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 |
Variables | TLRpeak60 ≥ 1.20 (n = 20) | TLRpeak60 < 1.20 (n = 21) | p-Value |
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Variables | Univariate Analysis | ||||||||
---|---|---|---|---|---|---|---|---|---|
HR | 95% CI | p-Value | |||||||
Sex (M/F) | 20/0 | 19/2 | 0.488 | ||||||
Sex (M/F) | 0.972 | ||||||||
Age (years), mean (SD) | 60.4 (12.8) | 62.6 (10.4) | 0.547 | ||||||
Age (years), mean (SD) | |||||||||
Age ≥ 70 years | 59.0 (13.5) | 63.8 (8.8) | 0.183 | 0.255 | BMI (kg/m2), mean (SD) | 26.6 (4.0) | 27.6 (4.6) | ||
BMI (kg/m | 0.450 | ||||||||
2), mean (SD) | 26.4 (4.3) | 27.8 (4.3) | 0.327 | ||||||
BMI ≥ 30 kg/m2 | 0.929 | HCV Ab+, n (%) HCV RNA+, n (%) |
2 (9.5) 0 |
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HCV Ab+, n (%) HCV RNA+, n (%) | 10 (50) | 2 (10) |
0.006 1.000 |
||||||
3 (15) | 0 (0) |
9 (42.9) 2 (22.2) |
0.085 1.000 |
||||||
Diabetes mellitus | HBV S Ag+, n (%) | 7 (33.3) | 0 (0) | 0.009 | |||||
HBV S Ag+, n (%) | 5 (25) | 2 (9.5) | 0.238 | AFP (ng/mL), mean (SD) | 2091.0 (13109.7) | 24 (66.8) | 0.359 | ||
AFP (ng/mL), mean (SD) | 3046.4 (13,432.9) | 22.6 (64.4) | 0.327 | AFP ≥ 200 ng/mL, n (%) | 3 (14.3) | 1 (5.6) | 0.609 | ||
0.282 | |||||||||
HCV Ab+, n (%) HCV RNA+, n (%) |
0.559 0.999 |
||||||||
HBV S Ag+, n (%) | 0.253 | AFP ≥ 200 ng/mL, n (%) | 3 (15) | 1 (5.3) | |||||
MELD ≥ 9 | 0.605 | 0.168 | Tumor characteristics on cross-sectional imaging | ||||||
AFP (ng/mL) | 0.535 | Size of the nodule (mm), mean (SD) | 5.1 (2.6) | 3.2 (1.2) | 0.006 | ||||
Tumor characteristics on cross-sectional imaging | |||||||||
Size of the largest nodule (mm), mean (SD) | 5.2 (2.7) | 3.3 (1.2) | |||||||
AFP ≥ 200 ng/mL | 0.008 | 0.337 | Functional preoperative status | ||||||
Functional preoperative status | |||||||||
Liver stiffness > 14 kPa | 0.140 | ASA classification (I/II/III/IV) | 1/6/14/0 | 0/13/7/0 | 0.053 | ||||
ASA classification (I/II/III/IV) | 1/7/12/0 | 0/12/9/0 | |||||||
Preoperative tumor size | 0.210 | 0.154 | MELD | 7.19 (1.8) | 7.2 (1.2) | 0.985 | |||
MELD | 7.6 (0.9) | 6.8 (1.9) | 0.104 | Intra-operative and post-operative variables | |||||
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 | |||||||||
Open/laparoscopic | 11/9 | 10/11 | 0.758 | ||||||
Major resection, n (%) | 2 (10) | 1 (4.8) | 0.606 | ||||||
Anatomical resection, n (%) | 10 (50) | ||||||||
Preoperative tumor size ≥30 mm | 0.469 | ||||||||
TLRpeak60 p50 | 7.50 | 1.87–29.98 | 7 (33.3) | 0.35018 (85.7) | 19 (95.0) | 1.000 | |||
0.343 | Perioperative transfusion yes/no | 3/18 | Pathological variables | ||||||
Pringle maneuver yes/no | 17/3 | 20/1 | 1/19 | 0.606 | |||||
0.004 | Perioperative transfusion yes/no | 3/17 | 1/20 | 0.343 | 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) | |||||||
Post-operative complications. Clavien classification (No/I/II/IIIa) | 14/3/1/2 | 14/3/3/1 | 0.727 | ||||||
Mortality, n | 0 | 0 | 0.982 | Fibrosis grade (0 + F1 + F2/F3 + F4) | 11/10 | 8/12 | 0.536 | ||
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) | 21/0 | 18/2 | 0.232 | ||
Histological type (HCC/hepatocholangiocarcinoma) | 20/0 | 19/2 | 0.488 | Number of tumors | 1.1 (0.4) | 1.05 (0.2) | 0.174 | ||
Number of tumors | 1.2 (0.4) | 1.05 (0.2) | 0.151 | Multiple tumors, n (%) | |||||
Multiple tumors, n (%) | 4 (19) | 4 (20)1 (5) | 1 (4.8)0.343 | ||||||
0.184 | Tumor size (mm), mean (SD) | 5.2 (2.8) | 3.4 (1.6) | 0.013 | |||||
Tumor size (mm), mean (SD) | 4.9 (2.6) | 3.9 (2.3) | 0.265 | Tumor size ≥ 30 mm, n (%) | 18 (85.7) | 10 (50) | 0.020 | ||
Tumor size > 30 mm, n (%) | 18 (90) | 10 (47.6) | Grade of differentiation (G1 + G2/G3 + G4) | 12/9 | 17/3 | 0.085 | |||
0.006 | Satellite nodules, n (%) | 3 (14.3) | 1 (5) | 0.606 | |||||
Microvascular invasion, n (%) | 13 (61.9) | 4 (20) | 0.010 | ||||||
Grade of differentiation (G1 + G2/G3 + G4)R1 resection, n (%) | 5 (23.8) | 1 (5.3) | 0.186 |
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 |