Research Papers:

Harmonized pretreatment quantitative volume-based FDG-PET/CT parameters for prognosis of stage I–III breast cancer: Multicenter study

Kazuhiro Kitajima _, Yasuo Miyoshi, Tetsuro Sekine, Hiroyuki Takei, Kimiteru Ito, Akihiko Suto, Hayato Kaida, Kazunari Ishii, Hiromitsu Daisaki and Koichiro Yamakado

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Kazuhiro Kitajima1, Yasuo Miyoshi2, Tetsuro Sekine3, Hiroyuki Takei4, Kimiteru Ito5, Akihiko Suto6, Hayato Kaida7, Kazunari Ishii7, Hiromitsu Daisaki8 and Koichiro Yamakado1

1 Department of Radiology, Hyogo College of Medicine, Hyogo, Japan

2 Department of Breast and Endocrine Surgery, Hyogo College of Medicine, Hyogo, Japan

3 Department of Radiology, Nippon Medical School Hospital, Tokyo, Japan

4 Department of Breast Surgery and Oncology, Nippon Medical School Hospital, Tokyo, Japan

5 Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan

6 Department of Breast Surgery, National Cancer Center Hospital, Tokyo, Japan

7 Department of Radiology, Kinki University Faculty of Medicine, Osaka, Japan

8 Department of Radiological Technology, School of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Japan

Correspondence to:

Kazuhiro Kitajima,email: [email protected]

Keywords: breast cancer; survival; fluorodeoxyglucose (FDG); positron emission tomography-computed tomography (PET-CT); harmonization

Received: October 29, 2020     Accepted: December 11, 2020     Published: January 19, 2021

Copyright: © 2021 Kitajima et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Objectives: This study investigated harmonized pretreatment volume-based quantitative FDG-PET/CT parameters in breast cancer patients for prognostic value.

Results: During a median overall follow-up period of 5.3 years, 91 patients had recurrence and 40 died. Multivariate analysis of ER-positive/HER2-negative patients showed high maximum standardized uptake value (SUVmax) (p = 0.018), high total lesion glycolysis (TLG) (p = 0.010), and clinical N-classification (p = 0.0027) as independent negative predictors of RFS, while high maximum SUVmax (p = 0.037), advanced clinical T-classification (p = 0.030), and advanced TNM stage (p = 0.0067) were independent negative predictors of OS. For recurrence and death in HER2-positive patients, high total TLG (p = 0.037, p = 0.0048, respectively) and advanced TNM stage (p = 0.048, p = 0.046, respectively) were independent prediction factors. In the triple-negative group, independent factors related to recurrence and death were high maximum SUVmax (p = 0.0014, p = 0.0003, respectively) and advanced TNM stage (p < 0.0001, p < 0.0001, respectively).

Materials and Methods: Records of 546 stage I–III invasive breast cancer patients, including 344 estrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative, 110 HER2-positive, and 92 triple-negative cases, treated at four institutions were reviewed retrospectively. Harmonized primary tumor and nodal maximum SUVmax, metabolic tumor volume (MTV), and TLG indicated in pretreatment FDG-PET/CT results were analyzed. Evaluations of relationships of clinicopathological factors, volume-based quantitative parameters, recurrence-free survival (RFS), and overall survival (OS) for each subtype were performed with a Cox proportional hazards model and log-rank test.

Conclusions: The results indicated that potential surrogate markers for prognosis in patients with the three main subtypes of operable breast cancer include harmonized pretreatment quantitative volume-based FDG-PET/CT parameters, particularly whole-lesion SUVmax and TLG.

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