The role of 18F−FDG PET in predicting the pathological response and prognosis to unresectable HCC patients treated with lenvatinib and PD-1 inhibitors as a conversion therapy

Frontiers in Immunology

Immunology

Ruimin Wang¹  Jiajin Liu¹  Baixuan Xu¹  Xiaodan Xu¹  Guangyu Ma¹  Jinming Zhang¹  Xiaohui Luan²  Guanyun Wang³  Zhanbo Wang⁴  Wenwen Zhang⁵  Shichun Lu⁵ 

[1] Department of Nuclear Medicine, The First Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China;Department of Nuclear Medicine, The First Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China;Graduate School, Medical School of Chinese People's Liberation Army (PLA), Beijing, China;Department of Nuclear Medicine, The First Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China;Nuclear Medicine Department, Beijing Friendship Hospital, Capital Medical University, Beijing, China;Department of Pathology, The First Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China;Faculty of Hepato-Pancreato-Biliary Surgery, Chinese People's Liberation Army (PLA) General Hospital/Institute of Hepatobiliary Surgery of Chinese People's Liberation Army/Key Laboratory of Digital Hepetobiliary Surgery, People's Liberation Army, Beijing, China;

关键词: unresectable hepatocellular carcinoma;    conversion therapy;    major pathological response;    prognosis;    F-FDG PET;   

DOI  :  10.3389/fimmu.2023.1151967

 received in 2023-01-27, accepted in 2023-04-25,  发布年份 2023

来源: Frontiers

【 摘 要 】

PurposeTo investigate the diagnostic value of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET), as an imaging biomarker, for predicting pathological response and prognosis of unresectable hepatocellular carcinoma (HCC) patients treated with Lenvatinib and programmed cell death protein 1 (PD-1) inhibitors as a conversion therapy.MethodsA total of 28 unresectable HCC patients with BCLC stage B or C were treated with Lenvatinib and PD-1 inhibitors before surgery. The 18F-FDG PET/CT scans were acquired before pre- (scan-1) and post-conversion therapy (scan-2). The maximum standardized uptake value (SUVmax), TLR (tumor-to-normal liver standardized uptake value ratio), and the percentages of post-treatment changes in metabolic parameters (ΔSUVmax [%] and ΔTLR [%]) were calculated. Major pathological response (MPR) was identified based on the residual viable tumor in the resected primary tumor specimen (≤10%). Differences in the progression-free survival (PFS) and overall survival (OS) stratified by ΔTLR were examined by the Kaplan-Meier method.Results11 (11/28, 39.3%) patients were considered as MPR responders and 17 (17/28, 60.7%) patients as non-MPR responders after conversion therapy. ΔSUVmax (-70.0 [-78.8, -48.8] vs. -21.7 [-38.8, 5.7], respectively; P<0.001) and ΔTLR (-67.6 [-78.1, -56.8] vs. -18.6 [-27.9, 4.0], respectively; P<0.001) were reduced in the responder group than those in the non-responder group. According to the results of the receiver operating characteristic curve analysis, ΔTLR showed an excellent predictive value for the MPR of primary HCC lesions (area under curve=0.989, with the optimal diagnostic threshold of -46.15). When using ΔTLR of -21.36% as a threshold, patients with ΔTLR-based metabolic response had superior PFS (log-rank test, P=0.001) and OS (log-rank test, P=0.016) compared with those without ΔTLR-based metabolic response.Conclusion18F-FDG PET is a valuable tool for predicting pathological response and prognosis of unresectable HCC patients treated by Lenvatinib combined with PD-1 as a conversion therapy.

【 授权许可】

Unknown   
Copyright © 2023 Wang, Zhang, Luan, Wang, Liu, Xu, Zhang, Xu, Lu, Wang and Ma