Refining prognosis in patients with hepatocellular carcinoma through incorporation of metabolic imaging biomarkers

Satoshi Takeuchi, Eric M. Rohren, Reham Abdel-Wahab, Lianchun Xiao, Jeffrey S. Morris, Homer A. Macapinlac, Manal M. Hassan, Ahmed O. Kaseb

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Purpose: 18F-fluorodeoxyglucose positron emission tomopraphy/computed tomography (FDGPET/CT) has been proven to be useful for imaging many types of cancer; however, its role is not well defined in hepatocellular carcinoma (HCC). We assessed the prognostic value of metabolic imaging biomarkers as established by baseline pretreatment FDG PET/CT in patients with HCC. Methods: We retrospectively analyzed the records of patients with HCC who underwent FDG PET/CT before initial treatment from May 2013 through May 2014. Four PET/CT parameters were measured: maximum standardized uptake value (SUVmax), total lesion glycolysis (TLG), metabolic tumor volume (MTV), and tumor-to-normal-liver SUV ratio (TNR). Optimal cut-off values for the PET/CT parameters to stratify patients in terms of overall survival (OS) were determined. Multivariate analysis was performed to determine whether the PET/CT parameters could add to the prognostic value of the Cancer of the Liver Italian Program (CLIP) scoring system and the Barcelona-Clinic Liver Cancer (BCLC) staging system. Results: The analysis included 56 patients. Univariate analysis of the association between OS and continuous variables, including the PET/CT parameters SUVmax, TLG, tumor size, total bilirubin level, and alkaline phosphatase level were significant predictors of OS. SUVmax ≥ 11.7, TLG ≥ 1,341, MTV ≥ 230 mL, and TNR ≥ 4.8 were identified as cut-off values. Multivariate analysis revealed that SUVmax ≥ 11.7 and TNR ≥ 4.8 were independent factors predicting a poor prognosis in both the CLIP scoring system and the BCLC staging system, as was TLG in the BCLC staging system. Conclusion: Pretreatment FDG PET/CT in patients with HCC can add to the prognostic value of standard clinical measures. Incorporation of imaging biomarkers derived from FDG PET/CT into HCC staging systems should be considered.

Original languageEnglish (US)
Pages (from-to)969-978
Number of pages10
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Issue number6
StatePublished - Jun 1 2017


  • BCLC staging system
  • CLIP scoring system
  • Hepatocellular carcinoma

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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