1. The SUV on 18F-FDG-PET/CT imaging as an independent predictor for overall survival and disease free survival after hepatectomy of Hepatocellular carcinoma（ ≤5cm）
Xu-Guang Hu, Sung yeon Hong，Ingyu Kim, Mao wei, Bong-Wan Kim,
Hee-Jung Wang
Department of Hepatobiliary Surgery and Liver Transplantation,
Ajou University School of Medicine, Suwon, Korea

2. Background & AIM:
18F-Fluoro-deoxyglucose (FDG) PET/CT can be used to monitor the biological behavior and predicts clinical outcome in patients with HCC.
To evaluate whether SUV could predict the risk of recurrence and death
for patients with HCC (≤5) patients after hepatectomy. .

3. 478 cases underwent surgical treatment 216 HCC cases with hepatectomy
Methods and patients:
Retrospective analysis was performed on a database of HCC patients who
underwent hepatectomy between November 2008 and December 2014.
478 cases underwent surgical treatment
cases Liver transplantation
262
cases More than 5cm
Exclusion
3. 55 cases without preoperative PET
216 HCC cases with hepatectomy

4. Methods and patients : Sensitivity：57.9% Specificty ：86.8%
Specificity：86.8%
Area under the Curve : 0.701
Cutoff value：4.75
P value: 0.004
Area under the Curve : 0.757
Cutoff value：3.75
P value: 0.000

5. Median follow-up time：32.5 months （range，1-83）
Results:
Number at risk ( DFS)
Year 1 3 5
216
169 66 20 %
81.6
64.4
56.3
Number at risk ( OS)
Year 1 3 5
216
195 94 37 %
94.8
90.3
Median follow-up time：32.5 months （range，1-83）

6. Results:
Comparison of clinical and pathological characteristics between the cutoff value of SUV
Variables
SUV<4.75 (n =179)
SUV≥4.75 (n =37)
P value
Male sex
137/179
30/37
0.093
Age (years)
55.6 ± 9.40
55.8 ± 9.23
0.900
Etiology of cirrhosis
HBV
138 29
1.000
HCV 12 4
0.486
Other
0.615
Albumin(g/L)
4.23 ± 0.34
4.19 ± 0.37
0.457
Tbilirubin(mg/dl)
0.80 ± 0.40
0.78 ± 0.35
0.747
AST(U/L)
41.4 ± 28.5
42.0 ± 19.8
0.903
ALT(U/L)
38.9 ± 30.9
37.0 ± 21.5
0.724
ICG R15 (%)
15.8 ± 7.92
15.0 ± 7.72
0.546
AFP (>400ng/ml)
29/179 (16.2%)
14/37 (37.8%)
0.008
Serum gloucose （mg/dl）
± 35.6
± 54.6
0.686
Tumor size(cm)
2.54 ± 0.96
3.51 ± 1.03
0.000
Tumor number (multi)
19/179
6/37
0.395
Vp present
28/178
18/36
Vv present
1/172
2/34
0.071
B present
6/172
5/36
0.025
IM present
17/177
10/36
0.006
McVI present
54/174
25/35
Microscopic resection Margin present
13/179
7/37
0.054
Cirrhosis (grade 4)
109//179
20/37
0.465
ES Grade ( grade 4)
34/168
20/32
0.002
Tumor recurrence
53/179 (29.6%)
19/37 (51.4%)
0.013

7. Results:
Kaplan-Meier survival curve comparing the disease free survival time and overall survival between the cutoff value of SUV
Normal SUV
n=179
Normal SUV
n=179
Elevated SUV n=37
Elevated SUV n=37
Log-rank test, P value=0.000
Log-rank test, P value=0.000
Number at risk ( DFS)
Year 1 3 5
suv<4.75
179
151 58 17 %
87.0
68.0
59.9
Suv≥4.75 37 18 8
54.8
46.3
39.7
Number at risk ( OS)
Year 1 3 5
suv<4.75)
179
169 82 31 %
98.3
94.4
Suv≥4.75) 37 27 12 6
77.5
69.0

8. Results:
Cox proportional hazards model of risk factors for Disease free survival in 216 HCC patients after hepatectomy
Prognostic variables
Univariate
Multivariate
HR (95%CI)
P value
SUV(4.75)
2.569( )
0.000
0.992( )
0.020
Tumor size(3.75cm)
2.226( )
0.002
1.752( )
0.056
AFP (>400ng/ml)
1.190( )
0.534
Vascular invasion
2.074( )
0.004
1.510( )
0.184
IM present
2.511( )
1.659( )
0.134
McVI present
2.102( )
1.317( )
0.384
Microscopic resection Margin present
1.875( )
0.079
ES grade (4)
1.441( )
0.165
Abbreviation: AFP; α- fetoprotein, CI: Confidence intervals, HR: hazard ratio, IM: introhepatic metastasis,
McVI: microvascular invasion, SUV: standardized uptake value.

9. Results:
Cox proportional hazards model of risk factors for Overall survival
in 216 HCC patients after hepatectomy
Prognostic variables
Univariate
Multivariate
HR (95%CI)
P value
SUV(4.75)
8.369( )
0.000
5.048( )
0.003
Tumor size(3.75cm)
6.089( )
4.101( )
0.009
AFP (>400ng/ml)
1.025( )
0.965
Vascular invasion
2.185( )
0.102
IM present
3.273( )
0.024
1.153( )
0.820
McVI present
2.876( )
0.029
1.003( )
0.996
Microscopic resection Margin present
3.923( )
2.875( )
0.081
ES grade (4)
1.947( )
0.198
Abbreviation: AFP; α- fetoprotein, CI: Confidence intervals, HR: hazard ratio, IM: introhepatic metastasis,
McVI: microvascular invasion, SUV: standardized uptake value.

10. Results:
Kaplan-Meier survival curve comparing the disease free survival time and overall survival between the low, moderate and high risk groups 1 1 2 2
Line 0 （low risk）: suv<4.75 and tumor size <3.75
Line 1 （moderate risk）: suv≥ or tumor size ≥ 3.75
Line 2 （high risk）: suv≥4.75 and tumor size ≥3.75

11. Conclusions：
The elevated SUV (≥4.75) on 18F-FDG-PET/CT imaging was an independent and
significant predictor for overall survival and disease free survival for the HCC
patient （≤5 cm）after hepatectomy.
SUV combined tumor size can be used for selecting patients who will be most
benefit from hepatectomy.
Otherwise , whether the patients with high risk factors (suv≥4.75 and tumor size ≥3.75) will be benefit from liver transplantation need further study.

12. Thanks for your kind attention!

13. Recurrence within 24 months
Recurrence beyond 24 months
Elevated SUV Value
TACE （n=12）
(N=19)
RFA（n=4）
RTx（n=2）
Re-resection（n=1）
Recurrent cases
TACE（n=29）
TACE（n=10）
(N=72)
Normal SUV Value
RFA（n=2）
(N=53)
LT（n=2）
RTx（n=4）