Division of Nuclear Medicine and Medical Oncology, University of Washington, Seattle, Washington 98109, USA.
Clin Cancer Res. 2011 Apr 15;17(8):2400-9. doi: 10.1158/1078-0432.CCR-10-2649. Epub 2011 Mar 1.
Changes in tumor metabolism from positron emission tomography (PET) in locally advanced breast cancer (LABC) patients treated with neoadjuvant chemotherapy (NC) are predictive of pathologic response. Serial dynamic [(18)F]-FDG (fluorodeoxyglucose) PET scans were used to compare kinetic parameters with the standardized uptake value (SUV) as predictors of pathologic response, disease-free survival (DFS), and overall survival (OS).
Seventy-five LABC patients underwent FDG PET prior to and at midpoint of NC. FDG delivery (K(1)), FDG flux (K(i)), and SUV measures were calculated and compared by clinical and pathologic tumor characteristics using regression methods and area under the receiver operating characteristic curve (AUC). Associations between K(1), K(i), and SUV and DFS and OS were evaluated using the Cox proportional hazards model.
Tumors that were hormone receptor negative, high grade, highly proliferative, or of ductal histology had higher FDG K(i) and SUV values; on an average, FDG K(1) 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 than SUV (AUC = 0.84, P = 0.005). Changes in K(1) and K(i) predicted both DFS and OS, whereas changes in SUV predicted OS only. In multivariate modeling, only changes in K(1) remained an independent prognosticator of DFS and OS.
Kinetic measures of FDG PET for LABC patients treated with NC accurately measured treatment response and predicted outcome compared with static SUV measures, suggesting that kinetic analysis may hold advantage of static uptake measures for response assessment.
正电子发射断层扫描（PET）在接受新辅助化疗（NC）的局部晚期乳腺癌（LABC）患者中肿瘤代谢的变化可预测病理反应。使用连续动态[18F]-FDG（氟脱氧葡萄糖）PET 扫描比较动力学参数与标准摄取值（SUV）作为病理反应、无病生存（DFS）和总生存（OS）的预测指标。
75 例 LABC 患者在 NC 前和中点进行 FDG PET。使用回归方法和接收器操作特性曲线（ROC）下面积（AUC）比较计算和比较 FDG 输送（K1）、FDG 通量（Ki）和 SUV 测量值与临床和病理肿瘤特征之间的关系。使用 Cox 比例风险模型评估 K1、Ki 和 SUV 与 DFS 和 OS 之间的关系。
激素受体阴性、高级别、高增殖性或导管组织学的肿瘤 Ki 和 SUV 值较高；平均而言，FDG K1 并未系统地按肿瘤特征差异。与雌激素受体（ER）和腋窝淋巴结阳性相结合，动力学测量（AUC = 0.97）比 SUV（AUC = 0.84，P = 0.005）更能准确预测病理反应。K1 和 Ki 的变化预测 DFS 和 OS，而 SUV 的变化仅预测 OS。在多变量建模中，只有 K1 的变化仍然是 DFS 和 OS 的独立预后因素。
与静态 SUV 测量值相比，NC 治疗的 LABC 患者的 FDG PET 动力学测量值准确地测量了治疗反应并预测了结果，这表明动力学分析可能比静态摄取测量值具有评估反应的优势。
