Composite criteria using clinical and FDG PET/CT factors for predicting recurrence of hepatocellular carcinoma after living donor liver transplantation

Yeon koo Kang, Joon Young Choi, Jin Chul Paeng, Yong il Kim, Hyun Woo Kwon, Gi Jeong Cheon, Kyungsuk Suh, Choon Hyuck David Kwon, Dong Soo Lee, Keon Wook Kang

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objectives: Fluorodeoxyglucose (FDG) PET/CT is effective for predicting recurrence of hepatocellular carcinoma after liver transplantation. This study aimed to design composite criteria for predicting post-transplantation recurrence using clinical and FDG PET/CT factors. Methods: We retrospectively enrolled 239 patients who underwent living donor transplantation in two independent centers between 2005 and 2013. On PET, maximum tumor-to-background ratio (TBRmax) was measured. Significant predictors for recurrence were selected by logistic regression and survival analyses. With varying cutoff values for the selected factors, composite criteria were designed to maximize the predictive performance for recurrence, and tenfold cross-validation was performed. Predictive values were compared between the composite criteria and the conventional recipient selection criteria. Results: Tumor size, number, alpha-fetoprotein, and TBRmax were selected as significant predictors in both logistic regression and multivariate survival analyses. In combination of these factors, the highest diagnostic performance was sensitivity of 75.7% and specificity of 88.5% with cutoff values of tumor size < 6.0 cm, tumor number < 8, alpha-fetoprotein < 465 ng/mL, and TBRmax < 2.8. The composite criteria exhibited the highest performance for predicting recurrence and recurrence-free survival among the tested criteria including conventional ones. Conclusions: The composite criteria adding FDG PET findings to clinical factors are effective in selecting appropriate liver cancer patients who are candidates for liver transplantation. Key Points: • In patients with HCC, tumor uptake on FDG PET/CT, tumor size, number, and serum AFP level are recognized individual predictors for tumor recurrence after LT. • A composite criterion set, combining tumor size, number, serum AFP level, and maximum tumor-to-background ratio (TBRmax), predicts post-LT recurrence most effectively when compared with conventional criteria sets in selecting candidates for living donor LT.

Original languageEnglish
Pages (from-to)6009-6017
Number of pages9
JournalEuropean Radiology
Volume29
Issue number11
DOIs
StatePublished - 1 Nov 2019

Fingerprint

Living Donors
Liver Transplantation
Hepatocellular Carcinoma
Recurrence
Neoplasms
alpha-Fetoproteins
Survival Analysis
Transplantation
Logistic Models
Liver Neoplasms
Serum
Patient Selection
Multivariate Analysis
Regression Analysis
Sensitivity and Specificity
Survival

Keywords

  • Hepatocellular carcinoma
  • Positron emission tomography
  • Recurrence
  • Transplantation

Cite this

@article{74cc47a25cac4ee08891e84c84f62fe2,
title = "Composite criteria using clinical and FDG PET/CT factors for predicting recurrence of hepatocellular carcinoma after living donor liver transplantation",
abstract = "Objectives: Fluorodeoxyglucose (FDG) PET/CT is effective for predicting recurrence of hepatocellular carcinoma after liver transplantation. This study aimed to design composite criteria for predicting post-transplantation recurrence using clinical and FDG PET/CT factors. Methods: We retrospectively enrolled 239 patients who underwent living donor transplantation in two independent centers between 2005 and 2013. On PET, maximum tumor-to-background ratio (TBRmax) was measured. Significant predictors for recurrence were selected by logistic regression and survival analyses. With varying cutoff values for the selected factors, composite criteria were designed to maximize the predictive performance for recurrence, and tenfold cross-validation was performed. Predictive values were compared between the composite criteria and the conventional recipient selection criteria. Results: Tumor size, number, alpha-fetoprotein, and TBRmax were selected as significant predictors in both logistic regression and multivariate survival analyses. In combination of these factors, the highest diagnostic performance was sensitivity of 75.7{\%} and specificity of 88.5{\%} with cutoff values of tumor size < 6.0 cm, tumor number < 8, alpha-fetoprotein < 465 ng/mL, and TBRmax < 2.8. The composite criteria exhibited the highest performance for predicting recurrence and recurrence-free survival among the tested criteria including conventional ones. Conclusions: The composite criteria adding FDG PET findings to clinical factors are effective in selecting appropriate liver cancer patients who are candidates for liver transplantation. Key Points: • In patients with HCC, tumor uptake on FDG PET/CT, tumor size, number, and serum AFP level are recognized individual predictors for tumor recurrence after LT. • A composite criterion set, combining tumor size, number, serum AFP level, and maximum tumor-to-background ratio (TBRmax), predicts post-LT recurrence most effectively when compared with conventional criteria sets in selecting candidates for living donor LT.",
keywords = "Hepatocellular carcinoma, Positron emission tomography, Recurrence, Transplantation",
author = "Kang, {Yeon koo} and Choi, {Joon Young} and Paeng, {Jin Chul} and Kim, {Yong il} and Kwon, {Hyun Woo} and Cheon, {Gi Jeong} and Kyungsuk Suh and Kwon, {Choon Hyuck David} and Lee, {Dong Soo} and Kang, {Keon Wook}",
year = "2019",
month = "11",
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doi = "10.1007/s00330-019-06239-z",
language = "English",
volume = "29",
pages = "6009--6017",
journal = "European radiology",
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number = "11",

}

Composite criteria using clinical and FDG PET/CT factors for predicting recurrence of hepatocellular carcinoma after living donor liver transplantation. / Kang, Yeon koo; Choi, Joon Young; Paeng, Jin Chul; Kim, Yong il; Kwon, Hyun Woo; Cheon, Gi Jeong; Suh, Kyungsuk; Kwon, Choon Hyuck David; Lee, Dong Soo; Kang, Keon Wook.

In: European Radiology, Vol. 29, No. 11, 01.11.2019, p. 6009-6017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Composite criteria using clinical and FDG PET/CT factors for predicting recurrence of hepatocellular carcinoma after living donor liver transplantation

AU - Kang, Yeon koo

AU - Choi, Joon Young

AU - Paeng, Jin Chul

AU - Kim, Yong il

AU - Kwon, Hyun Woo

AU - Cheon, Gi Jeong

AU - Suh, Kyungsuk

AU - Kwon, Choon Hyuck David

AU - Lee, Dong Soo

AU - Kang, Keon Wook

PY - 2019/11/1

Y1 - 2019/11/1

N2 - Objectives: Fluorodeoxyglucose (FDG) PET/CT is effective for predicting recurrence of hepatocellular carcinoma after liver transplantation. This study aimed to design composite criteria for predicting post-transplantation recurrence using clinical and FDG PET/CT factors. Methods: We retrospectively enrolled 239 patients who underwent living donor transplantation in two independent centers between 2005 and 2013. On PET, maximum tumor-to-background ratio (TBRmax) was measured. Significant predictors for recurrence were selected by logistic regression and survival analyses. With varying cutoff values for the selected factors, composite criteria were designed to maximize the predictive performance for recurrence, and tenfold cross-validation was performed. Predictive values were compared between the composite criteria and the conventional recipient selection criteria. Results: Tumor size, number, alpha-fetoprotein, and TBRmax were selected as significant predictors in both logistic regression and multivariate survival analyses. In combination of these factors, the highest diagnostic performance was sensitivity of 75.7% and specificity of 88.5% with cutoff values of tumor size < 6.0 cm, tumor number < 8, alpha-fetoprotein < 465 ng/mL, and TBRmax < 2.8. The composite criteria exhibited the highest performance for predicting recurrence and recurrence-free survival among the tested criteria including conventional ones. Conclusions: The composite criteria adding FDG PET findings to clinical factors are effective in selecting appropriate liver cancer patients who are candidates for liver transplantation. Key Points: • In patients with HCC, tumor uptake on FDG PET/CT, tumor size, number, and serum AFP level are recognized individual predictors for tumor recurrence after LT. • A composite criterion set, combining tumor size, number, serum AFP level, and maximum tumor-to-background ratio (TBRmax), predicts post-LT recurrence most effectively when compared with conventional criteria sets in selecting candidates for living donor LT.

AB - Objectives: Fluorodeoxyglucose (FDG) PET/CT is effective for predicting recurrence of hepatocellular carcinoma after liver transplantation. This study aimed to design composite criteria for predicting post-transplantation recurrence using clinical and FDG PET/CT factors. Methods: We retrospectively enrolled 239 patients who underwent living donor transplantation in two independent centers between 2005 and 2013. On PET, maximum tumor-to-background ratio (TBRmax) was measured. Significant predictors for recurrence were selected by logistic regression and survival analyses. With varying cutoff values for the selected factors, composite criteria were designed to maximize the predictive performance for recurrence, and tenfold cross-validation was performed. Predictive values were compared between the composite criteria and the conventional recipient selection criteria. Results: Tumor size, number, alpha-fetoprotein, and TBRmax were selected as significant predictors in both logistic regression and multivariate survival analyses. In combination of these factors, the highest diagnostic performance was sensitivity of 75.7% and specificity of 88.5% with cutoff values of tumor size < 6.0 cm, tumor number < 8, alpha-fetoprotein < 465 ng/mL, and TBRmax < 2.8. The composite criteria exhibited the highest performance for predicting recurrence and recurrence-free survival among the tested criteria including conventional ones. Conclusions: The composite criteria adding FDG PET findings to clinical factors are effective in selecting appropriate liver cancer patients who are candidates for liver transplantation. Key Points: • In patients with HCC, tumor uptake on FDG PET/CT, tumor size, number, and serum AFP level are recognized individual predictors for tumor recurrence after LT. • A composite criterion set, combining tumor size, number, serum AFP level, and maximum tumor-to-background ratio (TBRmax), predicts post-LT recurrence most effectively when compared with conventional criteria sets in selecting candidates for living donor LT.

KW - Hepatocellular carcinoma

KW - Positron emission tomography

KW - Recurrence

KW - Transplantation

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U2 - 10.1007/s00330-019-06239-z

DO - 10.1007/s00330-019-06239-z

M3 - Article

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