.
This retrospective analysis included 136 patients who underwent curative resection for HCC >3 cm between 2012 and 2021 with preoperative FDG-PET imaging. Patients were classified into low- and high-uptake groups based on tumor SUVmax. Associations between FDG-PET findings and clinicopathological factors were analyzed.
Patients with high SUVmax had significantly worse overall survival than those with low SUVmax (49.2% vs. 90.0%, p<0.0001). Multivariate analysis identified high SUVmax as an independent predictor of poor overall survival (hazard ratio=3.16, 95% confidence interval=1.42-7.03, p=0.0048). Furthermore, recurrence-free survival was significantly worse in the high SUVmax group (33.4% vs. 60.4%, p=0.0006). High SUVmax was strongly associated with microscopic vascular invasion (MVI). Combining SUVmax with alpha-fetoprotein improved preoperative prediction of MVI.
Preoperative FDG-PET SUVmax is an independent prognostic biomarker in HCC >3 cm and, when combined with serum alpha-fetoprotein, may enhance prediction of MVI. These findings support incorporating metabolic imaging into preoperative risk models to guide management.
Authors
Ishikawa Ishikawa, Itoh Itoh, Kitamura Kitamura, Iseda Iseda, Yoshiya Yoshiya, Motomura Motomura, Toshima Toshima, Isoda Isoda, Ishigami Ishigami, Yoshizumi Yoshizumi
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