Department of Nuclear Medicine, Centre GF Leclerc, 1 rue du Pr Marion, 21000, Dijon, France,
Eur J Nucl Med Mol Imaging. 2014 Mar;41(3):416-27. doi: 10.1007/s00259-013-2616-3. Epub 2013 Nov 21.
The objective of this study was to evaluate, in the luminal human epidermal growth factor receptor 2 (HER2)-negative breast cancer subtype, the prognostic value of tumour glucose metabolism at baseline and of its early changes during neoadjuvant chemotherapy (NAC).
This prospective study included 61 women with hormone-sensitive HER2-negative breast cancer treated with NAC. (18)F-Fluorodeoxyglucose (FDG) positron emission tomography (PET) was performed at baseline. Hepatic activity was used as a reference to distinguish between low metabolic and hypermetabolic tumours. In hypermetabolic tumours, a PET exam was repeated after the first course of NAC. The relative change in the maximum standardized uptake value of the tumour (∆SUV) was calculated.
Nineteen women had low metabolic luminal breast cancers at baseline, correlated with low proliferation indexes. Forty-two women had hypermetabolic tumours, corresponding to more proliferative breast cancers with higher Ki-67 expression (p = 0.017) and higher grade (p = 0.04). The median follow-up period was 64.2 months (range 11.5-93.2). Thirteen women developed recurrent disease, nine of whom died. Worse overall survival was associated with larger tumour size [>5 cm, hazard ratio (HR) = 6.52, p = 0.009] and with hypermetabolic tumours achieving a low metabolic response after one cycle of NAC (ΔSUV < 16%, HR = 10.63, p = 0.004). Five-year overall survival in these poor responder patients was 49.2%. Overall survival in women with low metabolic tumours or hypermetabolic/good response tumours was 100 and 96.15%, respectively.
In luminal HER2-negative breast tumours, tumour metabolism at baseline and changes after the first course of NAC are early surrogate markers of patients' survival. A subgroup of women with hypermetabolic/poorly responding tumours, correlated with poor prognosis at 5 years, can be identified early. These results may guide future studies by tailoring the NAC regimen to the metabolic response.
本研究旨在评估腔面人表皮生长因子受体 2（HER2）阴性乳腺癌亚型中，基线肿瘤葡萄糖代谢及其新辅助化疗（NAC）早期变化的预后价值。
本前瞻性研究纳入了 61 例接受 NAC 治疗的激素敏感型 HER2 阴性乳腺癌患者。（18）F-氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）在基线时进行。采用肝脏活性作为参考，以区分低代谢和高代谢肿瘤。在高代谢肿瘤中，NAC 第一疗程后重复进行 PET 检查。计算肿瘤最大标准化摄取值（SUV）的相对变化（∆SUV）。
19 例患者在基线时存在低代谢腔面乳腺癌，与低增殖指数相关。42 例患者存在高代谢肿瘤，与增殖性更高、Ki-67 表达更高（p=0.017）和分级更高（p=0.04）的乳腺癌相对应。中位随访时间为 64.2 个月（范围 11.5-93.2）。13 例患者发生复发性疾病，其中 9 例死亡。总生存较差与肿瘤较大有关（>5 cm，风险比[HR] = 6.52，p = 0.009），并且在 NAC 一个周期后达到低代谢反应的高代谢肿瘤（ΔSUV<16%，HR = 10.63，p = 0.004）。这些不良反应患者的 5 年总生存率为 49.2%。低代谢肿瘤或高代谢/良好反应肿瘤患者的 5 年总生存率分别为 100%和 96.15%。
在腔面 HER2 阴性乳腺癌中，基线肿瘤代谢和 NAC 第一疗程后的变化是患者生存的早期替代标志物。可以早期识别出与 5 年预后不良相关的高代谢/反应不良的肿瘤亚组。这些结果可能通过根据代谢反应调整 NAC 方案来指导未来的研究。
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