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