Gao Yuan, Yin Lei, Ma Linlin, Wu Caixia, Zhu Xiaojuan, Liu Hongjin, Liang Li, Chen Jinzhi, Chen Yulong, Ye Jingming, Xu Ling, Liu Meng
Department of Nuclear Medicine, Peking University First Hospital, No.8, Xishiku Street, West District, Beijing, 100034, China.
Thyroid and Breast Surgery, Peking University First Hospital, Beijing, China.
Cancer Imaging. 2024 Dec 18;24(1):166. doi: 10.1186/s40644-024-00812-6.
Recent advancements in novel anti-human epidermal growth factor receptor 2 (HER2) antibody-drug conjugates (ADCs) have highlighted the emerging HER2-low breast cancer subtype with promising therapeutic efficacy. This study aimed to comparatively analyze the metabolic characteristics and prognostic stratification of HER2-low and HER2-zero breast cancer using baseline fluorine-18 fluorodeoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT) imaging.
Consecutive patients with newly diagnosed breast cancer who underwent F-FDG PET/CT prior to therapy in our hospital were retrospectively reviewed. The relationship between metabolic parameters (maximum standardized uptake value (SUVmax), tumor-to-liver SUV ratio (TLR), total lesion glycolysis (TLG), and metabolic tumor volume (MTV)) in primary lesions and HER2 expression was analyzed. The survival analyses were performed to identify the prognostic factors for disease-free survival (DFS) in patients with HER2-negative (HER2-low versus -zero).
In total, 258 patients (mean age: 54 ± 12 years) were included. In hormone receptor (HR)-positive subgroup, SUVmax and TLR were significantly higher in HER2-low than in HER2-zero (P = 0.045 and 0.03, respectively). But in HR-negative subgroup, there was no significant metabolic difference between HER2-low and HER2-zero (All P > 0.05). The four metabolic parameters were significant predictors of DFS in HER2-negative patients (All P < 0.01), but there was no significant difference in DFS between HER2-low and -zero, regardless of tumor metabolism. Moreover, in HER2-zero patients, the DFS of patients with high metabolism was significantly shorter than that of patients with low metabolism (P = 0.002, P = 0.03, P= 0.005, P < 0.001, respectively), but without a similar finding in HER2-low patients.
Our study demonstrated the HR-positive HER2-low breast cancer exhibited a particularity in glucose metabolic profile. Additionally, HER2-zero patients with elevated metabolism were associated with inferior prognosis and warranted careful attention in clinical evaluations.
新型抗人表皮生长因子受体2（HER2）抗体药物偶联物（ADC）的最新进展突出了具有良好治疗效果的HER2低表达乳腺癌亚型。本研究旨在使用基线氟-18氟脱氧葡萄糖（F-FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）成像，比较分析HER2低表达和HER2零表达乳腺癌的代谢特征和预后分层。
回顾性分析我院连续收治的初治前接受F-FDG PET/CT检查的新发乳腺癌患者。分析原发灶代谢参数（最大标准化摄取值（SUVmax）、肿瘤与肝脏SUV比值（TLR）、总病变糖酵解（TLG）和代谢肿瘤体积（MTV））与HER2表达之间的关系。进行生存分析以确定HER2阴性（HER2低表达与零表达）患者无病生存期（DFS）的预后因素。
共纳入258例患者（平均年龄：54±12岁）。在激素受体（HR）阳性亚组中，HER2低表达组的SUVmax和TLR显著高于HER2零表达组（分别为P = 0.045和0.03）。但在HR阴性亚组中，HER2低表达和HER2零表达之间无显著代谢差异（所有P>0.05）。这四个代谢参数是HER2阴性患者DFS的显著预测因素（所有P<0.01），但无论肿瘤代谢情况如何，HER2低表达和零表达患者的DFS无显著差异。此外，在HER2零表达患者中，高代谢患者的DFS显著短于低代谢患者（分别为P = 0.002、P = 0.03、P = 0.005、P<0.001），但在HER2低表达患者中未发现类似结果。
我们的研究表明，HR阳性HER2低表达乳腺癌在葡萄糖代谢谱方面表现出特殊性。此外，代谢升高的HER2零表达患者预后较差，在临床评估中值得密切关注。
