Whole-body total lesion glycolysis measured on fluorodeoxyglucose positron emission tomography/computed tomography as a prognostic variable in metastatic breast cancer

Abstract

Background: In this retrospective study, the authors evaluated the prognostic value of whole-body total lesion glycolysis (WTLG) on FDG/PET images in metastatic breast cancer (MBC) patients. Methods: We retrospectively evaluated 54 MBC patients who were diagnosed as having one or more metastatic lesions between June 2005 and March 2013. Twenty-four patients were diagnosed at the initial presentation (group A) and 30 patients were diagnosed for the first time at some point after a surgery (group B). Patients were excluded if they had received chemotherapy within 30 days before PET/CT. SUV max and total TLG were calculated for all lesions in each patient and the highest SUV max and the whole-body TLG (WTLG) values were used as independent variables for the analyses. Mean ages and the proportions of histopathological subtypes were compared between two groups using Mann-Whitney U test and Fisher's exact test, respectively. The prognostic significance of PET parameters was assessed using Cox proportional hazards regression analysis. Results: For groups A and B, the median follow-up period was 26 months (range, 3-58 months) and 40.5 months (range, 3-69 months), and the median age was 61 years (range, 42-81 years) and 59 years (range, 24-74 years), respectively. There were no significant differences between two groups in age (p = 0.294) or histopathological subtype (p = 0.384). In the univariate analyses, WTLG was found to be significantly associated with overall survival (OS) for patients of group A (p = 0.012). In the multivariate analysis, WTLG was also significantly associated with OS (p = 0.015). Only hormonal receptor level was a significant indicator of longer OS in patients with recurrent MBC (group B). Conclusions: This study demonstrated that WTLG on PET/CT is an independent prognostic factor for survival in breast cancer patients with metastases at the initial presentation.

Could semiquantitative FDG analysis add information to the prognosis in patients with stage II/III breast cancer undergoing neoadjuvant treatment?

“…Satoh et al [7] evaluated two groups of patients with metastatic disease at initial staging and at restaging. The authors found that WB TLG was a significant predictor of OS in [16][17][18][19][20][21][22].…”

“…16 is a good predictor of disease progression and overall survival (OS). The usefulness of other measures, such as metabolic tumour volume (MTV) and total lesion glycolysis (TLG), for determining the aggressiveness of tumours and for predicting treatment response has been evaluated; however, although preliminary findings are encouraging, associations between these measures and prognosis have not been found consistently [6,7]. The aim of our study was to investigate whether SUVmax, MTV and TLG, and whole-body (WB) SUVmax, WB MTV and WB TLG can be considered prognostic factors predicting disease-free survival (DFS) and OS in patients with stage II/III breast cancer.…”

Risk stratification in patients with advanced‐stage breast cancer by pretreatment [18F]FDG PET/CT

“…In patients with BC, studies focused mainly on the predictive value of MTV or TLG in treatment response assessment after neoadjuvant therapy, whereas to the best of our knowledge, research regarding the prediction of long‐term survival by MTV or TLG in patients with BC remains limited, especially in patients with advanced‐stage BC. Two studies proved the prognostic value of the total TLG 50% or TLG 42% of metastatic lesions on OS in patients with stage IV disease . However, total TLG measures the sum of TLG of all the lesions, which could be time‐ and energy‐consuming and makes it less practical in daily clinical practice.…”

“…Two studies proved the prognostic value of the total TLG 50% or TLG 42% of metastatic lesions on OS in patients with stage IV disease. 16,17 However, total TLG measures the sum of TLG of all the lesions, which could be time-and energyconsuming and makes it less practical in daily clinical practice. To investigate the relationship between primary tumor burden and prognosis, the current study evaluated the association between TLG of the primary tumor and long-term survival.…”

Total Lesion Glycolysis on 18F-FDG PET/CT of Women with Non-Locally Advanced Breast Cancer: Does it Correlate with CT Density of the Lesion?

“…The TLG was computed for BC mass as metabolic tumor volume (MTV)xSUV-mean [14]. A board-certified nuclear medicine specialist with 15 years of experience interpreted the images and accomplished the measurements.…”