The influence of 18F-fluorodeoxyglucose positron emission tomography/computed tomography on the N- and M-staging and subsequent clinical management of intrahepatic cholangiocarcinoma

Youpei Lin; Huanhuan Chong; Guohe Song; Chenhao Zhang; Liangqing Dong; Ling Aye; Fei Liang; Shuaixi Yang; Mengsu Zeng; Guangyu Ding; Shu Zhang; Jieyi Shi; Aiwu Ke; Xiaoying Wang; Jian Zhou; Jia Fan; Qiang Gao

doi:10.21037/hbsn-21-25

The influence of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography on the N- and M-staging and subsequent clinical management of intrahepatic cholangiocarcinoma

Hepatobiliary Surg Nutr. 2022 Oct;11(5):684-695. doi: 10.21037/hbsn-21-25.

Authors

Youpei Lin^#¹, Huanhuan Chong^#², Guohe Song^#¹, Chenhao Zhang¹, Liangqing Dong¹, Ling Aye¹, Fei Liang³, Shuaixi Yang¹, Mengsu Zeng², Guangyu Ding¹, Shu Zhang¹, Jieyi Shi¹, Aiwu Ke¹, Xiaoying Wang¹, Jian Zhou^{1

4}, Jia Fan^{1

4}, Qiang Gao^{1

4}

Affiliations

¹ Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, China.
² Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
³ Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China.
⁴ Key Laboratory of Medical Epigenetics and Metabolism, Institutes of Biomedical Sciences, Fudan University, Shanghai, China.

^# Contributed equally.

Abstract

Background: Intrahepatic cholangiocarcinoma (ICC) is a highly metastatic cancer. ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) enables sensitive tumor and metastasis detection. Our aim is to evaluate the influence of pre-treatment PET/CT on the N- and M-staging and subsequent clinical management in ICC patients.

Methods: Between August 2010 and August 2018, 660 consecutive ICC patients, without prior anti-tumor treatments nor other malignancies, were enrolled. The diagnostic performance of PET/CT on the N- and M-staging was compared with conventional imaging, and the preoperative staging accuracy and treatment re-allocation by PET/CT were retrospectively calculated. Survival difference was compared between patients receiving PET/CT or not after propensity score matching.

Results: Patients were divided into group A (n=291) and group B (n=369) according to whether PET/CT was performed. Among 291 patients with both PET/CT and conventional imaging for staging in group A, PET/CT showed significantly higher sensitivity (83.0% vs. 70.5%, P=0.001), specificity (88.3% vs. 74.9%, P<0.001) and accuracy (86.3% vs. 73.2%, P<0.001) than conventional imaging in diagnosing regional lymph node metastasis, as well as higher sensitivity (87.8% vs. 67.6%, P<0.001) and accuracy (93.5% vs. 89.3%, P=0.023) in diagnosing distant metastasis. Overall, PET/CT improved the accuracy of preoperative staging from 60.1% to 71.8% (P<0.001), and modified clinical treatment strategy in 5.8% (17/291) of ICC patients, with unique roles in different tumor-node-metastasis (TNM) stages. High tumor-to-non-tumor ratio (TNR) predicted poor overall survival [hazard ratio (HR) = 2.17; 95% confidence interval (CI): 1.49-3.15; P<0.001]. Furthermore, patients performing PET/CT had longer overall survival compared with those without PET/CT (HR =0.74; 95% CI: 0.58-0.93; P=0.011) after propensity score matching.

Conclusions: PET/CT was valuable for diagnosing regional lymph node metastasis and distant metastasis in ICC patients, and facilitated accurate tumor staging and optimal treatment allocation.

Keywords: Intrahepatic cholangiocarcinoma (ICC); clinical management; positron emission tomography/computed tomography (PET/CT); staging.