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Abstract
Glucose utilization by visceral adipose tissue (VAT) reflects inflammatory activity, which also promotes tumor growth and carcinogenesis. The effect of metabolically active VAT on survival outcomes in breast cancer is unknown. We investigated survival outcomes in patients with breast cancer based on the standardized uptake value (SUV) of VAT (SUVmean-VAT) using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). A total of 148 patients with breast cancer were divided into high- and low groups according to their SUVmean-VAT and SUVmax-tumor. Clinical characteristics and survival outcomes were compared between the groups. High SUVmean-VAT was associated with poor recurrence-free survival (RFS; hazard ratio [HR], 2.754; 95% confidence interval [CI], 1.090-6.958, p = 0.032) and distant metastasis-free survival (DMFS; HR, 3.500; 95% CI, 1.224-10.01, p = 0.019). Multivariate analysis showed that high SUVmean-VAT was a significant factor for poor RFS and poor DMFS (p = 0.023 and 0.039, respectively). High SUVmax-tumor was significantly associated with short RFS (p = 0.0388). Tumors with a high SUV tended to have a short DMFS, although the difference was not significant (p = 0.0718). Our findings showed that upregulated glucose metabolism in the VAT measured using 18F-FDG PET/CT may be a prognostic biomarker for adverse outcomes in breast cancer.

Figure 1. Representative images of (A) 18F-FDG uptake of visceral adipose tissue (VAT) according to the breast cancer recurrence status and (B) their corresponding magnified views. CT: computed tomography, PET: positron emission tomography, Recur: Recurrence.

Figure 2. Kaplan–Meier survival curves of (A) recurrence-free survival (RFS) and (B) distant metastasis-free survival (DMFS) according to the 18F-FDG uptake of visceral adipose tissue (VAT). Patients with high SUV-VAT showed a poorer RFS and DMFS, (A, hazard ratio 2.754, 95% confidence interval [CI] 1.090–6.958, p=0.032; B, HR 3.500, 95% CI 1.224–10.01, p=0.019, respectively).

Affiliations

Hyun Jeong Kim 1, Dooreh Kim 2, Soong June Bae 3 4, Sung Gwe Ahn 3 4, Joon Jeong 3 4, Woo-Chan Park 2, Young Hoon Ryu 5, Tae Joo Jeon 5, Yangkyu Lee 4 6, Yoon Jin Cha 7 8, Chang Ik Yoon 9
1Department of Nuclear Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea.
2Division of Breast Surgery, Department of Surgery, College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea.
3Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
4Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
5Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
6Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonju-Ro 211, Gangnam-Gu, Seoul, 06273, Republic of Korea.
7Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea. yooncha@yuhs.ac.
8Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonju-Ro 211, Gangnam-Gu, Seoul, 06273, Republic of Korea. yooncha@yuhs.ac.
9Division of Breast Surgery, Department of Surgery, College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea. fayn03@catholic.ac.kr.