F-FDG and F-Fluorocholine PET as Prognostic Biomarkers in Patients with Advanced Hepatocellular Carcinoma Treated with Sorafenib: A Prospective Multicenter Study.

Fiche publication

Date publication

avril 2026

Journal

Journal of nuclear medicine : official publication, Society of Nuclear Medicine

Auteurs

Membres identifiés du Cancéropôle Est :
Dr BERTAUT Aurélie , Pr BRONOWICKI Jean-Pierre , Pr PAPATHANASSIOU Dimitri , Dr VINCENT Julie , Pr COCHET Alexandre , Pr MANFREDI Sylvain

Tous les auteurs :
Cochet A, Besson V, Bertaut A, Fouquier A, Vrigneaud JM, Bronowicki JP, Chevalier E, Heurgue A, Papathanassiou D, Blanc JF, Pinaquy JB, Vincent J, Palard-Novello X, Bourien H, Tabouret-Viaud C, Manfredi S

Lien Pubmed

https://www.ncbi.nlm.nih.gov/pubmed/42061943

Résumé

The aim of this study was to evaluate the clinical significance of studies with dual radiotracers, F-FDG and F-fluorocholine (F-FCH), performed before and after 1 mo of sorafenib therapy, in patients with advanced hepatocellular carcinoma (HCC) for the prediction of 1-y survival. Patients with advanced HCC eligible for sorafenib therapy were recruited in the prospective open-label single-arm multicenter PREMETHEP trial (NCT02847468; 6 recruiting centers). Patients had to undergo F-FDG and F-FCH PET/CT before treatment initiation and 1 mo after to evaluate baseline and residual tumor metabolism. The following parameters were extracted from each scan: the SUV and tumor-to-normal-liver ratio (TNR) (SUV of the tumor divided by SUV of normal liver) for the more significant lesion, and the volumetric parameters of the intrahepatic tumor burden: metabolic tumor volume (MTV), total lesion glycolysis (TLG) for F-FDG, and total lesion choline kinase activity for F-FCH. The tumor metabolic response (change in SUV, TNR, MTV, TLG, and total lesion choline kinase activity) was also calculated. Patients were followed during 1 y after treatment initiation. Cox analysis was performed to determine predictors of death. Optimal thresholds for quantitative parameters were determined using logistic regressions with the Youden index method. Among 61 patients included, 36 were considered for final analysis (all male; median age, 70 y). Twenty-one patients died during follow-up. On univariate analysis, a serum albumin level of less than 36 g/L and parameters reflecting high F-FDG tumor burden at baseline were significantly associated with death (TNR ≥ 1.5 [hazard ratio (HR), 7.6; 95% CI, 2.2-26.5; = 0.001], MTV ≥ 18 cm [HR, 6.3; 95% CI, 2.1-19.3; < 0.001], and TLG ≥ 53 [HR, 12.6; 95% CI, 2.9-55.2; = 0.002]). In contrast, neither of the F-FCH parameters (baseline and follow-up) and clinical data had prognostic significance. On multivariate analysis, an MTV of at least 18 cm on baseline F-FDG PET/CT remained an independent predictor of death (HR, 6.6; 95% CI, 1.7-25.2; < 0.001). Baseline metabolic tumor burden determined with F-FDG PET/CT is a strong prognostic biomarker in patients with advanced HCC receiving sorafenib therapy. F-FCH PET/CT does not provide additional prognostic information.