Combination of 18F-FDG PET/CT metabolic parameters and endoplasmic reticulum stress levels in predicting prognosis of hepatocellular carcinoma
Objective To investigate the relationship between endoplasmic reticulum stress markers[C/EBP ho-mologous protein(CHOP)and glucose-regulated protein 78(GRP78)]and metabolic parameters derived from 18F-FDG PET/CT in hepatocellular carcinoma(HCC),and to evaluate the combined predictive value of CHOP,GRP78,and metabolic parameters for HCC prognosis.Methods A retrospective analysis was conducted on 217 patients with histolog-ically confirmed HCC who underwent curative surgical resection between 2017 and 2021.Patients were divided into a sur-vival group(n=139)and a mortality group(n=78)based on follow-up outcomes.Clinicopathological data and overall survival(OS)were recorded.Immunohistochemistry was used to detect CHOP and GRP78 expression in tumor tissues.Tumor maximum standardized uptake value(SUVmax)was assessed using PET/CT.Results Compared with the survival group,the mortality group had significantly higher incidences of hypertension,CHOP-positive expression,and SUVmax levels(P＜0.05).Patients with CHOP-positive expression had significantly higher SUVmax levels than CHOP-nega-tive patients(P＜0.05).Cox regression analysis revealed that SUVmax(HR=1.198,95％CI=1.110-1.294,P＜0.001)and CHOP(HR=9.179,95％CI=3.610-23.341,P＜0.001)were independent prognostic factors for OS in HCC patients.ROC analysis demonstrated that the combination of SUVmax and CHOP yielded an AUC of 0.904(95％CI=0.858-0.950),with a sensitivity of 92.3％and a specificity of 88.5％.Kaplan-Meier survival analysis showed that patients with high SUVmax(≥3.9)and CHOP-positive expression had the shortest survival time(35.8±1.1 months),while those with low SUVmax(＜3.9)and CHOP-negative expression had the longest survival time(56.9±2.9 months),with significant differences between the groups(Log-rank=4.810,P=0.045).Conclusion In HCC pa-tients undergoing curative liver resection,positive CHOP expression in the tumor microenvironment and high SUVmax were significantly associated with lower OS.Both are independent prognostic factors for HCC and provide valuable insights into patient prognosis.
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