AUTHOR=Wang Guanyun , Zhang Wenwen , Chen Jiaxin , Luan Xiaohui , Wang Zhanbo , Wang Yanmei , Xu Xiaodan , Yao Shulin , Guan Zhiwei , Tian Jiahe , Lu Shichun , Xu Baixuan , Ma Guangyu 

TITLE=Pretreatment Metabolic Parameters Measured by 18F-FDG PET to Predict the Pathological Treatment Response of HCC Patients Treated With PD-1 Inhibitors and Lenvatinib as a Conversion Therapy in BCLC Stage C

JOURNAL=Frontiers in Oncology

VOLUME=12

YEAR=2022

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.884372

DOI=10.3389/fonc.2022.884372

ISSN=2234-943X

ABSTRACT=<sec><title>Objectives</title><p>This study aimed to assess the pretreatment <sup>18</sup>F-fluorodeoxyglucose positron emission tomography/computed tomography (<sup>18</sup>F-FDG PET/CT) as a predictor of the pathological treatment response (PTR) of hepatocellular carcinoma (HCC) patients treated with PD-1 inhibitors and lenvatinib as a conversion therapy in BCLC stage C.</p></sec><sec><title>Methods</title><p>All patients (n=20) underwent pretreatment <sup>18</sup>F-FDG PET/CT and were treated with conversion therapy and surgery. Patients were categorized into responders (n=9) and non-responders (n=11) according to PTR. The parameters of PET/CT, including lesion size, SUVmean (mean standard uptake value), MTV (metabolic tumor volume), TLG (total lesion glycolysis), SUVpeak (peak standard uptake value), and TLR (tumor-to-normal liver standardized uptake value ratio), were calculated. The diagnostic efficacy was evaluated by receiver operating characteristic analysis (ROC). PTR was compared with pretreatment PET/CT parameters by using Spearman correlation analysis. The patients were followed up.</p></sec><sec><title>Results</title><p>There was significant difference in TLR (5.59 ± 1.90 vs. 2.84 ± 1.70, respectively; <italic>P</italic>=0.003) between responders and non-responders, with the largest area under the curve (sensitivity=100%, specificity=72.7%, AUC=0.899, 95%CI: 0.759-1.000, optimal diagnostic threshold of 3.09). The relationship between <sup>18</sup>F-FDG PET/CT parameters and PTR indicated TLR was moderately and positively correlated with pathological treatment response, with correlation coefficients (rs) of 0.69 (<italic>P</italic>&lt;0.01). During the follow-up, no patients died, and tumor recurrence was found in one of the responders (11.1%). In all 11 non-responders, tumor recurrence was found in six patients (54.5%) and four patients (36.4%) died.</p></sec><sec><title>Conclusions</title><p>TLR may be a powerful marker to predict PTR of HCC patients with BCLC stage C who were treated with conversion therapy.</p></sec>