18FDG-PET/CT for predicting the outcome in ER+/HER2- breast cancer patients: comparison of clinicopathological parameters and PET image-derived indices including tumor texture analysis

Abstract

BackgroundThis study investigated the value of some clinicopathological parameters and 18 F-fluorodeoxyglucose-positron emission tomography/computed tomography (18FDG-PET/CT) indices, including textural features, to predict event-free survival (EFS) in estrogen receptor-positive/human epidermal growth factor receptor 2-negative (ER+/HER2-) locally advanced breast cancer (BC) patients.MethodsFDG-PET/CT indices and clinicopathological parameters were assessed before neoadjuvant chemotherapy (NAC). After completion of chemotherapy, all patients had breast surgery with axillary lymph node dissection, followed by radiation therapy and endocrine therapy for 5 years. EFS was estimated using the Kaplan-Meier method. A Cox proportional hazard regression model was used for multivariate analysis.ResultsOne hundred forty-three consecutive patients with stage II–III ER+/HER2- BC and without distant metastases at baseline PET were included. High standardized uptake values (SUVs), were associated with shorter EFS (HR = 3.51, P < 0.01 for SUVmax; HR = 2.76, P = 0.02 for SUVmean; and HR = 4.40 P < 0.01 for SUVpeak). Metabolically active tumor volume (MATV, HR = 3.47, P < 0.01) and total lesion glycolysis (TLG, HR = 3.10, P < 0.01) were also predictive of EFS. Homogeneity was not predictive (HR = 2.27, P = 0.07) and entropy had weak prediction (HR = 2.89, P = 0.02). Among clinicopathological parameters, EFS was shorter in progesterone receptor (PR)-negative tumor (vs. PR-positive tumor; HR = 3.25, P < 0.01); histology was predictive of EFS (lobular vs. ductal invasive carcinoma; HR = 3.74, P = 0.01) but not tumor grade (grade 3 vs. grade 1–2; HR = 1.64, P = 0.32). Pathological complete response after NAC was not correlated to the risk of relapse. Three parameters remained significantly associated with EFS in multivariate analysis. MATV (HR = 1.01, P < 0.01), progesterone receptor expression (HR = 2.90, P = 0.03) and tumor histology (HR = 3.80, P = 0.02).ConclusionsBaseline PET parameters measured before neoadjuvant treatment have prognostic values in ER+/HER2- locally advanced breast cancer patients. After multivariate analysis, metabolically active tumor volume remains significant while textural analysis of PET images is not of added value. Considering histopathological parameters, our study shows that patients with PR-negative or lobular invasive tumor have poorer prognosis than patients with PR-positive or ductal carcinoma, respectively.

Prognostic Value of Tumor Heterogeneity on 18F-FDG PET/CT in HR+HER2− Metastatic Breast Cancer Patients receiving 500 mg Fulvestrant: a retrospective study

“…Groheux et al . found that high SUV, including SUVmax, SUVmean and SUVpeak, were associated with shorter EFS 8 . However, homogeneity was not predictive for EFS (HR = 2.27, P = 0.07).…”

“…Heterogeneity is therefore a prognostic factor 5 and may be a predictor of treatment failure and drug resistance, including endocrine resistance. Recently, 18F-FDG PET/CT is used to evaluate tumor heterogeneity by tumor textural information and glucose uptake 6 – 8 . It is an easy and non-invasive method to assess heterogeneity compared with genomic approach by biopsy.…”

18F-fluorodeoxyglucose positron emission tomography/computed tomography features in locally advanced breast cancer and their correlation with molecular subtypes

“…The imaging findings on 18 F-FDG PET/CT in patients with breast cancer have been correlated to tumor type, size, grade, receptor expression, and nodal metastases with variable success. [ 14 15 ] The present study aimed to see if the changes in 18 F-FDG PET/CT could reflect the tumor biology as represented by the molecular subtype. The study population was fairly uniform that all patients had locally advanced infiltrating duct breast cancer.…”

Comparative diagnostic accuracy of ¹⁸F-FDG PET/CT for breast cancer recurrence

“…Some authors have suggested that FDG PET/CT can have a significant impact on the therapeutic management; however, information concerning its utility for a long-term prognostic stratification, when compared with CI, is limited 48. In particular, there is no consensus about the best PET-derived parameters to predict patients’ prognosis and/or survival 76. First published studies were focused on the prognostic value of SUV max , without testing other PET parameters 76.…”

“…In particular, there is no consensus about the best PET-derived parameters to predict patients’ prognosis and/or survival 76. First published studies were focused on the prognostic value of SUV max , without testing other PET parameters 76. More recently, other PET-derived parameters such as metabolic tumor volume (MTV) and total lesion glycolysis have demonstrated to potentially improve risk stratification, in this specific subtype of breast cancer patients 77–80…”