The Prognostic Impact of Early Change in 18F-FDG PET SUV After Neoadjuvant Chemotherapy in Patients with Locally Advanced Breast Cancer
Journal of Nuclear Medicine
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
... went 18 F-FDG PET at baseline and after 3 cycles of neoadjuvant chemotherapy, and the SUV max 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 SUV max and RCB index (r 5 −0.408; P , 0.001). On multivariate analysis, DSUV max 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 (DSUV max # 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 18 F-FDG PET SUV max 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.