The prognostic impact of early change in 18F-FDG PET SUV after neoadjuvant chemotherapy in patients with locally advanced breast cancer

Hak Woo Lee, Hak Min Lee, Sung Eun Choi, Hanna Yoo, Sung Gwe Ahn, Min Kyung Lee, Jeong Joon, Woo Hee Jung

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

SUV, which is an indicator of the degree of glucose uptake in 18FFDG PET, can be applied as a prognostic factor in various malignant tumors. We investigated the prognostic impact of early changes in 18F-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 18F-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 5-0.408; P, 0.001). On multivariate analysis, DSUVmax 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 5 0.001) and 0.97 (95% confidence interval, 0.95-0.99; P 5 0.015). When patients were categorized into groups according to pathologic response (RCB index ≤ 1 vs. ≥ 2) and metabolic response (DSUVmax # 66.4% vs%. 66.4%), metabolic responders had significantly better recurrencefree 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 18F-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 DSUVmax should be considered not only for the assessment of tumor response but for the prediction of posttreatment outcome.

Original languageEnglish
Pages (from-to)1183-1188
Number of pages6
JournalJournal of Nuclear Medicine
Volume57
Issue number8
DOIs
Publication statusPublished - 2016 Aug 1

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Fluorodeoxyglucose F18
Residual Neoplasm
Breast Neoplasms
Drug Therapy
Survival
Confidence Intervals
Neoplasms
Multivariate Analysis
Glucose
Recurrence

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

Lee, Hak Woo ; Lee, Hak Min ; Choi, Sung Eun ; Yoo, Hanna ; Ahn, Sung Gwe ; Lee, Min Kyung ; Joon, Jeong ; Jung, Woo Hee. / The prognostic impact of early change in 18F-FDG PET SUV after neoadjuvant chemotherapy in patients with locally advanced breast cancer. In: Journal of Nuclear Medicine. 2016 ; Vol. 57, No. 8. pp. 1183-1188.
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title = "The prognostic impact of early change in 18F-FDG PET SUV after neoadjuvant chemotherapy in patients with locally advanced breast cancer",
abstract = "SUV, which is an indicator of the degree of glucose uptake in 18FFDG PET, can be applied as a prognostic factor in various malignant tumors. We investigated the prognostic impact of early changes in 18F-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 18F-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 5-0.408; P, 0.001). On multivariate analysis, DSUVmax 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 5 0.001) and 0.97 (95{\%} confidence interval, 0.95-0.99; P 5 0.015). When patients were categorized into groups according to pathologic response (RCB index ≤ 1 vs. ≥ 2) and metabolic response (DSUVmax # 66.4{\%} vs{\%}. 66.4{\%}), metabolic responders had significantly better recurrencefree 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 18F-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 DSUVmax should be considered not only for the assessment of tumor response but for the prediction of posttreatment outcome.",
author = "Lee, {Hak Woo} and Lee, {Hak Min} and Choi, {Sung Eun} and Hanna Yoo and Ahn, {Sung Gwe} and Lee, {Min Kyung} and Jeong Joon and Jung, {Woo Hee}",
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The prognostic impact of early change in 18F-FDG PET SUV after neoadjuvant chemotherapy in patients with locally advanced breast cancer. / Lee, Hak Woo; Lee, Hak Min; Choi, Sung Eun; Yoo, Hanna; Ahn, Sung Gwe; Lee, Min Kyung; Joon, Jeong; Jung, Woo Hee.

In: Journal of Nuclear Medicine, Vol. 57, No. 8, 01.08.2016, p. 1183-1188.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The prognostic impact of early change in 18F-FDG PET SUV after neoadjuvant chemotherapy in patients with locally advanced breast cancer

AU - Lee, Hak Woo

AU - Lee, Hak Min

AU - Choi, Sung Eun

AU - Yoo, Hanna

AU - Ahn, Sung Gwe

AU - Lee, Min Kyung

AU - Joon, Jeong

AU - Jung, Woo Hee

PY - 2016/8/1

Y1 - 2016/8/1

N2 - SUV, which is an indicator of the degree of glucose uptake in 18FFDG PET, can be applied as a prognostic factor in various malignant tumors. We investigated the prognostic impact of early changes in 18F-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 18F-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 5-0.408; P, 0.001). On multivariate analysis, DSUVmax 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 5 0.001) and 0.97 (95% confidence interval, 0.95-0.99; P 5 0.015). When patients were categorized into groups according to pathologic response (RCB index ≤ 1 vs. ≥ 2) and metabolic response (DSUVmax # 66.4% vs%. 66.4%), metabolic responders had significantly better recurrencefree 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 18F-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 DSUVmax should be considered not only for the assessment of tumor response but for the prediction of posttreatment outcome.

AB - SUV, which is an indicator of the degree of glucose uptake in 18FFDG PET, can be applied as a prognostic factor in various malignant tumors. We investigated the prognostic impact of early changes in 18F-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 18F-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 5-0.408; P, 0.001). On multivariate analysis, DSUVmax 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 5 0.001) and 0.97 (95% confidence interval, 0.95-0.99; P 5 0.015). When patients were categorized into groups according to pathologic response (RCB index ≤ 1 vs. ≥ 2) and metabolic response (DSUVmax # 66.4% vs%. 66.4%), metabolic responders had significantly better recurrencefree 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 18F-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 DSUVmax should be considered not only for the assessment of tumor response but for the prediction of posttreatment outcome.

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