Purpose: To prospectively investigate dynamic13N-ammonia PET-CT for evaluating early treatment response and predicting prognosis in advanced hepatocellular carcinoma (HCC) patients who have undergone antiangiogenic therapy. Methods: Dynamic13N-ammonia PET-CT was performed in 23 advanced HCC patients before antiangiogenic therapy (baseline) and in 18/23 patients after 8-10 weeks of treatment (post-therapy). At kinetic PET-CT analysis, mean, maximum, and peak values ofK1(mL/cm3/min) andk2(min−1) were estimated in HCC lesions and non-neoplastic liver using cardiologic13N-ammonia PET-CT in 15 patients without any liver diseases as normal controls. Outcome endpoints were treatment response after 8–10 weeks assessed by contrast-enhanced CT, progression-free survival (PFS), and overall survival (OS). Results: At both baseline and post-therapy PET-CT, all kinetic PET parameters were significantly higher (p< 0.05) in HCC lesions than in non-neoplastic and healthy liver of HCC patients and controls. According to mRECIST criteria, 13/18 patients (72.2%) were responders (1 CR, 1 PR, and 11 SD), and 5/18 patients (27.8%) were non-responders (PD), with no significant differences in baseline and post-therapy PET parameters between the two groups. At follow-up (median: 14.2 months), 15/18 patients (83.3%) experienced radiological progression, and 14/18 (77.8%) died (7/14 within 12 months from treatment). The nine earlier-progression patients (within 6 months from treatment) showed significantly lower baselineK1meanin HCC lesions than all nine patients with later or no-progression (p= 0.03). Patients still alive 12 months after treatment (n = 11) showed significantly lower post-therapyK1mean(p= 0.05),K1max(p= 0.05), andK1peak(p= 0.03) in non-neoplastic liver than patients with shorter OS (n = 7). Conclusions: In advanced HCC patients treated with antiangiogenic agents, kinetic parameters from baseline and post-therapy13N-ammonia PET-CT may predict early disease progression and survival. PET-CT seems not able to discriminate responders and non-responders after 8-10 weeks of treatment, suggesting the need for future and larger studies after a longer treatment period.
目的：前瞻性研究动态13N-氨PET-CT在评估接受抗血管生成治疗的晚期肝细胞癌（HCC）患者早期治疗反应及预测预后方面的价值。方法：对23例晚期HCC患者于抗血管生成治疗前（基线期）及其中18例患者于治疗8-10周后（治疗后）行动态13N-氨PET-CT检查。通过动力学PET-CT分析，以15例无肝脏疾病患者的心脏13N-氨PET-CT数据作为正常对照，分别估算HCC病灶区、非肿瘤肝组织的K1（mL/cm³/min）与k2（min⁻¹）均值、最大值及峰值。研究终点包括增强CT评估的治疗8-10周后疗效反应、无进展生存期（PFS）和总生存期（OS）。结果：在基线期及治疗后PET-CT中，HCC病灶的所有动力学PET参数均显著高于患者非肿瘤肝组织、健康对照者肝脏（p<0.05）。根据mRECIST标准，18例患者中13例（72.2%）为应答者（1例完全缓解、1例部分缓解、11例疾病稳定），5例（27.8%）为无应答者（疾病进展），两组间基线期及治疗后PET参数均无显著差异。中位随访14.2个月期间，18例患者中15例（83.3%）出现影像学进展，14例（77.8%）死亡（其中7例在治疗12个月内死亡）。9例早期进展患者（治疗6个月内）的HCC病灶基线K1均值显著低于9例晚期进展或无进展患者（p=0.03）。治疗12个月后仍存活的患者（n=11）其非肿瘤肝组织的治疗后K1均值（p=0.05）、K1最大值（p=0.05）及K1峰值（p=0.03）均显著低于OS较短的患者（n=7）。结论：在接受抗血管生成治疗的晚期HCC患者中，基线期及治疗后的13N-氨PET-CT动力学参数可能预测早期疾病进展及生存情况。PET-CT在治疗8-10周后可能无法有效区分治疗应答者与非应答者，提示未来需开展更长期治疗后的扩大样本研究。
肿瘤(癌症)患者之家