Lebon Vincent, Alberini Jean-Louis, Pierga Jean-Yves, Diéras Véronique, Jehanno Nina, Wartski Myriam
Service de Médecine Nucléaire, Institut Curie, Paris, France
Service de Médecine Nucléaire, Institut Curie, Saint-Cloud, France.
J Nucl Med. 2017 Feb;58(2):252-257. doi: 10.2967/jnumed.116.178749. Epub 2016 Sep 1.
Women who have breast cancer and are younger than 40 y have a poorer outcome than older women. A higher rate of undetected metastases at the time of diagnosis in younger women has been proposed to account for this difference. Our main objective was to test this hypothesis by comparing the distant metastasis rate (DMR) on initial F-FDG PET/CT in a group of breast cancer patients younger than 40 y (<40 y group) with that in a group of breast cancer patients older than 40 y (≥40 y group). An assessment of associations between distant metastases and tumor characteristics was a second objective of the present study.
A retrospective single-institution study was performed on women who had breast cancer and no prior malignancy, who were asymptomatic for metastatic lesions on initial clinical examination, and who had initial F-FDG PET/CT within 3 mo after pathologic breast cancer diagnosis and before initial treatment. On the basis of these criteria, data for 2 groups of women differing only in age (<40 y and ≥40 y) were extracted from the hospital information system of Curie Institute-Paris. F-FDG PET/CT examinations were reviewed, and the DMR was recorded for each clinical stage subgroup (stages I-III).
For each group (<40 y and ≥40 y), 107 patients were included, with the same number of patients in each clinical stage subgroup (12 stage I patients, 32 stage IIA patients, 30 stage IIB patients, and 33 stage III patients). The ages of the patients (mean ± SD) were 34.5 ± 4.0 y (<40 y group) and 56.0 ± 10.7 y (≥40 y group). No significant difference in DMRs was observed between the <40 y group and the ≥40 y group (DMRs, 21% and 22%, respectively; P = 1). The DMRs in patients not selected for age were 8% for stage I, 11% for stage IIA, 15% for stage IIB, and 44% for stage III.
The DMR was not significantly higher in younger breast cancer patients (<40 y) than in older breast cancer patients (≥40 y), ruling out the assumption that undetected metastases at diagnosis explain the poorer outcome of younger women. However, our results highlight the high yield of F-FDG PET/CT for initial breast cancer staging, even in stage II patients, whatever their age.
患有乳腺癌且年龄小于40岁的女性比年龄较大的女性预后更差。有人提出，年轻女性在诊断时未被检测到的转移率较高是造成这种差异的原因。我们的主要目的是通过比较一组年龄小于40岁的乳腺癌患者（<40岁组）与一组年龄大于40岁的乳腺癌患者（≥40岁组）初始F-FDG PET/CT上的远处转移率（DMR）来验证这一假设。评估远处转移与肿瘤特征之间的关联是本研究的第二个目的。
对患有乳腺癌且既往无恶性肿瘤、初始临床检查时无转移病灶症状、在病理诊断乳腺癌后3个月内且在初始治疗前进行初始F-FDG PET/CT检查的女性进行了一项回顾性单机构研究。基于这些标准，从巴黎居里研究所的医院信息系统中提取了仅年龄不同的两组女性（<40岁和≥40岁）的数据。对F-FDG PET/CT检查进行了回顾，并记录了每个临床分期亚组（I-III期）的DMR。
每组（<40岁和≥40岁）纳入107例患者，每个临床分期亚组的患者数量相同（12例I期患者、32例IIA期患者、30例IIB期患者和33例III期患者）。患者的年龄（均值±标准差）分别为34.5±4.0岁（<40岁组）和56.0±10.7岁（≥40岁组）。<40岁组和≥40岁组之间未观察到DMR有显著差异（DMR分别为21%和22%；P=1）。未按年龄选择的患者中，I期的DMR为8%，IIA期为11%，IIB期为15%，III期为44%。
年龄小于40岁的年轻乳腺癌患者的DMR并不显著高于年龄大于40岁的老年乳腺癌患者，排除了诊断时未检测到的转移解释年轻女性预后较差的假设。然而，我们的结果强调了F-FDG PET/CT对初始乳腺癌分期的高检出率，即使是II期患者，无论其年龄大小。
