[18F]FDG uptake of bone marrow on PET/CT for predicting distant recurrence in breast cancer patients after surgical resection

Abstract

Background: The objective of this study was to investigate the prognostic value of 2-Deoxy-2-[ 18 F]fluoro-D-glucose ([ 18 F]FDG) uptake of bone marrow (BM) and metabolic parameters of primary tumor on positron emission tomography/computed tomography (PET/CT) for predicting distant recurrence in patients with breast cancer. Methods: Pretreatment [ 18 F]FDG PET/CT images of 345 breast cancer patients were retrospectively evaluated. Maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis (TLG) of primary breast cancer and bone marrow-to-liver uptake ratio (BLR) on PET/CT were measured. A Cox proportional hazard regression model was used to evaluate the prognostic potential of parameters for predicting recurrence-free survival (RFS) and distant RFS. For Kaplan-Meier analysis, the specific cutoff values pf BLR and TLG were determined by the maximal chi-square method. Results: The median follow-up duration of the enrolled patients was 48.7 months, and during follow-up, 36 patients (10.4%) experienced the cancer recurrence. BLR was significantly correlated with T stage, serum inflammatory markers, and recurrence pattern (p < 0.05). Patients with high BLR and TLG showed worse RFS and distant RFS than those with low BLR and TLG. On multivariate analysis, BLR was significantly associated with both RFS and distant RFS after adjusting for T stage, estrogen receptor status, and TLG (p = 0.001 for both). Only 0.5% of patients with TLG < 9.64 g and BLR < 0.91 experienced distant recurrence. However, patients with TLG ≥ 9.64 g and BLR ≥ 0.91 had a distant recurrence rate of 40.7%. Conclusions: BLR on pretreatment [ 18 F]FDG PET/CT were significant predictors for RFS and distant RFS in patients with breast cancer. By combining [ 18 F]FDG uptake of BM and volumetric PET/CT index of breast cancer, the risk of distant recurrence could be stratified.

Predicting treatment outcomes using 18F-FDG PET biomarkers in patients with non-small-cell lung cancer receiving chemoimmunotherapy

“…The spleen-to-liver ratio of SUV (SLR) was calculated by dividing the spleen SUVmean by the liver SUVmean, and the bone marrow-to-liver ratio of the SUV (BLR) was calculated by dividing the bone marrow SUVmean by the liver SUVmean, similarly to previous reports. 28 – 30 , 34 , 35 …”

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

“…Demonstration that lymphoid tissue glucose metabolism is an imaging biomarker correlated with RFS in breast cancer is an interesting finding, consistent with data published in the literature. In a recent study, Lee et al explored the association between RFS or DRFS (systemic control) and PET biomarkers including bone marrow metabolism (BLR) in 345 patients with invasive ductal (89%) or lobular (11%) breast carcinoma treated by upfront surgery prior to adjuvant therapy [24]. They confirmed that metabolic tumor volume and noninvasive measurement of glucose metabolism on nontumoral lymphoid tissues can both be used to predict recurrence, especially the onset of metastasis.…”

“…Nontumoral lymphoid tissues. Liver, spleen, and BM SUVmax values were computed with the same methodology as that used in several published studies [18][19][20]24] by drawing a spherical 3 cm-VOI in the liver, a spherical 2 cm-VOI in the spleen, and four spherical 1.5 cm-VOI placed in the center of L1 to L4 (lumbar) vertebral bodies for BM. BM SUVmax was defined as the average of the maximum standardized uptake values of all vertebral bodies.…”

“…An original approach to the prognosis of patient outcomes does not focus exclusively on tumor imaging characteristics but includes imaging assessment of lymphoid tissues [17][18][19][20][21]. In the era of precision medicine, such an approach might provide novel prognostic biomarkers to guide breast cancer patient management [22][23][24]. Two main types of imaging biomarkers can be extracted from baseline [18F]-FDG PET/CT for this purpose: tumor metabolism (tumor uptake and tumor volume) and nontumoral lymphoid tissue metabolism (spleen and bone marrow).…”

“…The current hypothesis is that tumor growth could play a pivotal role in reprogramming the host immune system by regulating hematopoiesis, which might be associated with the expansion of BM and/or spleen-derived immunosuppressive cells, such as tumor associated macrophages (TAMs) [28], regulatory T cells (Tregs) [29], and Myeloid-Derived Suppressor Cells (MDSCs) [30]. In the specific population of patients with invasive breast cancer of no special type (NST), only two recent studies, evaluating spleen [23] or BM [24] metabolism as prognostic factors, could possibly improve stratification risk and guide treatment strategies.…”