The prognostic value of 18F-FDG PET/CT prior to liver transplantation for nonresectable colorectal liver metastases

Harald Grut; Svein Dueland; Pål Dag Line; Mona Elisabeth Revheim

doi:10.1007/s00259-017-3843-9

The prognostic value of ¹⁸F-FDG PET/CT prior to liver transplantation for nonresectable colorectal liver metastases

Eur J Nucl Med Mol Imaging. 2018 Feb;45(2):218-225. doi: 10.1007/s00259-017-3843-9. Epub 2017 Oct 12.

Authors

Harald Grut^{1

2}, Svein Dueland³, Pål Dag Line^{4

5}, Mona Elisabeth Revheim^{6

4}

Affiliations

¹ Division of Radiology and Nuclear Medicine, Oslo University Hospital, P.o.box 4950, Nydalen, 0424, Oslo, Norway. harald.grut@gmail.com.
² Institute of Clinical Medicine, University of Oslo, Oslo, Norway. harald.grut@gmail.com.
³ Division of Oncology, Oslo University Hospital, Oslo, Norway.
⁴ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁵ Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.
⁶ Division of Radiology and Nuclear Medicine, Oslo University Hospital, P.o.box 4950, Nydalen, 0424, Oslo, Norway.

PMID: 29026950
DOI: 10.1007/s00259-017-3843-9

Abstract

Purpose: The main objective of this study was to evaluate the prognostic value of volumetric and metabolic information derivied from F-18 fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET) in combination with computed tomography (CT) prior to liver transplantation (LT) in patients with nonresectable colorectal liver metastases (CLM). Due to scarcity of liver grafts, prognostic information enabling selection of candidates who will gain the highest survival after LT is of vital importance. ¹⁸F-FDG PET/CT was a part of the preoperative study protocol. Patients without evidence of extrahepatic malignant disease on ¹⁸F-FDG PET/CT who also fulfilled all the other inclusion criteria underwent LT.

Methods: The preoperative ¹⁸F-FDG PET/CT examinations of all patients included in the SECA (secondary cancer) study were retrospectively assessed. Maximum, mean and peak standardized uptake values (SUV_max, SUV_mean and SUV_peak), tumor to background (T/B) ratio, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were measured and calculated for all liver metastases. Total MTV and TLG were calculated for each patient. Cut-off values were determined for each of these parameters by using receiver operating characteristic (ROC) analysis dividing the patients into two groups. One, three and five-year overall survival (OS) and disease free survival (DFS) for patients over and under the cut-off value were compared by using the Kaplan-Meier method and log rank test.

Results: Twenty-three patients underwent LT in the SECA study. Total MTV and TLG under the cut-off values were significantly correlated to improved OS at three and five years (p = 0.027 and 0.026) and DFS (p = 0.01). One, three and five-year OS and DFS were not significantly related to SUV_max, SUV_mean, SUV_peak or T/B-ratio.

Conclusion: Total MTV and TLG from ¹⁸F FDG PET/CT prior to LT for nonresectable CLM were significantly correlated to improved three and five-year OS and DFS and can potentially improve the patient selection for LT.

Keywords: 18F-FDG PET/CT; Colorectal cancer; Liver metastases; Liver transplantation.

MeSH terms

Adult
Colorectal Neoplasms / pathology*
Female
Fluorodeoxyglucose F18*
Humans
Liver Neoplasms / diagnostic imaging*
Liver Neoplasms / metabolism*
Liver Neoplasms / surgery
Liver Transplantation*
Male
Middle Aged
Patient Selection
Positron Emission Tomography Computed Tomography*
Retrospective Studies

Substances

Fluorodeoxyglucose F18