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Page 6 of 11 Costa et al. Hepatoma Res 2018;4:35 I http://dx.doi.org/10.20517/2394-5079.2018.06

15

P = 0.01
10
SUVmax

5

0
Sorafenib Control
Figure 3. Comparison of SUVmax values between nodules of the control and sorafenib groups

12.00 P = 0.008

10.00

8.00
SUVmax 6.00

4.00

2.00

0.00

II III IV
HCC pathologic classificaion

Figure 4. Comparison between SUVmax and HCC pathological classification

Correlation between less differentiated/undifferentiated HCC (Grades III/IV) and the highest values of [ F]
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FDG uptake, presented as tumor SUVmax (R = 0.44, P = 0.01) or as a tumor ratio, either Tumor SUVmax/
2
Liver SUVmax ratio (R = 0.42, P = 0.02) or Tumor SUVmax/SUVmax muscle ratio (R = 0.54, P = 0.006) was
2
2
found [Figure 5].
The pathology results showed that the sorafenib-treated group had more well-differentiated HCC (39% vs.
5%, respectively I/II vs. III/IV, P = 0.01), and less poorly-differentiated HCC (52% vs. 81%, respectively I/II vs.
III/IV, P = 0.003). There was no difference between the two groups for necroinflammatory activity, degree
of hepatic fibrosis, vascular invasion, intra-nodule hemorrhage, nodule necrosis, and low-grade dysplastic
nodules [Table 3].

DISCUSSION
Our study is the first to evaluate the effect of sorafenib in a mixed experimental model of advanced HCC
secondary to NAFLD using PET imaging with [ F]FDG for quantitation of tumor growth. The decreased
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HCC nodules per animal in the treated group suggests the positive effect of sorafenib treatment, which is
affirmed by the higher proportion of well-differentiated lesions (Edmondson-Steiner Grades I/II) in the
treated group. The PET findings showing fewer lesions with high uptake per animal in the sorafenib group