基于 PERCIST 标准评估新辅助化疗治疗乳腺癌的疗效：日本多中心研究。
Response to neoadjuvant chemotherapy for breast cancer judged by PERCIST - multicenter study in Japan.
机构信息
Department of Radiology, Division of Nuclear Medicine and PET Center, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
Department of Diagnostic Radiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan.
出版信息
Eur J Nucl Med Mol Imaging. 2018 Sep;45(10):1661-1671. doi: 10.1007/s00259-018-4008-1. Epub 2018 May 12.
PURPOSE
The purpose of this study was to evaluate therapeutic response to neoadjuvant chemotherapy (NAC) and predict breast cancer recurrence using Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST).
MATERIALS AND METHODS
Fifty-nine breast cancer patients underwent fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) before and after NAC prior to planned surgical resection. Pathological complete response (pCR) of the primary tumor was evaluated using PERCIST, while effects of clinicopathological factors on progression-free survival (PFS) were examined using log-rank and Cox methods.
RESULTS
Fifty-six patients and 54 primary tumors were evaluated. Complete metabolic response (CMR), partial metabolic response, stable metabolic disease, and progressive metabolic disease were seen in 45, 7, 3, and 1 patients, respectively, and 43, 7, 3, and 1 primary tumors, respectively. Eighteen (33.3%) of the 54 primary tumors showed pCR. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PERCIST to predict pCR were 100% (18/18), 30.6% (11/36), 41.9% (18/43), 100% (11/11), and 53.7% (29/54), respectively. An optimal percent decrease in peak standardized uptake value for a primary tumor corrected for lean body mass (SULpeak) of 84.3% was found to have a sensitivity of 77.8% (14/18), specificity of 77.8% (28/36), PPV of 63.6% (14/22), NPV of 87.5% (28/32), and accuracy of 77.8% (42/54). Seven (12.5%) of the 56 patients developed recurrent disease (median follow-up 28.1 months, range 11.4-96.4 months). CMR (p = 0.031), pCR (p = 0.024), and early TNM stage (p = 0.033) were significantly associated with longer PFS.
CONCLUSION
PERCIST is useful for predicting pathological response and prognosis following NAC in breast cancer patients. However, FDG-PET/CT showed a tendency toward underestimation of the residual tumor, and relatively low specificity and PPV of PERCIST showed that a combination of other imaging modalities would still be needed to predict pCR.
目的
本研究旨在使用实体瘤正电子发射断层扫描疗效评价标准（PERCIST）评估新辅助化疗（NAC）的治疗反应，并预测乳腺癌复发。
材料与方法
59 例乳腺癌患者在计划行手术切除前接受了氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）检查。使用 PERCIST 评估原发肿瘤的病理完全缓解（pCR），使用对数秩和 Cox 方法检查临床病理因素对无进展生存期（PFS）的影响。
结果
对 56 例患者和 54 个原发肿瘤进行了评估。45 例患者的完全代谢缓解（CMR）、部分代谢缓解、稳定代谢疾病和进展性代谢疾病分别为 4 例、7 例、3 例和 1 例，43 例、7 例、3 例和 1 例分别为 43 例、7 例、3 例和 1 例。18 例（33.3%）原发肿瘤出现 pCR。PERCIST 预测 pCR 的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性分别为 100%（18/18）、30.6%（11/36）、41.9%（18/43）、100%（11/11）和 53.7%（29/54）。发现经瘦体重校正后的最大标准化摄取值百分比下降（SULpeak）84.3%是预测 pCR 的最佳截断值，其敏感性为 77.8%（14/18），特异性为 77.8%（28/36），PPV 为 63.6%（14/22），NPV 为 87.5%（28/32），准确性为 77.8%（42/54）。56 例患者中有 7 例（12.5%）发生复发病例（中位随访 28.1 个月，范围 11.4-96.4 个月）。CMR（p=0.031）、pCR（p=0.024）和早期 TNM 分期（p=0.033）与更长的 PFS 显著相关。
结论
PERCIST 可用于预测乳腺癌患者 NAC 后的病理反应和预后。然而，FDG-PET/CT 显示出低估残留肿瘤的趋势，PERCIST 的特异性和 PPV 相对较低，表明仍需要结合其他成像方式来预测 pCR。
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