Ga-68-PSMA-11 PET/CT improves tumor detection and impacts management in patients with hepatocellular carcinoma (HCC)

Ziel/Aim A growing number of local and systemic therapies are available for hepatocellular carcinoma (HCC), and accurate staging is critical for management decisions. We assessed the impact of imaging by 68-Ga-PSMA-11 PET/CT on disease staging, prognostic groups and management of patients with HCC compared to staging with computed tomography (CT).

Methodik/Methods Forty patients who underwent 68-Ga-PSMA-11 PET/CT for HCC staging between September 2018 and September 2019 were retrospectively included. Management pre- and post-PET scan was assessed by standardized surveys. Presence of HCC was evaluated by three blinded readers on per-patient and per-region bases for PET/CT and multi-phase contrast-enhanced CT in separate sessions. Lesions were validated by follow-up imaging or histopathology, and progression-free survival (PFS) was recorded. Endpoints were detection rate and positive predictive value (PPV) for 68-Ga-PSMA-11 PET vs. CT, inter-reader reproducibility, and changes in stage, prognostic groups and management plans.

Ergebnisse/Results The sensitivity of PET vs. CT to identify liver lesions for patients with lesion validation was 31 (97 %) for both modalities, while it was 6 (100 %) vs. 4 (67 %) for extra-hepatic lesions. PET and CT each had a PPV of 100 % at the liver level. PET vs. CT stage was congruent in 30 (75 %) patients; upstaging was seen in 8 patients (20 %), while 2 (5 %) had downstaging by PET. Intended management changed in 19 patients (47.5 %); 9 of these patients were found to have detectable distant metastases (47.4 %) and assigned stage 4 disease, the majority of whom were shifted to systemic therapy (8 of 9, 89 %). Median PFS was 5.2 months for the entire cohort; 5.3 months for PET M0, and 4.7 months for PET M1 patients, respectively.

Schlussfolgerungen/Conclusions 68-Ga-PSMA-11 PET demonstrated higher accuracy than CT in the detection of HCC metastases and was associated with management change in about half of the patient cohort.

Publication History

Article published online:
08 April 2021