Purpose
Changes in tumor metabolism from PET in locally advanced breast cancer (LABC) patients treated with neoadjuvant chemotherapy (NC) are predictive of pathologic response. Serial dynamic [18F]-FDG PET scans were used to compare kinetic parameters to the standardized uptake value (SUV) as predictors of pathologic response, disease-free survival (DFS) and overall survival (OS).
Experimental Design
Seventy-five LABC patients underwent FDG PET prior to and at midpoint of NC. FDG delivery (K1), FDG flux (Ki), and SUV measures were calculated and compared by clinical and pathological tumor characteristics using regression methods and area under the receiver operating characteristic curve (AUC). Associations between K1, Ki, and SUV and DFS and OS were evaluated using the Cox proportional hazards model.
Results
Tumors that were hormone receptor negative, high grade, highly proliferative, or of ductal histology had higher FDG Ki and SUV values; on average, FDG K1 did not differ systematically by tumor features. Predicting pathologic response in conjunction with estrogen receptor (ER) and axillary lymph node positivity, kinetic measures (AUC = 0.97) were more robust predictors compared to SUV (AUC = 0.84, P = 0.005). Changes in K1 and Ki predicted both DFS and OS, while changes in SUV predicted OS only. In multivariate modeling, only changes in K1 remained an independent prognosticator of DFS and OS.
Conclusion
Kinetic measures of FDG PET for LABC patients treated with NC accurately measured treatment response and predicted outcome compared to static SUV measures, suggesting kinetic analysis may hold advantage of static uptake measures for response assessment.