HÌNH ẢNH PET-CT TRÊN BỆNH NHÂN SAU ĐIỀU TRỊ UNG THƯ BIỂU MÔ TẾ BÀO GAN CÓ PIVKA-II HOẶC AFP-L3 CAO

Khánh Cao Văn; Quốc Lê Nho; Tấn Ngô Văn; Ly Nguyễn Hoàng Ái; Cảnh Nguyễn Xuân

doi:10.59354/ydth175.2021.92

Keywords:

Hepatocellular cancer (HCC), PET/CT (Positron Emission Tomography/ Computed Tomography), FDG (F-18 Fluorodeoxyglucose), PIVKA-II and AFP-L3

Abstract

Objective: Many diagnostic imaging modalities are used in follow-up of treated hepatocellular carcinoma (HCC). The aim of this study is to investigate characteristics of FDG PET/CT in follow-up of treated HCC with elevated levels of PIVKA-II or AFP-L3.

Patients and methods: A retrospective study analyzed treated HCC patients who had PIVKA-II >40 mAU/ml or AFP-L3 >10% and underwent FDG PET/CT with dynamic CT. We investigated PET/CT imaging characteristics in correlation with serum PIVKA-II and AFP-L3.

Results: FDG PET/CT detected lesions in 42 of 48 patients (87.5 %), including hepatic lesions in 16 (33,3 %), extrahepatic lesions in 10 (20,8 %) and both in 16 patients (33,3 %). 26 of 48 patients (54,2 %) had extrahepatic lesions: lung (31.2 %), distal lymph node (16.6 %), peritoneum (8,3 %), regional lymph node (6.2 %), bone (6.2 %) and adrenal gland (2.1 %).

Mean AFP-L3 value was 40,6 % in group of patients with lesions in PET/CT and 11.7 % in patients without lesions (p = 0.02). There was no difference on PIVKA-II value between both groups.

Conclusion: In patients with treated HCC with high serum concentration of PIVKA-II or AFP-L3, FDG PET/CT played an important role in detection of lesions. The indication for FDG PET/CT should be considered when negative conventional imaging or to further evaluate and find out further lesions.

References

Nguyễn Văn Thành, Nguyễn Quang Nghĩa (2018). Kết quả điều trị phẫu thuật ung thư biểu mô tế bào gan kích thước lớn tại Bệnh viện Hữu nghị Việt Đức. Tạp chí Y – Dược học quân sự số chuyên đề ngoại bụng. Trang 64-69.

Chen Z, Liang H, Zhang X, et al (2012). Value of (18)F-FDG PET/ CT and CECT in detecting postoperative recurrence and extrahepatic metastasis of hepatocellular carcinoma in patients with elevated serum alpha-fetoprotein]. Nan Fang Yi Ke Da Xue Xue Bao. Nov;32(11):1615-9.

Izuishi K, Yamamoto Y, Mori H, et al (2014). Molecular mechanisms of [18F] fluorodeoxyglucose accumulation in liver cancer. Oncol Rep. Feb;31(2):701-6.

Katyal S, Oliver JH 3rd, Peterson MS, et al (2000). Extrahepatic metastases of hepatocellular carcinoma. Radiology. Sep;216(3):698-703.

Kim DY, Paik YH, Ahn SH, et al (2007). PIVKA-II is a useful tumor marker for recurrent hepatocellular carcinoma after surgical resection. Oncology. 72 Suppl 1:52-7.

Park SJ, Jang JY, Jeong SW, et al (2017). Usefulness of AFP, AFP-L3, and PIVKA-II, and their combinations in diagnosing hepatocellular carcinoma. Medicine (Baltimore). Mar;96(11): e5811.

Shawky Elsawabi, A., Abdel wahab, K., Ibrahim, W. et al (2019). α-Fetoprotein (AFP)-L3% and transforming growth factor B1 (TGFB1) in prognosis of hepatocellular carcinoma after radiofrequency. Egypt Liver Journal 9, 8.

Globocan (2020). https:// g c o . i a r c . f r / t o d a y / d a t a / f a c t s h e e t s / populations/704-viet-nam-fact-sheets.pdf

Yamamoto K, Imamura H, Matsuyama Y, et al (2010). AFP, AFP-L3, DCP, and GP73 as markers for monitoring treatment response and recurrence and as surrogate markers of clinicopathological variables of HCC. J Gastroenterol. Dec;45(12):1272-82.

Yip VS, Gomez D, Tan CY, et al (2013). Tumour size and differentiation predict survival after liver resection for hepatocellular carcinoma arising from non-cirrhotic and non-fibrotic liver: a case-controlled study. Int J Surg. 11(10):1078- 82.

Yu R, Tan Z, Xiang X, et al (2017). Effectiveness of PIVKA-II in the detection of hepatocellular carcinoma based on real-world clinical data. BMC Cancer. 17(1):608. Published 2017 Sep 1.