Tőkés Tímea, Kajáry Kornélia, Szentmártoni Gyöngyvér, Lengyel Zsolt, Györke Tamás, Torgyík László, Somlai Krisztián, Tőkés Anna-Mária, Kulka Janina, Dank Magdolna
Oncological Division, 1st Department of Internal Medicine, Semmelweis University, Tömő utca 25-29, 4th floor, Budapest, 1083, Hungary.
Pozitron PET/CT Center, Hunyadi J. út 9, Budapest, 1117, Hungary.
Breast Cancer. 2017 Jan;24(1):137-146. doi: 10.1007/s12282-016-0685-4. Epub 2016 Mar 15.
(1) To predict pathological complete remission (pCR) and survival after primary systemic therapy (PST) in patients diagnosed with breast cancer by using two different PET/CT based scores: a simplified PERCIST-based PET/CT score (Method 1) and a combined PET/CT score supplemented with the morphological results of the RECIST system (Method 2) and (2) to assess the effect of different breast carcinoma subtypes on tumor response and its evaluation.
Eighty-eight patients were enrolled in the study who underwent PET/CT imaging before and after PST. PET/CTs were evaluated by changes in maximum Standardized Uptake Value (SUVmax) and tumor size. Method 1 and 2 were applied to predict pathological complete remission (pCR). Kaplan-Meier analyses for survival were performed. Classification into biological subtypes was performed based on the pre-therapeutic tumor characteristics.
A total of 30/88 patients showed pCR (34.1 %). Comparing pCR/non-pCR patient groups, significant differences were detected by changes in SUVmax (p < 0.001) and tumor size (p < 0.001) regarding the primary breast lesions. To predict pCR, Method 2 had higher sensitivity (72.4 % vs. 44.8 %) and negative predictive value (57.9 % vs. 45.8 %) with lower false negativity rate (16 vs. 32) than Method 1. pCR rate was higher in Her2-positive and triple negative tumors. Despite the significant differences detected between the biological subtypes regarding changes in primary tumor SUVmax (p = 0.007) and size (p = 0.015), the subtypes only had significant impact on response evaluation with Method 2 and not with Method 1. In our study, neither clinical nor pathological CR were predictors of longer progression-free survival.
Our results suggest that combined PET/CT criteria are more predictive of pCR. The effect of biological subtypes is significant on pCR rate as well as on the changes in FDG-uptake and morphological tumor response. Response evaluation with combined criteria was also able to reflect the differences between the biological behavior of breast tumor subtypes.
（1）使用两种基于PET/CT的不同评分方法预测乳腺癌患者接受一线全身治疗（PST）后的病理完全缓解（pCR）和生存率：一种简化的基于PERCIST的PET/CT评分（方法1）和一种结合了RECIST系统形态学结果的PET/CT综合评分（方法2）；（2）评估不同乳腺癌亚型对肿瘤反应及其评估的影响。
88例患者纳入本研究，这些患者在PST前后均接受了PET/CT成像检查。通过最大标准化摄取值（SUVmax）和肿瘤大小的变化对PET/CT进行评估。应用方法1和方法2预测病理完全缓解（pCR）。进行Kaplan-Meier生存分析。根据治疗前肿瘤特征进行生物学亚型分类。
88例患者中共有30例（34.1%）出现pCR。比较pCR/非pCR患者组，在原发性乳腺病变的SUVmax变化（p<0.001）和肿瘤大小变化（p<0.001）方面检测到显著差异。为预测pCR，方法2比方法1具有更高的敏感性（72.4%对44.8%）和阴性预测值（57.9%对45.8%），假阴性率更低（16对32）。Her2阳性和三阴性肿瘤的pCR率更高。尽管在原发性肿瘤SUVmax变化（p=0.007）和大小（p=0.015）方面，生物学亚型之间检测到显著差异，但这些亚型仅对方法2的反应评估有显著影响，而对方法1没有影响。在我们的研究中，临床或病理CR均不是无进展生存期更长的预测因素。
我们的结果表明，PET/CT综合标准对pCR的预测性更强。生物学亚型对pCR率以及FDG摄取和形态学肿瘤反应的变化均有显著影响。综合标准的反应评估也能够反映乳腺肿瘤亚型生物学行为之间的差异。
