Impact of contrast-enhanced fluorine-¹⁸ fluoro-D-glucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) on outcome in patients with hepatocellular carcinoma in cirrhosis after liver transplantation

Background Against the background of organ shortage and restricted allocation criteria, based on tumor load and count, we evaluated the importance of contrast-enhanced fluorine-18 fluoro-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) in patients with hepatocellular carcinoma (HCC) in cirrhosis after liver transplantation (LT).

Methods We analyzed age, sex, pre-transplant α-fetoprotein levels (AFP), Milan stage, pathological findings, Child stage and ¹⁸F‐FDG‐uptake in liver lesions and in the tumor free liver of 103 HCC patients who underwent ¹⁸F‐FDG‐Pet/CT prior to liver transplantation. We calculated the ratio between maximum uptake value of the tumor and the normal liver (SUV ratio). Lesions were called PET positive when SUV ratio was >1.

Results In univariate analysis the distribution of the SUV ratio was statistically significant influenced only by Milan stage and the diameter of the largest lesion.

43 patients (62%) had PET positive tumors. In these tumors the median AFP level was higher (13 vs.8 ng/ml) than in PET negative tumors.

10-year cumulative recurrence rate was lower in patients with a SUV ratio < 2 than in patients with a SUV ratio ≥ 2 (36% vs. 57%; p=0,010). There was also a trend (p=0,073) to different survival in the two groups. In multivariate analysis (COX) with the parameters Milan stage, diameter of the largest lesion, AFP and SUV ratio, the cumulative 10- year recurrence rate was independently influenced only by the number of intrahepatic lesions and the SUV ratio.

Conclusion The ¹⁸F-FDG PET/CT SUV ratio can help to characterize patients with a high risk for tumor recurrence after LT.

Publication History

Article published online:
07 September 2021