간세포암종 환자의 예후 예측에 있어 양전자방출단층촬영(PET)의 유용성 = Positron Emission Tomography with Fluorine-18-Fluorodeoxyglucose is Useful for Predicting the Prognosis of Patients with Hepatocellular Carcinoma

다국어 초록 (Multilingual Abstract)

Background/Aims: Hepatocellular carcinoma (HCC) is heterogenous in terms of its glucose metabolism. Positron emission tomography with fluorine-18-fluorodeoxyglucose (FDG-PET) shows various levels of FDG uptake for patients with HCC. This study was designed to assess the usefulness of FDG-PET for predicting the outcome of the patients with HCC. Methods: FDG-PET was performed for 27 patients with HCC. The standardized uptake value (SUV) and SUV ratio (defined as the tumor-to-nontumor ratio of SUV) was calculated for each patient. The clinical factors of the outcome were analyzed by regression analysis using Cox’s multivariate proportional hazard model. The survival rate was calculated by the Kaplan-Meier method. Results: Among the analyzed clinical factors including tumor size, number of tumors, AFP, involvement of major vessels, presence of systemic metastases, Child-Pugh class the SUV and SUV ratio, only the SUV was the only significant independent prognostic factor (p=0.001). On the basis of the SUV, the patients were divided into two groups of roughly equal size: group A, SUV of <7; group B, SUV >7. The cumulative survival rate was significantly lower for group B than for group A, and the median survival time was significantly different (4 months vs 15 months, respectively) (p=0.003). Conclusions: These results suggest that FDG-PET is useful to predict the outcome for patients with hepatocellular carcinoma.

국문 초록 (Abstract)

목적: 간세포암종은 FDG-PET 영상에서 다양한 수준의 FDG 축적을 보인다. 이는 간세포암종의 포도당 대사 활성이 다양함을 의미하는데, 이러한 차이가 환자의 예후와 연관이 있는지를 알아보고자 하였다. 대상과 방법: 27예의 간세포암종 환자들을 대상으로 각각의 환자에서 FDG-PET 영상을 얻어 FDG 축적의 정도(SUV 및 SUV비)를 조사하였고 이들 변수들이 생존율에 영향을 줄 수 있는 인자인지를 확인하기 위해 Cox proportional hazard model로 회귀분석을 시행하였다. 생존율은 Kaplan-Meier법으로 계산하였고 생존율의 차이는 Wilcoxon test로 검증하였다. 결과: 1년 누적생존율은 37%, 3년 누적생존율은 11%였다. 조사된 생존율 관련 인자들 중 통계적 유의성을 보였던 지표는 SUV뿐이었으며(P=0.001), SUV비는 통계적 유의성을 보이지 않았다. SUV가 7 미만인 군과 7 이상인 군에서 생존기간의 중간치는 각각 15개월과 4개월로서 SUV가 높은 군, 즉 종양의 포도당 대사가 항진되어 있는 환자군에서 통계적으로 의미 있게 짧은 생존 기간을 보였다(P=0.003). 결론: 간세포암종 환자의 FDG-PET 영상에서 측정된 SUV는 중요한 예후 예측 지표이며 높은 SUV는 불량한 예후를 시사한다.

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