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PET/CT Standardized Uptake Value of 11C-choline as a Predictor of Long-Term Survival in Patients Operated for Hepatocellular Carcinoma: A Preliminary Report
Guido Costa*1, Matteo Donadon1, Egesta Lopci2, Anaid Anna Kasangian1, Angela Palmisano1, Andrea Fontana1, Arturo Chiti2, Guido Torzilli1
1Department of Hepatobiliary and General Surgery, Humanitas Research Hospital, Rozzano, Milano, Italy; 2Department of Nuclear Medicine, Humanitas Research Hospital, Rozzano, Milano, Italy
Introduction:
Recent data support the use of 11C-choline PET/CT in patients with hepatocellular carcinoma (HCC) because it may change the treatment planning in up to one fourth of patients evaluated by conventional staging. The aim of this study was to analyze the 5-year survival rate of patients with HCC screened with 11C-choline PET/CT before hepatectomy.
Methods:
From January 2010 to September 2014 all patients resected for HCC and preoperatively screened with 11C-choline PET/CT were reviewed. For each patient we determined tumor number and size, as well as 11C-choline uptake parameters on PET/CT. The endpoint was the overall and disease-free survival analysis following HCC resection.
Results:
Among 158 consecutive patients resected for HCC, 20 patients (13%) were screened with 11C-choline PET/CT. The median tumor number was 1 (range 1-5), while the median tumor size was 7.2 cm (range 2.1-18.5). Of these patients only 5 (25%) had major resections. Overall morbidity was 45%, while the 90-day mortality was nil. After a median follow-up of 24.6 months (range 2.2-71.4) the 5-year overall and disease-free survival rates were 53.7% and 28.6% respectively. Among the different semiquantitative parameters analyzed on 11C-choline PET/CT, only standardized uptake value > 14.1 was found to be associated with worse survival.
Conclusions:
The use of 11C-choline PET/CT improves patient selection and is associated with an excellent 5-year survival rate for patients resected for HCC, now approaching 55%. Further insights are required to validate our findings.
Overall and disease-free Kaplan Meier survival curves. The continuous line represents overall survival while the dotted line represents disease-free survival of the whole series (n=20).
  Overall and disease-free Kaplan Meier survival curves. The continuous line represents overall survival while the dotted line represents disease-free survival of the whole series (n=20).
Disease-free Kaplan Meier survival curve. The blue line represents patients with SUV peak of the tumor below 14.1 (n=10), the green line represents patients with SUV peak of the tumor above 14.1 (n=10). P value: ns.
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