Harmonized pretreatment quantitative volume-based FDG-PET/CT parameters for prognosis of stage I-III breast cancer: Multicenter study

Kitajima, Kazuhiro; Miyoshi, Yasuo; Sekine, Tetsuro; Takei, Hiroyuki; Ito, Kimiteru; Suto, Akihiko; Kaida, Hayato; Ishii, Kazunari; Daisaki, Hiromitsu; Yamakado, Koichiro

doi:10.18632/oncotarget.27851

Cited by 17 publications

(11 citation statements)

References 23 publications

(40 reference statements)

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“…Both SUVmax and SUVpeak were superior parameters of response than TLG in 36 patients with MBC (19). Kitajima et al examined the highest SUVmax of all lesions, whole-body MTV, and whole-body TLG in 65 patients with Stage IV and demonstrated that whole-body TLG was a significant predictor for OS, but the difference in PFS of the first-line therapy was marginal (p=0.057) (20). In contrast, Li et al reported that PFS of first-line therapy was significantly associated with SUVmax, SUVmean, MTV, and TLG levels at baseline in 177 patients with MBC (21).…”

Section: Discussionmentioning

confidence: 99%

“…Thus, the predictive significance of MTV and TLG has yet to be discovered so far. The studies conducted by Kitajima et (20,21). The MTV and TLG were significantly associated with PFS in patients with the triple negative subtype (n=60, p=0.001 and p=0.023, respectively) but not in those with the hormone receptor (HR)-positive/HER2-negative subtype (n=87, p=0.151 and p=0.151, respectively) (21).…”

Section: Discussionmentioning

confidence: 99%

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Total Lesion Glycolysis Levels as Predictive Indicators in Patients With Metastatic and Recurrent Breast Cancer Undergoing Endocrine Therapy With or Without CDK4/6 Inhibitor

et al. 2022

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Background/Aim: Endocrine therapy (ET) with or without CDK4/6 inhibitors is the primary treatment choice for patients with estrogen receptor (ER)-positive and HER2-negative subtype of metastatic breast cancer (MBC). We examined the metabolic parameters identified using 18 Ffluorodeoxyglucose-positron emission tomography (FDG-PET) in terms of sensitivity, since no predictive factors exist. Patients and Methods: We included 136 patients with MBC treated with ET alone (n=107) or combined with CDK4/6 inhibitor (n=29) and examined using FDG-PET before treatment began. The highest maximum value of the standard uptake value (SUVmax), whole-body metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were calculated. Results: Progression-free survival (PFS) was significantly longer in patients with low levels of MTV, TLG, and SUVmax than those with higher levels (median PFS 49.5 vs. 20.7 months, p=0.001 for MTV, 49.5 vs. 20.7 months, p=0.0016 for TLG, 37.0 vs. 20.7 months, p=0.012 for SUVmax). Multivariable analysis revealed that TLG (hazard ratio=6.383, 95% confidence interval=1.167-34.913, p=0.033) was independently and significantly associated with PFS. The relationship between TLG levels and PFS was significant in patients treated with ET with (p=0.0054) and without (p=0.0188) CDK4/6 inhibitor. Conclusion: TLG at baseline was a significant predictor for sensitivity to ET alone or combined with CDK4/6 inhibitor. These data may be useful to identify patients that would benefit from ET.Cyclin-dependent kinase 4/6 (CDK4/6) inhibitor plus endocrine therapy (ET) is recommended as the first-line therapy for patients with estrogen receptor (ER)-positive and human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer (MBC), except for those with visceral crisis (1, 2). From 2017 to 2018, 9.3% and 64.3% of patients with ER-positive/ HER2-negative MBC were treated with ET alone and the combination of ET with CDK4/6 inhibitor, respectively, as first-line therapy (3). However, predictive factors for ET with or without CDK4/6 inhibitor have yet to be identified. Clinically useful biomarkers that can be used in daily practice as alternatives to ER or HER2 status to select agents that would serve as effective treatments are urgently needed.Clinicopathological factors including tumor grade, ER, progesterone receptor (PgR), HER2, and Ki67 are considered as prognostic factors; however, only ER is a significant predictive factor for ET (4). In the phase III FALCON study, which compared first-line treatment with anastrozole and fulvestrant for patients with MBC, longer progression-free survival (PFS) was demonstrated in the fulvestrant arm. Interestingly, in the subgroup analysis, improved PFS was consistently recognized in the non-visceral diseases, but not visceral diseases [hazard ratio (HR)=0.59, 95% confidence interval (95%CI)=0.42-0.84, median PFS 13.8 vs. 22.3 months for non-visceral diseases; HR=0.99, 95%CI=0.74-4813

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Total Lesion Glycolysis Levels as Predictive Indicators in Patients With Metastatic and Recurrent Breast Cancer Undergoing Endocrine Therapy With or Without CDK4/6 Inhibitor

et al. 2022

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“…The SUVmax in different anatomical regions was related to the overall risk of death. There is a growing recognition that quantitative continuous SUVmax and other SUV metrics have an important prognostic role[ 39 ]. Our study adds to the evidence that SUVmax as a continuous variable improves the power of the analysis to optimize research yield, which can be particularly important when the resources and number of patients are restricted.…”

Section: Discussionmentioning

confidence: 99%

Is there utility for fluorine-18-fluorodeoxyglucose positron-emission tomography scan before surgery in breast cancer? A 15-year overall survival analysis

Perrin¹,

Farid²,

Parijs³

et al. 2022

WJCO

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BACKGROUND The prognostic value of preoperative fluorine-18-fluorodeoxyglucose positron-emission tomography ( 18 F-FDG PET) scan for determining overall survival (OS) in breast cancer (BC) patients is controversial. AIM To evaluate the OS predictive value of preoperative PET positivity after 15 years. METHODS We performed a retrospective search of the Universitair Ziekenhuis Brussel patient database for nonmetastatic patients who underwent preoperative PET between 2002-2008. PET positivity was determined by anatomical region of interest (AROI) findings for breast and axillary, sternal, and distant sites. The prognostic role of PET was examined as a qualitative binary factor (positive vs negative status) and as a continuous variable [maximum standard uptake value (SUVmax)] in multivariate survival analyses using Cox proportional hazards models. Among the 104 identified patients who received PET, 36 were further analyzed for the SUVmax in the AROI. RESULTS Poor OS within the 15-year study period was predicted by PET-positive status for axillary ( P = 0.033), sternal ( P = 0.033), and combined PET-axillary/sternal ( P = 0.008) nodes. Poor disease-free survival was associated with PET-positive axillary status ( P = 0.040) and combined axillary/sternal status ( P = 0.023). Cox models confirmed the long-term prognostic value of combined PET-axillary/sternal status [hazard ratio (HR): 3.08, 95% confidence interval: 1.42-6.69]. SUVmax of ipsilateral breast and axilla as continuous covariates were significant predictors of long-term OS with HRs of 1.25 ( P = 0.048) and 1.54 ( P = 0.029), corresponding to relative increase in the risk of death of 25% and 54% per SUVmax unit, respectively. In addition, the ratio of the ipsilateral axillary SUVmax over the contralateral axillary SUVmax was the most significant OS predictor ( P = 0.027), with 1.94 HR, indicating a two-fold relative increase of mortality risk. CONCLUSION Preoperative PET is valuable for prediction of long-term survival. Ipsilateral axillary SUVmax ratio over the uninvolved side represents a new prognostic finding that warrants further investigation.

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“…Changes in harmonized SUVs correlated well with overall survival of NSCLC patients. Kitajima et al [ 63 ] investigated relationships of prognosis for stage I–III breast cancer patients and pre-treatment FDG-PET/CT-derived quantitative metrics. They harmonized maximum SUVs of the image quality phantom among five PET/CT scanners according to the JSNM harmonization method.…”

Section: Introductionmentioning

confidence: 99%

A review of harmonization strategies for quantitative PET

et al. 2023

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PET can reveal in vivo biological processes at the molecular level. PET-derived quantitative values have been used as a surrogate marker for clinical decision-making in numerous clinical studies and trials. However, quantitative values in PET are variable depending on technical, biological, and physical factors. The variability may have a significant impact on a study outcome. Appropriate scanner calibration and quality control, standardization of imaging protocols, and any necessary harmonization strategies are essential to make use of PET as a biomarker with low bias and variability. This review summarizes benefits, limitations, and remaining challenges for harmonization of quantitative PET, including whole-body PET in oncology, brain PET in neurology, PET/MR, and non-18F PET imaging. This review is expected to facilitate harmonization of quantitative PET and to promote the contribution of PET-derived biomarkers to research and development in medicine.

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Harmonized pretreatment quantitative volume-based FDG-PET/CT parameters for prognosis of stage I-III breast cancer: Multicenter study

Cited by 17 publications

References 23 publications

Total Lesion Glycolysis Levels as Predictive Indicators in Patients With Metastatic and Recurrent Breast Cancer Undergoing Endocrine Therapy With or Without CDK4/6 Inhibitor

Total Lesion Glycolysis Levels as Predictive Indicators in Patients With Metastatic and Recurrent Breast Cancer Undergoing Endocrine Therapy With or Without CDK4/6 Inhibitor

Is there utility for fluorine-18-fluorodeoxyglucose positron-emission tomography scan before surgery in breast cancer? A 15-year overall survival analysis

A review of harmonization strategies for quantitative PET

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