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그림 1. SUV 감소량과 RCB지수와의 상관관계 : RCB 지수가 낮을수록 SUV감소량의 평균값이 크다는 것을 보여줌​

그림 2. SUV 감소량에 따른 무병생존 및 전체생존의 차이

 

그림 3. SUV 감소량과 RCB지수를 이용하여 환자를 4가지 그룹으로 나누어 시행한 생존분석​

Abstract

SUV, which is an indicator of the degree of glucose uptake in (18)F-FDG PET, can be applied as a prognostic factor in various malignant tumors. We investigated the prognostic impact of early changes in (18)F-FDG PET uptake in patients with locally advanced breast cancer who received neoadjuvant chemotherapy.

METHODS:

We retrospectively identified 87 patients who were treated with neoadjuvant chemotherapy followed by surgery for locally advanced breast cancer. All patients underwent (18)F-FDG PET at baseline and after 3 cycles of neoadjuvant chemotherapy, and the SUVmax of the primary tumor was assessed in each scan. Pathologic slides were retrospectively reviewed, and the residual cancer burden (RCB) index was calculated to estimate pathologic response. RCB-0 indicates no residual disease; patients with residual disease were categorized as RCB-1 (minimal residual disease), RCB-2 (moderate residual disease), or RCB-3 (extensive residual disease).

RESULTS:

There was a negative correlation between reduction in SUVmax and RCB index (r = -0.408; P < 0.001). On multivariate analysis, ΔSUVmax was a significant independent prognostic factor for recurrence-free and overall survival, and the respective adjusted hazard ratios were 0.97 (95% confidence interval, 0.95-0.99; P = 0.001) and 0.97 (95% confidence interval, 0.95-0.99; P = 0.015). When patients were categorized into groups according to pathologic response (RCB index ≤ 1 vs. ≥ 2) and metabolic response (ΔSUVmax ≤ 66.4% vs. > 66.4%), metabolic responders had significantly better recurrence-free and overall survival than metabolic nonresponders among poor-pathologic-response patients. In contrast, among metabolic responders, there was no survival difference according to pathologic response.

CONCLUSION:

The early change in (18)F-FDG PET SUVmax after third-cycle neoadjuvant chemotherapy is an independent and good prognostic marker beyond pathologic response in patients with locally advanced breast cancer. We suggest that in these patients, the use of ΔSUVmax should be considered not only for the assessment of tumor response but for the prediction of posttreatment outcome.

Author information​

Lee HW1, Lee HM2, Choi SE3, Yoo H4, Ahn SG1, Lee MK5, Jeong J6, Jung WH3.

1Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

2Department of Surgery, MizMedi Women's Hospital, Seoul, Republic of Korea.

3Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

4Biostatistics Collaboration Lab, Yonsei University College of Medicine, Seoul, Republic of Korea; and.

5Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

6Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea gsjjoon@yuhs.ac.