F-FDG PET/CT在三阴性和HER2阳性乳腺癌新辅助治疗期间对腋窝淋巴结反应评估的附加价值
Additional value of F-FDG PET/CT response evaluation in axillary nodes during neoadjuvant therapy for triple-negative and HER2-positive breast cancer.
作者信息
van Ramshorst Mette S, Teixeira Suzana C, Koolen Bas B, Pengel Kenneth E, Gilhuijs Kenneth G, Wesseling Jelle, Rodenhuis Sjoerd, Valdés Olmos Renato A, Rutgers Emiel J, Vogel Wouter V, Sonke Gabe S, Vrancken Peeters Marie-Jeanne T
机构信息
Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
Department of Nuclear Medicine, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
出版信息
Cancer Imaging. 2017 May 25;17(1):15. doi: 10.1186/s40644-017-0117-5.
BACKGROUND
F-FDG PET/CT can monitor metabolic activity in early breast cancer during neoadjuvant systemic therapy (NST), but it is unknown if the metabolic breast and axillary response differ. We evaluated the correlation between metabolic breast and axillary response at various time points during NST. Furthermore, we analysed if the combined metabolic response improves pathologic complete response (pCR) prediction compared to using the metabolic breast response alone.
METHODS
F-FDG PET/CT was performed at baseline (PET1), 2-3 weeks (PET2), and 6-8 weeks (PET3) of NST in patients with triple-negative (TN) and HER2-positive node-positive breast cancer. SUVmax and ∆SUVmax were determined separately for breast and axilla. Spearman's correlation coefficients (r) between both localisations were calculated. The accuracy of pCR total (ypT0/is,ypN0) prediction using the metabolic response in breast, axilla or both was examined using logistic regression analysis.
RESULTS
Hundred-five patients were included: 45 TN and 60 HER2-positive tumours. The metabolic response in breast and axilla correlated moderately in TN tumours (r = 0.57) using ∆SUVmax between PET1-PET3 and poorly in HER2-positive tumours (r = 0.49) using SUVmax at PET2. In TN tumours, metabolic breast response predicted pCR well without improvement after adding axillary response (c-index 0.82 versus 0.85, p = 0.63). In HER2-positive tumours, metabolic breast response predicted pCR poorly with improvement after adding axillary response (c-index 0.64 versus 0.72, p = 0.06).
CONCLUSIONS
F-FDG PET/CT response during NST differs between breast and axilla. In TN tumours, pCR total prediction can be made independent of metabolic axillary response. In HER2-positive tumours, axillary response may improve pCR total prediction. These findings may help guide PET/CT-response-based changes during NST.
TRIAL REGISTRATION
NTR NTR1797 . Registered 29 May 2009, retrospectively registered.
背景
F-FDG PET/CT可在新辅助全身治疗（NST）期间监测早期乳腺癌的代谢活性，但尚不清楚乳腺和腋窝的代谢反应是否存在差异。我们评估了NST期间不同时间点乳腺和腋窝代谢反应之间的相关性。此外，我们分析了与单独使用乳腺代谢反应相比，联合代谢反应是否能改善病理完全缓解（pCR）的预测。
方法
对三阴性（TN）和HER2阳性淋巴结阳性乳腺癌患者在NST的基线（PET1）、2-3周（PET2）和6-8周（PET3）时进行F-FDG PET/CT检查。分别测定乳腺和腋窝的SUVmax和∆SUVmax。计算两个部位之间的Spearman相关系数（r）。使用逻辑回归分析检验单独使用乳腺、腋窝或两者的代谢反应预测pCR总缓解（ypT0/is，ypN0）的准确性。
结果
纳入105例患者：45例TN肿瘤和60例HER2阳性肿瘤。在TN肿瘤中，使用PET1-PET3之间的∆SUVmax，乳腺和腋窝的代谢反应中度相关（r = 0.57）；在HER2阳性肿瘤中，使用PET2时的SUVmax，两者相关性较差（r = 0.49）。在TN肿瘤中，乳腺代谢反应对pCR的预测良好，加入腋窝反应后无改善（c指数0.82对0.85，p = 0.63）。在HER2阳性肿瘤中，乳腺代谢反应对pCR的预测较差，加入腋窝反应后有改善（c指数0.64对0.72，p = 0.06）。
结论
NST期间F-FDG PET/CT反应在乳腺和腋窝之间存在差异。在TN肿瘤中，pCR总缓解的预测可不依赖腋窝代谢反应。在HER2阳性肿瘤中，腋窝反应可能改善pCR总缓解的预测。这些发现可能有助于指导NST期间基于PET/CT反应的治疗调整。
试验注册
NTR NTR1797。2009年5月29日注册，回顾性注册。
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