18F-FDG PET/CT在预测局部晚期乳腺癌患者新辅助治疗反应中的作用
The Role of 18F-FDG PET/CT in Predicting the Neoadjuvant Treatment Response in Patients with Locally Advanced Breast Cancer.
作者信息
Goktas Aydin Sabin, Bilici Ahmet, Olmez Omer Fatih, Oven Basak B, Acikgoz Ozgur, Cakir Tansel, Basim Pelin, Cakir Asli, Kutlu Yasin, Hamdard Jamshid
机构信息
aDepartment of Medical Oncology, Medical Faculty, Istanbul Medipol University, Istanbul, Turkey.
bDepartment of Medical Oncology, Medical Faculty, Bahcesehir University, Istanbul, Turkey.
出版信息
Breast Care (Basel). 2022 Oct;17(5):470-479. doi: 10.1159/000524446. Epub 2022 May 3.
PURPOSE
Patients with locally advanced breast cancer (LABC) should be treated with neoadjuvant chemotherapy (NAC). Pathological complete response (pCR) is related to better disease-free survival (DFS). The best strategy for assessing the efficacy of NAC has not been established yet, but several studies have shown that 18F-FDG PET/CT is a potential imaging tool for assessing pCR. The aim of this study is to investigate the merits of 18F-FDG PET/CT imaging in predicting pCR in both axillary and breast tissue and to establish a threshold maximum standard uptake value (SUVmax) for predicting the response after completion of NAC.
METHODS
A total of 186 LABC patients, treated with an NAC regimen according to tumor subtype, were retrospectively analyzed in this study. All patients underwent 18F-FDG PET/CT imaging before and after completion of NAC. PET parameters were measured in the most FDG avid breast tissue and axillary lymph nodes. We analyzed the correlation between the tumor SUVmax of the PET/CT response and the pCR after surgery. DFS was also evaluated with respect to pCR.
RESULTS
Higher pCR rates were significantly associated with a higher tumor grade, an initial Ki-67 ≥20% ( = 0.03 and = 0.003, respectively), a triple-negative subtype (32.9%), and a human epidermal growth factor receptor 2 (HER-2)-positive subtype (24.7%) ( < 0.001). There was a significant correlation between the pCR and a complete response in 18F-FDG PET/CT ( < 0.001). The overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 18F-FDG PET/CT to determine the pCR after NAC were 100%, 72.2%, 85%, 75.2%, and 100%, respectively. We demonstrated a 1.1 cutoff SUVmax for breast tumors after NAC (OR: 3.94, 95% CI: 1.14-5.05, = 0.004), the 18F-FDG PET/CT response to NAC (OR: 0.50, 95% CI: 0.25-0.99, = 0.003), and the molecular subtype of breast tumors (OR: 0.58, 95% CI: 0.38-0.88, = 0.011).
CONCLUSION
Our results confirm that 18F-FDG PET/CT is a useful method for predicting the NAC response in LABC.
目的
局部晚期乳腺癌（LABC）患者应接受新辅助化疗（NAC）。病理完全缓解（pCR）与更好的无病生存期（DFS）相关。评估NAC疗效的最佳策略尚未确立，但多项研究表明，18F-FDG PET/CT是评估pCR的一种潜在影像学工具。本研究的目的是探讨18F-FDG PET/CT成像在预测腋窝和乳腺组织pCR方面的优点，并建立一个预测NAC完成后反应的最大标准摄取值（SUVmax）阈值。
方法
本研究回顾性分析了186例根据肿瘤亚型接受NAC方案治疗的LABC患者。所有患者在NAC完成前后均接受了18F-FDG PET/CT成像。在最摄取FDG的乳腺组织和腋窝淋巴结中测量PET参数。我们分析了PET/CT反应的肿瘤SUVmax与术后pCR之间的相关性。还根据pCR评估了DFS。
结果
更高的pCR率与更高的肿瘤分级、初始Ki-67≥20%（分别为P = 0.03和P = 0.003）、三阴性亚型（32.9%）和人表皮生长因子受体2（HER-2）阳性亚型（24.7%）显著相关（P < 0.001）。pCR与18F-FDG PET/CT中的完全反应之间存在显著相关性（P < 0.001）。18F-FDG PET/CT确定NAC后pCR的总体敏感性、特异性、准确性、阳性预测值和阴性预测值分别为100%、72.2%、85%、75.2%和100%。我们证明NAC后乳腺肿瘤的SUVmax临界值为1.1（OR：3.94，95%CI：1.14 - 5.05，P = 0.004），18F-FDG PET/CT对NAC的反应（OR：0.50，95%CI：0.25 - 0.99，P = 0.003），以及乳腺肿瘤的分子亚型（OR：0.58，95%CI：0.38 - 0.88，P = 0.011）。
结论
我们的结果证实18F-FDG PET/CT是预测LABC中NAC反应的一种有用方法。
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