Lee Jeong Won, Kim Sung Yong, Han Sun Wook, Lee Jong Eun, Lee Hyun Ju, Heo Nam Hun, Lee Sang Mi
Department of Nuclear Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Simgok-ro 100-gil 25, Seo-gu, Incheon, 22711, South Korea.
Department of Surgery, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, Chungcheongnam-do, 31151, South Korea.
EJNMMI Res. 2020 Jun 30;10(1):72. doi: 10.1186/s13550-020-00660-y.
The objective of this study was to investigate the prognostic value of 2-Deoxy-2-[F]fluoro-D-glucose ([F]FDG) uptake of bone marrow (BM) and metabolic parameters of primary tumor on positron emission tomography/computed tomography (PET/CT) for predicting distant recurrence in patients with breast cancer.
Pretreatment [F]FDG PET/CT images of 345 breast cancer patients were retrospectively evaluated. Maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis (TLG) of primary breast cancer and bone marrow-to-liver uptake ratio (BLR) on PET/CT were measured. A Cox proportional hazard regression model was used to evaluate the prognostic potential of parameters for predicting recurrence-free survival (RFS) and distant RFS. For Kaplan-Meier analysis, the specific cutoff values pf BLR and TLG were determined by the maximal chi-square method.
The median follow-up duration of the enrolled patients was 48.7 months, and during follow-up, 36 patients (10.4%) experienced the cancer recurrence. BLR was significantly correlated with T stage, serum inflammatory markers, and recurrence pattern (p < 0.05). Patients with high BLR and TLG showed worse RFS and distant RFS than those with low BLR and TLG. On multivariate analysis, BLR was significantly associated with both RFS and distant RFS after adjusting for T stage, estrogen receptor status, and TLG (p = 0.001 for both). Only 0.5% of patients with TLG < 9.64 g and BLR < 0.91 experienced distant recurrence. However, patients with TLG ≥ 9.64 g and BLR ≥ 0.91 had a distant recurrence rate of 40.7%.
BLR on pretreatment [F]FDG PET/CT were significant predictors for RFS and distant RFS in patients with breast cancer. By combining [F]FDG uptake of BM and volumetric PET/CT index of breast cancer, the risk of distant recurrence could be stratified.
本研究的目的是探讨正电子发射断层扫描/计算机断层扫描（PET/CT）上骨髓的2-脱氧-2-[F]氟-D-葡萄糖（[F]FDG）摄取及原发性肿瘤的代谢参数对预测乳腺癌患者远处复发的预后价值。
回顾性评估345例乳腺癌患者的治疗前[F]FDG PET/CT图像。测量原发性乳腺癌的最大标准化摄取值、代谢肿瘤体积和总病变糖酵解（TLG）以及PET/CT上的骨髓与肝脏摄取比值（BLR）。采用Cox比例风险回归模型评估各参数预测无复发生存期（RFS）和远处无复发生存期的预后潜力。对于Kaplan-Meier分析，通过最大卡方法确定BLR和TLG的特定临界值。
纳入患者的中位随访时间为48.7个月，随访期间，36例患者（10.4%）出现癌症复发。BLR与T分期、血清炎症标志物和复发模式显著相关（p<0.05）。高BLR和TLG的患者比低BLR和TLG的患者表现出更差的RFS和远处RFS。多因素分析显示，在调整T分期、雌激素受体状态和TLG后，BLR与RFS和远处RFS均显著相关（两者p均=0.001）。TLG<9.64g且BLR<0.91的患者中只有0.5%发生远处复发。然而，TLG≥9.64g且BLR≥0.91的患者远处复发率为40.7%。
治疗前[F]FDG PET/CT上的BLR是乳腺癌患者RFS和远处RFS的重要预测指标。通过结合骨髓的[F]FDG摄取和乳腺癌的PET/CT体积指数，可以对远处复发风险进行分层。
