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PET (positron emission tomography) is a noninvasive functional imaging technique based on the detection of photons resulting from the annihilation of positrons emitted by a radioactive substance known as radiotracer or radiopharmaceutical. PET equipments usually incorporate a computed tomography scanner (PET/CT) in order to obtain hybrid functional-anatomical images.
Different radiotracers are used to study different physiologic processes, such as blood flow, bone turnover or expression of certain cell receptors. The most common radiotracer used in clinical practice is 2-deoxy-2-[18F]fluoro-d-glucose (2-[18F]FDG), a glucose analogue binded to a radioactive isotope of fluor that informs about glucose metabolism in the body. As cancer cells have high energy requirements (and, therefore, high glucose consumption), this radiotracer is mostly used to evaluate oncologic processes (disease extension, response to treatment, etc.). However, some types of cancer have low 2-[18F]FDG uptake (e.g., well-differentiated or slow-growing neoplasms), and others can have a variable uptake due to the action of certain enzymes in the metabolic route of glucose (e.g., hepatocellular carcinoma).
Variables | SULpeak60 ≥ 2.26 (n = 21) | SULpeak60 < 2.26 (n = 20) | p-Value |
---|---|---|---|
Sex (M/F) | 21/0 | 18/2 | 0.232 |
Age (years), mean (SD) | 60.4 (12.8) | 62.6 (10.4) | 0.547 |
BMI (kg/m2), mean (SD) | 26.6 (4.0) | 27.6 (4.6) | 0.450 |
HCV Ab+, n (%) HCV RNA+, n (%) |
2 (9.5) 0 |
10 (50) 2 (10) |
0.006 1.000 |
HBV S Ag+, n (%) | 7 (33.3) | 0 (0) | 0.009 |
AFP (ng/mL), mean (SD) | 2091.0 (13109.7) | 24 (66.8) | 0.359 |
AFP ≥ 200 ng/mL, n (%) | 3 (14.3) | 1 (5.6) | 0.609 |
Tumor characteristics on cross-sectional imaging | |||
Size of the nodule (mm), mean (SD) | 5.1 (2.6) | 3.2 (1.2) | 0.006 |
Functional preoperative status | |||
ASA classification (I/II/III/IV) | 1/6/14/0 | 0/13/7/0 | 0.053 |
MELD | 7.19 (1.8) | 7.2 (1.2) | 0.985 |
Intra-operative and post-operative variables | |||
Open/laparoscopic | 13/8 | 8/12 | 0.217 |
Major resection, n (%) | 2 (9.5) | 1 (5) | 1.000 |
Anatomical resection, n (%) | 10 (47.6) | 8 (35) | 0.530 |
Pringle maneuver yes/no | 18 (85.7) | 19 (95.0) | 1.000 |
Perioperative transfusion yes/no | 3/18 | 1/19 | 0.606 |
Post-operative complications. Clavien classification (No/I/II/IIIa) | 14/4/1/2 | 14/2/3/1 | 0.577 |
Mortality, n | 0 | 0 | |
Hospitalization time (days), mean (SD) | 6.95 (5.5) | 7.1 (8.0) | 0.982 |
Pathological variables | |||
Fibrosis grade (0 + F1 + F2/F3 + F4) | 11/10 | 8/12 | 0.536 |
Histological type (HCC/hepatocholangiocarcinoma) | 21/0 | 18/2 | 0.232 |
Number of tumors | 1.1 (0.4) | 1.05 (0.2) | 0.174 |
Multiple tumors, n (%) | 4 (19) | 1 (5) | 0.343 |
Tumor size (mm), mean (SD) | 5.2 (2.8) | 3.4 (1.6) | 0.013 |
Tumor size ≥ 30 mm, n (%) | 18 (85.7) | 10 (50) | 0.020 |
Grade of differentiation (G1 + G2/G3 + G4) | 12/9 | 17/3 | 0.085 |
Satellite nodules, n (%) | 3 (14.3) | 1 (5) | 0.606 |
Microvascular invasion, n (%) | 13 (61.9) | 4 (20) | 0.010 |
R1 resection, n (%) | 5 (23.8) | 1 (5.3) | 0.186 |
Variables | TLRpeak60 ≥ 1.20 (n = 20) | TLRpeak60 < 1.20 (n = 21) | p-Value |
---|---|---|---|
Sex (M/F) | 20/0 | 19/2 | 0.488 |
Age (years), mean (SD) | 59.0 (13.5) | 63.8 (8.8) | 0.183 |
BMI (kg/m2), mean (SD) | 26.4 (4.3) | 27.8 (4.3) | 0.327 |
HCV Ab+, n (%) HCV RNA+, n (%) |
3 (15) 0 (0) |
9 (42.9) 2 (22.2) |
0.085 1.000 |
HBV S Ag+, n (%) | 5 (25) | 2 (9.5) | 0.238 |
AFP (ng/mL), mean (SD) | 3046.4 (13,432.9) | 22.6 (64.4) | 0.327 |
AFP ≥ 200 ng/mL, n (%) | 3 (15) | 1 (5.3) | 0.605 |
Tumor characteristics on cross-sectional imaging | |||
Size of the largest nodule (mm), mean (SD) | 5.2 (2.7) | 3.3 (1.2) | 0.008 |
Functional preoperative status | |||
ASA classification (I/II/III/IV) | 1/7/12/0 | 0/12/9/0 | 0.210 |
MELD | 7.6 (0.9) | 6.8 (1.9) | 0.104 |
Intra-operative and post-operative variables | |||
Open/laparoscopic | 11/9 | 10/11 | 0.758 |
Major resection, n (%) | 2 (10) | 1 (4.8) | 0.606 |
Anatomical resection, n (%) | 10 (50) | 7 (33.3) | 0.350 |
Pringle maneuver yes/no | 17/3 | 20/1 | 0.343 |
Perioperative transfusion yes/no | 3/17 | 1/20 | 0.343 |
Post-operative complications. Clavien classification (No/I/II/IIIa) | 14/3/1/2 | 14/3/3/1 | 0.727 |
Mortality, n | 0 | 0 | |
Hospitalization time (days), mean (SD) | 6.9 (5.6) | 7.0 (7.8) | 0.945 |
Pathological variables | |||
Fibrosis grade (0 + F1 + F2/F3 + F4) | 11/9 | 8/13 | 0.354 |
Histological type (HCC/hepatocholangiocarcinoma) | 20/0 | 19/2 | 0.488 |
Number of tumors | 1.2 (0.4) | 1.05 (0.2) | 0.151 |
Multiple tumors, n (%) | 4 (20) | 1 (4.8) | 0.184 |
Tumor size (mm), mean (SD) | 4.9 (2.6) | 3.9 (2.3) | 0.265 |
Tumor size > 30 mm, n (%) | 18 (90) | 10 (47.6) | 0.006 |
Grade of differentiation (G1 + G2/G3 + G4) | 10/10 | 19/2 | 0.006 |
Satellite nodules yes/no | 4/16 | 0/21 | 0.048 |
Microvascular invasion, n (%) | 12 (60) | 5 (23.8) | 0.028 |
R1 resection, n (%) | 5 (25) | 1 (5) | 0.182 |
Variables | Univariate Analysis | ||
---|---|---|---|
HR | 95% CI | p-Value | |
Sex (M/F) | 0.972 | ||
Age ≥ 70 years | 0.255 | ||
BMI ≥ 30 kg/m2 | 0.929 | ||
Diabetes mellitus | 0.282 | ||
HCV Ab+, n (%) HCV RNA+, n (%) |
0.559 0.999 |
||
HBV S Ag+, n (%) | 0.253 | ||
MELD ≥ 9 | 0.168 | ||
AFP (ng/mL) | 0.535 | ||
AFP ≥ 200 ng/mL | 0.337 | ||
Liver stiffness > 14 kPa | 0.140 | ||
Preoperative tumor size | 0.154 | ||
Preoperative tumor size ≥30 mm | 0.469 | ||
TLRpeak60 p50 | 7.50 | 1.87–29.98 | 0.004 |