Background: This study aims to investigate the prognostic role of complete metabolic response (CMR) on interim 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) in patients with breast cancer (BC) receiving neoadjuvant chemotherapy (NAC) according to tumor subtypes and PET timing.
Patients and methods: Eighty-six consecutive patients with stage II/III BC who received PET/CT during or following NAC were included. Time-dependent receiver operating characteristic analysis and Kaplan-Meier analysis were used to determine correlation between metabolic parameters and survival outcomes.
Results: The median follow-up duration was 71 months. Maximum standardized uptake value (SUVmax) on an interim PET/CT independently correlated with survival by multivariate analysis (overall survival [OS]: hazard ratio: 1.139, 95% confidence interval: 1.058-1.226, p = .001). By taking PET timing into account, best association of SUVmax with survival was obtained on PET after two to three cycles of NAC (area under the curve [AUC]: 0.941 at 1 year after initiation of NAC) and PET after four to five (AUC: 0.871 at 4 years), while PET after six to eight cycles of NAC had less prognostic value. CMR was obtained in 62% of patients (23/37) with estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (HER2-) BC, in 48% (12/25) triple-negative BC (TNBC), and in 75% (18/24) HER2-positive (HER2+) tumors. Patients with CMR on an early-mid PET had 5-year OS rates of 92% for ER+/HER2- tumors and 80% for TNBC, respectively. Among HER2+ subtype, 89% patients (16/18) with CMR had no relapse.
Conclusion: CMR indicated a significantly better outcome in BC and may serve as a favorable imaging prognosticator. The Oncologist 2017;22:526-534 IMPLICATIONS FOR PRACTICE: This study shows a significantly better outcome for breast cancer (BC) patients who achieved complete metabolic response (CMR) on 18F-fluorodeoxyglucose emission tomography/computed tomography (PET/CT) during neoadjuvant chemotherapy, especially for hormone receptor-positive tumors and triple negative BC. Moreover, PET/CT performed during an early- or mid-course neoadjuvant therapy is more predictive for long-term survival outcome than a late PET/CT. These findings support that CMR may serve as a favorable imaging prognosticator for BC and has potential for application to daily clinical practice.
摘要
背景. 本研究旨在按照肿瘤亚型和PET时间评价中期18F‐氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（PET/CT）显示的完全代谢缓解（CMR）在接受新辅助化疗（NAC）的乳腺癌（BC）患者中的预后作用。
患者和方法. 连续纳入了86例在NAC治疗期间或治疗后接受PET/CT检查的II/III期BC患者。采用具有时间依赖性的受试者工作特征分析和Kaplan‐Meier分析, 确定代谢参数与生存预后间的相关性。
结果. 中位随访持续时间为71个月。多变量分析显示, 中期PET/CT图像上的最大标准化摄取值（SUVmax）与生存独立相关[总生存（OS）：风险比：1.139, 95%置信区间：1.058‐1.226, p =0.001]。将PET时间纳入考虑时, NAC治疗2‐3个周期[开始NAC治疗后1年时的曲线下面积（AUC）为0.941]和4‐5个周期（4年时AUC为0.871）后PET图像上的SUVmax 与生存期之间的相关性最高 , 而NAC治疗6‐8个周期后PET的预后价值有所下降。雌激素受体阳性（ER+）/人类表皮生长因子受体2阴性（HER2‐）BC患者、三阴性BC（TNBC）患者和HER2阳性（HER2+）肿瘤患者中分别有62%（23/37）、48%（12/25）和75%（18/24）达到了CMR。在早‐中期PET显示CMR的ER+/HER2‐肿瘤患者和TNBC患者中, 5年OS率分别为92%和80%。在HER2+亚型中, 89%（16/18）的CMR患者没有复发。
结论.CMR意味着BC的预后显著更佳, 或许可作为有利的影像学预后因子。The Oncologist 2017;22:526–534
对临床实践的提示：本研究表明, 新辅助化疗期间18F‐氟脱氧葡萄糖PET/CT显示达到CMR的BC患者预后显著更佳, 在激素受体阳性肿瘤患者和三阴性BC患者中尤其如此。此外, 新辅助化疗早期或中期进行的PET/CT在长期生存方面的预后价值高于后期PET/CT。上述结果支持CMR在BC患者中可作为有利的影像学预后因子, 且有望应用于日常临床实践
Keywords: 18F‐fluorodeoxyglucose positron emission tomography/computed tomography; Breast cancer; Complete metabolic response; Neoadjuvant chemotherapy; Prognosis.
© AlphaMed Press 2017.