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The role of (18)F−FDG PET in predicting the pathological response and prognosis to unresectable HCC patients treated with lenvatinib and PD-1 inhibitors as a conversion therapy

PURPOSE: To investigate the diagnostic value of (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET), as an imaging biomarker, for predicting pathological response and prognosis of unresectable hepatocellular carcinoma (HCC) patients treated with Lenvatinib and programmed cell death...

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Autores principales: Wang, Guanyun, Zhang, Wenwen, Luan, Xiaohui, Wang, Zhanbo, Liu, Jiajin, Xu, Xiaodan, Zhang, Jinming, Xu, Baixuan, Lu, Shichun, Wang, Ruimin, Ma, Guangyu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10196479/
https://www.ncbi.nlm.nih.gov/pubmed/37215117
http://dx.doi.org/10.3389/fimmu.2023.1151967
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author Wang, Guanyun
Zhang, Wenwen
Luan, Xiaohui
Wang, Zhanbo
Liu, Jiajin
Xu, Xiaodan
Zhang, Jinming
Xu, Baixuan
Lu, Shichun
Wang, Ruimin
Ma, Guangyu
author_facet Wang, Guanyun
Zhang, Wenwen
Luan, Xiaohui
Wang, Zhanbo
Liu, Jiajin
Xu, Xiaodan
Zhang, Jinming
Xu, Baixuan
Lu, Shichun
Wang, Ruimin
Ma, Guangyu
author_sort Wang, Guanyun
collection PubMed
description PURPOSE: To investigate the diagnostic value of (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET), as an imaging biomarker, for predicting pathological response and prognosis of unresectable hepatocellular carcinoma (HCC) patients treated with Lenvatinib and programmed cell death protein 1 (PD-1) inhibitors as a conversion therapy. METHODS: A total of 28 unresectable HCC patients with BCLC stage B or C were treated with Lenvatinib and PD-1 inhibitors before surgery. The (18)F-FDG PET/CT scans were acquired before pre- (scan-1) and post-conversion therapy (scan-2). The maximum standardized uptake value (SUVmax), TLR (tumor-to-normal liver standardized uptake value ratio), and the percentages of post-treatment changes in metabolic parameters (ΔSUVmax [%] and ΔTLR [%]) were calculated. Major pathological response (MPR) was identified based on the residual viable tumor in the resected primary tumor specimen (≤10%). Differences in the progression-free survival (PFS) and overall survival (OS) stratified by ΔTLR were examined by the Kaplan-Meier method. RESULTS: 11 (11/28, 39.3%) patients were considered as MPR responders and 17 (17/28, 60.7%) patients as non-MPR responders after conversion therapy. ΔSUVmax (-70.0 [-78.8, -48.8] vs. -21.7 [-38.8, 5.7], respectively; P<0.001) and ΔTLR (-67.6 [-78.1, -56.8] vs. -18.6 [-27.9, 4.0], respectively; P<0.001) were reduced in the responder group than those in the non-responder group. According to the results of the receiver operating characteristic curve analysis, ΔTLR showed an excellent predictive value for the MPR of primary HCC lesions (area under curve=0.989, with the optimal diagnostic threshold of -46.15). When using ΔTLR of -21.36% as a threshold, patients with ΔTLR-based metabolic response had superior PFS (log-rank test, P=0.001) and OS (log-rank test, P=0.016) compared with those without ΔTLR-based metabolic response. CONCLUSION: (18)F-FDG PET is a valuable tool for predicting pathological response and prognosis of unresectable HCC patients treated by Lenvatinib combined with PD-1 as a conversion therapy.
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spelling pubmed-101964792023-05-20 The role of (18)F−FDG PET in predicting the pathological response and prognosis to unresectable HCC patients treated with lenvatinib and PD-1 inhibitors as a conversion therapy Wang, Guanyun Zhang, Wenwen Luan, Xiaohui Wang, Zhanbo Liu, Jiajin Xu, Xiaodan Zhang, Jinming Xu, Baixuan Lu, Shichun Wang, Ruimin Ma, Guangyu Front Immunol Immunology PURPOSE: To investigate the diagnostic value of (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET), as an imaging biomarker, for predicting pathological response and prognosis of unresectable hepatocellular carcinoma (HCC) patients treated with Lenvatinib and programmed cell death protein 1 (PD-1) inhibitors as a conversion therapy. METHODS: A total of 28 unresectable HCC patients with BCLC stage B or C were treated with Lenvatinib and PD-1 inhibitors before surgery. The (18)F-FDG PET/CT scans were acquired before pre- (scan-1) and post-conversion therapy (scan-2). The maximum standardized uptake value (SUVmax), TLR (tumor-to-normal liver standardized uptake value ratio), and the percentages of post-treatment changes in metabolic parameters (ΔSUVmax [%] and ΔTLR [%]) were calculated. Major pathological response (MPR) was identified based on the residual viable tumor in the resected primary tumor specimen (≤10%). Differences in the progression-free survival (PFS) and overall survival (OS) stratified by ΔTLR were examined by the Kaplan-Meier method. RESULTS: 11 (11/28, 39.3%) patients were considered as MPR responders and 17 (17/28, 60.7%) patients as non-MPR responders after conversion therapy. ΔSUVmax (-70.0 [-78.8, -48.8] vs. -21.7 [-38.8, 5.7], respectively; P<0.001) and ΔTLR (-67.6 [-78.1, -56.8] vs. -18.6 [-27.9, 4.0], respectively; P<0.001) were reduced in the responder group than those in the non-responder group. According to the results of the receiver operating characteristic curve analysis, ΔTLR showed an excellent predictive value for the MPR of primary HCC lesions (area under curve=0.989, with the optimal diagnostic threshold of -46.15). When using ΔTLR of -21.36% as a threshold, patients with ΔTLR-based metabolic response had superior PFS (log-rank test, P=0.001) and OS (log-rank test, P=0.016) compared with those without ΔTLR-based metabolic response. CONCLUSION: (18)F-FDG PET is a valuable tool for predicting pathological response and prognosis of unresectable HCC patients treated by Lenvatinib combined with PD-1 as a conversion therapy. Frontiers Media S.A. 2023-05-05 /pmc/articles/PMC10196479/ /pubmed/37215117 http://dx.doi.org/10.3389/fimmu.2023.1151967 Text en Copyright © 2023 Wang, Zhang, Luan, Wang, Liu, Xu, Zhang, Xu, Lu, Wang and Ma https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Immunology
Wang, Guanyun
Zhang, Wenwen
Luan, Xiaohui
Wang, Zhanbo
Liu, Jiajin
Xu, Xiaodan
Zhang, Jinming
Xu, Baixuan
Lu, Shichun
Wang, Ruimin
Ma, Guangyu
The role of (18)F−FDG PET in predicting the pathological response and prognosis to unresectable HCC patients treated with lenvatinib and PD-1 inhibitors as a conversion therapy
title The role of (18)F−FDG PET in predicting the pathological response and prognosis to unresectable HCC patients treated with lenvatinib and PD-1 inhibitors as a conversion therapy
title_full The role of (18)F−FDG PET in predicting the pathological response and prognosis to unresectable HCC patients treated with lenvatinib and PD-1 inhibitors as a conversion therapy
title_fullStr The role of (18)F−FDG PET in predicting the pathological response and prognosis to unresectable HCC patients treated with lenvatinib and PD-1 inhibitors as a conversion therapy
title_full_unstemmed The role of (18)F−FDG PET in predicting the pathological response and prognosis to unresectable HCC patients treated with lenvatinib and PD-1 inhibitors as a conversion therapy
title_short The role of (18)F−FDG PET in predicting the pathological response and prognosis to unresectable HCC patients treated with lenvatinib and PD-1 inhibitors as a conversion therapy
title_sort role of (18)f−fdg pet in predicting the pathological response and prognosis to unresectable hcc patients treated with lenvatinib and pd-1 inhibitors as a conversion therapy
topic Immunology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10196479/
https://www.ncbi.nlm.nih.gov/pubmed/37215117
http://dx.doi.org/10.3389/fimmu.2023.1151967
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