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Total metabolic tumor volume and spleen metabolism on baseline [18F]-FDG PET/CT as independent prognostic biomarkers of recurrence in resected breast cancer

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Abstract

Purpose

We evaluated whether biomarkers on baseline [18F]-FDG PET/CT are associated with recurrence after surgery in patients with invasive breast cancer of no special type (NST).

Methods

In this retrospective single-center study, we included consecutive patients with non-metastatic breast cancer of NST who underwent [18F]-FDG PET/CT before treatment, including surgery, between 2011 and 2016. Clinicopathological data were collected. Tumor SUVmax, total metabolic tumor volume (TMTV), and spleen- and bone marrow-to-liver SUVmax ratios (SLR, BLR) were measured from the PET images. Cut-off values were determined using predictiveness curves to predict 5-year recurrence-free survival (5y-RFS). A multivariable prediction model was developed using Cox regression. The association with stromal tumor-infiltrating lymphocytes (TILs) levels (low if <50%) was studied by logistic regression.

Results

Three hundred and three women were eligible, including 93 (31%) with triple-negative breast carcinoma. After a median follow-up of 6.2 years, 56 and 35 patients experienced recurrence and death, respectively. The 5y-RFS rate was 86%. In multivariable analyses, high TMTV (>20 cm3) and high SLR (>0.76) were associated with shorter 5y-RFS (HR 2.4, 95%CI 1.3–4.5, and HR 1.9, 95%CI 1.0–3.6). In logistic regression, high SLR was the only independent factor associated with low stromal TILs (OR 2.8, 95%CI 1.4–5.7).

Conclusion

High total metabolic tumor volume and high spleen glucose metabolism on baseline [18F]-FDG PET/CT were associated with poor 5y-RFS after surgical resection in patients with breast cancer of NST. Spleen metabolism was inversely correlated with stromal TILs and might be a surrogate for an immunosuppressive tumor microenvironment.

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Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Institut Curie, 92210, Saint-Cloud, France

    Romain-David Seban, Nicolas Deleval & Laurence Champion

  2. Laboratoire d’Imagerie Translationnelle en Oncologie, Inserm U1288, PSL Research University, Institut Curie, 91400, Orsay, France

    Romain-David Seban, Irene Buvat & Laurence Champion

  3. Department of Surgery, Institut Curie, PSL Research University, 75005 Paris &, 92210, Saint-Cloud, France

    Roman Rouzier

  4. Bioinformatics and Computational Systems Biology of Cancer, PSL Research University, Mines Paris Tech, INSERM U900, 75005, Paris, France

    Aurelien Latouche

  5. Conservatoire national des arts et métiers, Paris, France

    Aurelien Latouche

  6. Department of Pathology, Institut Curie, 92210, Saint-Cloud, France

    Jean-Marc Guinebretiere

  7. Department of Medical Oncology, Institut Curie, PSL Research University, 75005 Paris &, 92210, Saint-Cloud, France

    Francois-Clement Bidard

  8. Circulating Tumor Biomarkers Laboratory, SiRIC, Institut Curie, PSL Research University, Paris, France

    Francois-Clement Bidard

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  1. Romain-David Seban
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Contributions

All authors made substantial contributions to the design of the work or the acquisition, analysis, or interpretation of data; revised it critically for important intellectual content; approved the version to be published; and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Material preparation, data collection, and analysis were performed by R-D. Seban, A. Latouche, N. Deleval, F-C. Bidard, and L. Champion. The first draft of the manuscript was written by R-D Seban, F-C. Bidard, and L. Champion. All authors commented on previous versions of the manuscript. All authors read and approved the manuscript.

Corresponding author

Correspondence to Romain-David Seban.

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All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration.

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The authors declare no competing interests.

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Ackowledgements

We would like to thank Marie-Laure TANGUY for her help (statistical analysis).

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Seban, RD., Rouzier, R., Latouche, A. et al. Total metabolic tumor volume and spleen metabolism on baseline [18F]-FDG PET/CT as independent prognostic biomarkers of recurrence in resected breast cancer. Eur J Nucl Med Mol Imaging 48, 3560–3570 (2021). https://doi.org/10.1007/s00259-021-05322-2

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