Pretreatment Metabolic Parameters Measured by 18F-FDG PET to Predict the Pathological Treatment Response of HCC Patients Treated With PD-1 Inhibitors and Lenvatinib as a Conversion Therapy in BCLC Stage C

Guanyun Wang; Wenwen Zhang; Jiaxin Chen; Xiaohui Luan; Zhanbo Wang; Yanmei Wang; Xiaodan Xu; Shulin Yao; Zhiwei Guan; Jiahe Tian; Shichun Lu; Baixuan Xu; Guangyu Ma

doi:10.3389/fonc.2022.884372

Pretreatment Metabolic Parameters Measured by ¹⁸F-FDG PET to Predict the Pathological Treatment Response of HCC Patients Treated With PD-1 Inhibitors and Lenvatinib as a Conversion Therapy in BCLC Stage C

Front Oncol. 2022 Jun 3:12:884372. doi: 10.3389/fonc.2022.884372. eCollection 2022.

Authors

Guanyun Wang¹, Wenwen Zhang², Jiaxin Chen^{3

4}, Xiaohui Luan^{1

4}, Zhanbo Wang⁵, Yanmei Wang⁶, Xiaodan Xu¹, Shulin Yao¹, Zhiwei Guan¹, Jiahe Tian¹, Shichun Lu², Baixuan Xu¹, Guangyu Ma¹

Affiliations

¹ Department of Nuclear Medicine, The First Medical Centre, Chinese the People's Liberation Army (PLA) General Hospital, Beijing, China.
² Key Laboratory of Digital Hepetobiliary Surgery, Faculty of Hepato-Pancreato-Biliary Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese People's Liberation Army (PLA), Beijing, China.
³ Department of Oncology, The Fifth Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
⁴ Graduate School, Medical School of Chinese People's Liberation Army (PLA), Beijing, China.
⁵ Department of Pathology, The First Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
⁶ General Electric (GE) Healthcare China, Shanghai, China.

Abstract

Objectives: This study aimed to assess the pretreatment ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) as a predictor of the pathological treatment response (PTR) of hepatocellular carcinoma (HCC) patients treated with PD-1 inhibitors and lenvatinib as a conversion therapy in BCLC stage C.

Methods: All patients (n=20) underwent pretreatment ¹⁸F-FDG PET/CT and were treated with conversion therapy and surgery. Patients were categorized into responders (n=9) and non-responders (n=11) according to PTR. The parameters of PET/CT, including lesion size, SUVmean (mean standard uptake value), MTV (metabolic tumor volume), TLG (total lesion glycolysis), SUVpeak (peak standard uptake value), and TLR (tumor-to-normal liver standardized uptake value ratio), were calculated. The diagnostic efficacy was evaluated by receiver operating characteristic analysis (ROC). PTR was compared with pretreatment PET/CT parameters by using Spearman correlation analysis. The patients were followed up.

Results: There was significant difference in TLR (5.59 ± 1.90 vs. 2.84 ± 1.70, respectively; P=0.003) between responders and non-responders, with the largest area under the curve (sensitivity=100%, specificity=72.7%, AUC=0.899, 95%CI: 0.759-1.000, optimal diagnostic threshold of 3.09). The relationship between ¹⁸F-FDG PET/CT parameters and PTR indicated TLR was moderately and positively correlated with pathological treatment response, with correlation coefficients (rs) of 0.69 (P<0.01). During the follow-up, no patients died, and tumor recurrence was found in one of the responders (11.1%). In all 11 non-responders, tumor recurrence was found in six patients (54.5%) and four patients (36.4%) died.

Conclusions: TLR may be a powerful marker to predict PTR of HCC patients with BCLC stage C who were treated with conversion therapy.

Keywords: BCLC stage C; conversion therapy; hepatocellular carcinoma; pathological treatment response; positron emission tomography.