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Could semiquantitative FDG analysis add information to the prognosis in patients with stage II/III breast cancer undergoing neoadjuvant treatment?

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

We investigated whether maximum standardized uptake value (SUVmax), metabolic tumour volume (MTV), total lesion glycolysis (TLG) and whole-body (WB) SUVmax, WB MTV and WB TLG measured by 18F-FDG PET/CT could improve prognostic stratification in patients with stage II/III breast cancer (BC).

Methods

We prospectively enrolled 99 consecutive women (median age 50 years, range 27 – 77 years) with pathologically proven stage II/III BC who underwent pretreatment FDG PET/CT. WB SUVmax, WB MTV and WB TLG were measured in all malignant lesions. Survival was analysed using the Kaplan-Meier method. Cox proportional hazards models were constructed to test for relationships among WB SUVmax, WB MTV, WB TLG, and overall survival (OS) and disease-free survival (DFS), after adjustment for age, and histopathological and immunohistochemical features (oestrogen/progesterone and HER2 expression, proliferation index and grade).

Results

The median values of WB SUVmax, WB MTV and WB TLG were 16.2 (range 1.5 – 33.1), 14 cm3 (range 0.03 – 708.6 cm3) and 62.5 (0.06 – 3869.4), respectively. All WB semiquantitative values were higher in patients with higher TNM stage, although not significantly (all p > 0.05). The median follow-up for surviving patients was 30 months, with a range of 13 – 45 months. Both PFS and OS of patients with low WB SUVmax, WB MTV and WB TLG were longer than that of patients with high WB values for progression, although not statistically significant. However, stratifying the patients in accordance with the stage of disease, both PFS and OS were significantly lower in patients with high WB TLG and stage III than in patients with stage II (p < 0.05). In multivariate analyses, WB MTV and WB TLG were independent prognostic factors for PFS (hazard ratio 1.004, 95 % confidence interval 1.002 – 1.006, p < 0.001, and hazard ratio 1.001, 95 % confidence interval 1.000 – 1.001, p = 0.011, respectively).

Conclusion

The addition of WB TLG to clinical data may provide a more detailed prediction of outcome in patients with stage III BC. Moreover, WB MTV and WB TLG are independent factors predicting recurrence of BC. On the contrary, WB SUVmax has poor prognostic significance in this cohort of patients.

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Compliance with ethical standards

Conflicts of interest

None.

Ethical approval

The study was conducted according to the principles of the Declaration of Helsinki (2000). All procedures performed in the studies were in accordance with the ethical standards of institutional and/or national research committees.

Informed consent

Written informed consent to undergo PET/CT was obtained from all subjects included in the study.

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Authors and Affiliations

  1. Radiotherapy and Nuclear Medicine Unit, Veneto Institute of Oncology IOV – IRCCS, Via Gattamelata, 64, 35128, Padua, Italy

    Laura Evangelista & Anna Rita Cervino

  2. Medical Oncology 2 Unit, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy

    Cristina Ghiotto, Valentina Guarneri & Pierfranco Conte

  3. Breast Unit, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy

    Tania Saibene, Silvia Michieletto & Bozza Fernando

  4. Department of Pathology, University Hospital of Padua, Padua, Italy

    Enrico Orvieto

Authors
  1. Laura Evangelista
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  2. Anna Rita Cervino
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  3. Cristina Ghiotto
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  4. Tania Saibene
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Correspondence to Laura Evangelista.

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Figure 1S

Kaplan-Meier analyses for clinical features (upper) and whole-body semiquantitative PET data (lower) (GIF 116 kb)

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Evangelista, L., Cervino, A.R., Ghiotto, C. et al. Could semiquantitative FDG analysis add information to the prognosis in patients with stage II/III breast cancer undergoing neoadjuvant treatment?. Eur J Nucl Med Mol Imaging 42, 1648–1655 (2015). https://doi.org/10.1007/s00259-015-3088-4

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  • DOI: https://doi.org/10.1007/s00259-015-3088-4

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