Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), 75 Nowongil, Nowon Gu, Seoul, 139-706, Korea.
Eur J Nucl Med Mol Imaging. 2014 Oct;41(10):1852-60. doi: 10.1007/s00259-014-2797-4. Epub 2014 Jun 14.
The aim of this study was to investigate the potential of FDG PET/CT and MRI in predicting disease-free survival (DFS) after neoadjuvant chemotherapy (NAC) and surgery in patients with advanced breast cancer.
The analysis included 54 women with advanced breast cancer. All patients received three cycles of NAC, underwent curative surgery, and then received three cycles of additional chemotherapy. Before and after the first cycle of NAC, all patients underwent sequential PET/CT and MRI. All patients were analysed using a diverse range of parameters. including maximal standardized uptake value (SUV), percent change in SUV (ΔSUV), initial slope of the enhancement curve (MRslope), apparent diffusion coefficient (ADC), tumour size, change in MRslope (ΔMRslope), change in ADC (ΔADC), change in tumour size (Δsize) and other clinicopathological parameters]. The relationships between covariates and DFS after surgery were analysed using the Kaplan-Meier method and the multivariate Cox proportional hazards model. Time-dependent receiver operating characteristic curves were used to determine the optimal cut-off values of imaging parameters for DFS.
Of the 54 patients, 13 (24 %) experienced recurrence at a median follow-up of 38 months (range 25 - 45 months). Univariate and multivariate analyses showed that a lesser decline in SUV, a lesser decline in MRslope, a lesser increase in ADC, and ER negativity were significantly associated with a poorer DFS (P = 0.0006, ΔSUV threshold -41 %; P = 0.0016, ΔMRslope threshold -6 %; P = 0.011, ΔADC threshold 11 %; and P = 0.0086, ER status, respectively). Patients with a combination of ΔSUV >-41 % and ΔMRslope >-6 % showed a significantly higher recurrence rate (77.8 %) than the remaining of patients (13.3 %, P < 0.0001).
Functional parameters of both FDG PET and MRI after the first cycle of NAC are useful for predicting DFS in patients with advanced breast cancer. This approach could lead to an improvement in patient care because ineffective NAC agents could be avoided and more aggressive therapy could be used in high-risk patients.
本研究旨在探讨 18F-FDG PET/CT 和 MRI 在预测新辅助化疗（NAC）和手术治疗晚期乳腺癌患者无病生存（DFS）方面的潜力。
分析纳入了 54 例晚期乳腺癌患者。所有患者均接受了 3 个周期的 NAC，接受了根治性手术，然后接受了 3 个周期的辅助化疗。在 NAC 的第一个周期前后，所有患者均接受了连续的 PET/CT 和 MRI 检查。所有患者均使用多种参数进行了分析，包括最大标准化摄取值（SUV）、SUV 变化百分比（ΔSUV）、初始强化曲线斜率（MRslope）、表观扩散系数（ADC）、肿瘤大小、MRslope 变化（ΔMRslope）、ADC 变化（ΔADC）、肿瘤大小变化（Δsize）和其他临床病理参数。使用 Kaplan-Meier 方法和多变量 Cox 比例风险模型分析协变量与手术后 DFS 之间的关系。使用时间依赖性受试者工作特征曲线确定预测 DFS 的影像学参数的最佳截断值。
54 例患者中，13 例（24%）在中位随访 38 个月（25-45 个月）时复发。单因素和多因素分析显示，SUV 下降幅度较小、MRslope 下降幅度较小、ADC 增加幅度较小、ER 阴性与较差的 DFS 显著相关（P=0.0006，SUV 下降阈值-41%；P=0.0016，MRslope 下降阈值-6%；P=0.011，ADC 增加阈值 11%；P=0.0086，ER 状态）。ΔSUV＞-41%和ΔMRslope＞-6%的患者复发率明显高于其余患者（77.8%比 13.3%，P＜0.0001）。
NAC 第一个周期后 FDG PET 和 MRI 的功能参数可用于预测晚期乳腺癌患者的 DFS。这种方法可以改善患者的治疗效果，因为可以避免无效的 NAC 药物，并在高危患者中使用更积极的治疗方法。
