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Stratifying triple-negative breast cancer prognosis using 18F-FDG-PET/CT imaging.

Yue Y, Cui X, Bose S, Audeh W, Zhang X, Fraass B - Breast Cancer Res. Treat. (2015)

Bottom Line: The risk stratification with integrative EGFR and PET was statistically significant with log-rank p ≪ 0.001.Pre-treatment 18F-FDG-PET/CT imaging has significant prognostic value for predicting survival outcome of TNBC patients.Integrated with basal-biomarker EGFR, PET imaging can further stratify patient risks in the pre-treatment stage and help select appropriate treatment strategies for individual patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA. yong.yue@cshs.org.

ABSTRACT
This study aims to stratify prognosis of triple-negative breast cancer (TNBC) patients using pre-treatment 18F-FDG-PET/CT, alone and with correlation to immunohistochemistry biomarkers. 200 consecutive TNBC breast cancer patients treated between 2008 and 2012 were retrieved. Among the full cohort, 79 patients had pre-treatment 18F-FDG-PET/CT scans. Immunostaining status of basal biomarkers (EGFR, CK5/6) and other clinicopathological variables were obtained. Three PET image features were evaluated: maximum uptake values (SUVmax), mean uptake (SUVmean), and metabolic volume (SUVvol) defined by SUV > 2.5. All variables were analyzed versus disease-free survival (DFS) using univariate and multivariate Cox analysis, Kaplan-Meier curves, and log-rank tests. The optimal cutoff points of variables were estimated using time-dependent survival receiver operating characteristic (ROC) analysis. All PET features significantly correlated with proliferation marker Ki-67 (all p < 0.010). SUVmax stratified the prognosis of TNBC patients with optimal cutoff derived by ROC analysis (≤3.5 vs. >3.5, AUC = 0.654, p = 0.006). SUVmax and EGFR were significant prognostic factors in univariate and multivariate Cox analyses. To integrate prognosis of biological and imaging markers, patients were first stratified by EGFR into low (≤15 %) and high (>15 %) risk groups. Further, SUVmax was used as a variable to stratify the two EGFR groups. In the high EGFR group, patients with high FDG uptake (SUVmax > 3.5) had worse survival outcome (median DFS = 7.6 months) than those patients with low FDG uptake (SUVmax ≤ 3.5, median DFS = 11.6 months). In the low EGFR group, high SUVmax also indicated worse survival outcome (17.2 months) than low SUVmax (22.8 months). The risk stratification with integrative EGFR and PET was statistically significant with log-rank p ≪ 0.001. Pre-treatment 18F-FDG-PET/CT imaging has significant prognostic value for predicting survival outcome of TNBC patients. Integrated with basal-biomarker EGFR, PET imaging can further stratify patient risks in the pre-treatment stage and help select appropriate treatment strategies for individual patients.

No MeSH data available.


Related in: MedlinePlus

Two TNBC cases of pre-treatment PET/CT images with the different SUVmax and prognosis. PET images were fused with CT images, and the locations of tumor were pointed by yellow arrows. a SUVmax = 1.5 for a 77-yr-old patient with EGFR = 10 %, CK5/6 = 10 %, Ki-67 = 39 %, who was undergone lumpectomy and is still event free after 24 months. b SUVmax = 19.7 for a 75-yr-old patient with EGFR = 70 %, CK5/6 = 95 %, Ki-67 = 57 %, SUVmean = 7.5, SUVvol = 52.1 cc, who was undergone lumpectomy, and had lung metastasis after 21 months event free
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Fig1: Two TNBC cases of pre-treatment PET/CT images with the different SUVmax and prognosis. PET images were fused with CT images, and the locations of tumor were pointed by yellow arrows. a SUVmax = 1.5 for a 77-yr-old patient with EGFR = 10 %, CK5/6 = 10 %, Ki-67 = 39 %, who was undergone lumpectomy and is still event free after 24 months. b SUVmax = 19.7 for a 75-yr-old patient with EGFR = 70 %, CK5/6 = 95 %, Ki-67 = 57 %, SUVmean = 7.5, SUVvol = 52.1 cc, who was undergone lumpectomy, and had lung metastasis after 21 months event free

Mentions: Patient and tumor characteristics are summarized in Table 1. All patients in the full cohort were women with a median age of 57 years (range, 28–92 years) and a median disease-free survival of 11.5 months. No significant difference was observed between patients with and without PET/CT images. The imaging subgroup had a median age of 57 years (range, 28–88 years) and a median disease-free survival of 11.4 months. 70 % patients were CK5/6 positive, and 91 % patients were EGFR positive. A total of 73 (92 %) patients were identified as having basal-like TNBC (any EGFR and/or CK5/6 positivity). 67 patients were treated with chemotherapy and/or radiotherapy, and 12 patients were treated with neither chemotherapy nor radiotherapy. Figure 1 shows two TNBC cases of pre-treatment PET/CT images with the different SUVmax and prognosis: patient 1, diagnosed with low SUVmax (=1.5) and low expressions of basal marker (EGFR = 10 %, CK5/6 = 10 %), is still event free after 24 months; patient 2, diagnosed with high SUVmax (=19.7) and high expressions of EGFR (=70 %) and CK5/6 (=95 %), had lung metastasis after 21 months event free.Table 1


Stratifying triple-negative breast cancer prognosis using 18F-FDG-PET/CT imaging.

Yue Y, Cui X, Bose S, Audeh W, Zhang X, Fraass B - Breast Cancer Res. Treat. (2015)

Two TNBC cases of pre-treatment PET/CT images with the different SUVmax and prognosis. PET images were fused with CT images, and the locations of tumor were pointed by yellow arrows. a SUVmax = 1.5 for a 77-yr-old patient with EGFR = 10 %, CK5/6 = 10 %, Ki-67 = 39 %, who was undergone lumpectomy and is still event free after 24 months. b SUVmax = 19.7 for a 75-yr-old patient with EGFR = 70 %, CK5/6 = 95 %, Ki-67 = 57 %, SUVmean = 7.5, SUVvol = 52.1 cc, who was undergone lumpectomy, and had lung metastasis after 21 months event free
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4589560&req=5

Fig1: Two TNBC cases of pre-treatment PET/CT images with the different SUVmax and prognosis. PET images were fused with CT images, and the locations of tumor were pointed by yellow arrows. a SUVmax = 1.5 for a 77-yr-old patient with EGFR = 10 %, CK5/6 = 10 %, Ki-67 = 39 %, who was undergone lumpectomy and is still event free after 24 months. b SUVmax = 19.7 for a 75-yr-old patient with EGFR = 70 %, CK5/6 = 95 %, Ki-67 = 57 %, SUVmean = 7.5, SUVvol = 52.1 cc, who was undergone lumpectomy, and had lung metastasis after 21 months event free
Mentions: Patient and tumor characteristics are summarized in Table 1. All patients in the full cohort were women with a median age of 57 years (range, 28–92 years) and a median disease-free survival of 11.5 months. No significant difference was observed between patients with and without PET/CT images. The imaging subgroup had a median age of 57 years (range, 28–88 years) and a median disease-free survival of 11.4 months. 70 % patients were CK5/6 positive, and 91 % patients were EGFR positive. A total of 73 (92 %) patients were identified as having basal-like TNBC (any EGFR and/or CK5/6 positivity). 67 patients were treated with chemotherapy and/or radiotherapy, and 12 patients were treated with neither chemotherapy nor radiotherapy. Figure 1 shows two TNBC cases of pre-treatment PET/CT images with the different SUVmax and prognosis: patient 1, diagnosed with low SUVmax (=1.5) and low expressions of basal marker (EGFR = 10 %, CK5/6 = 10 %), is still event free after 24 months; patient 2, diagnosed with high SUVmax (=19.7) and high expressions of EGFR (=70 %) and CK5/6 (=95 %), had lung metastasis after 21 months event free.Table 1

Bottom Line: The risk stratification with integrative EGFR and PET was statistically significant with log-rank p ≪ 0.001.Pre-treatment 18F-FDG-PET/CT imaging has significant prognostic value for predicting survival outcome of TNBC patients.Integrated with basal-biomarker EGFR, PET imaging can further stratify patient risks in the pre-treatment stage and help select appropriate treatment strategies for individual patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA. yong.yue@cshs.org.

ABSTRACT
This study aims to stratify prognosis of triple-negative breast cancer (TNBC) patients using pre-treatment 18F-FDG-PET/CT, alone and with correlation to immunohistochemistry biomarkers. 200 consecutive TNBC breast cancer patients treated between 2008 and 2012 were retrieved. Among the full cohort, 79 patients had pre-treatment 18F-FDG-PET/CT scans. Immunostaining status of basal biomarkers (EGFR, CK5/6) and other clinicopathological variables were obtained. Three PET image features were evaluated: maximum uptake values (SUVmax), mean uptake (SUVmean), and metabolic volume (SUVvol) defined by SUV > 2.5. All variables were analyzed versus disease-free survival (DFS) using univariate and multivariate Cox analysis, Kaplan-Meier curves, and log-rank tests. The optimal cutoff points of variables were estimated using time-dependent survival receiver operating characteristic (ROC) analysis. All PET features significantly correlated with proliferation marker Ki-67 (all p < 0.010). SUVmax stratified the prognosis of TNBC patients with optimal cutoff derived by ROC analysis (≤3.5 vs. >3.5, AUC = 0.654, p = 0.006). SUVmax and EGFR were significant prognostic factors in univariate and multivariate Cox analyses. To integrate prognosis of biological and imaging markers, patients were first stratified by EGFR into low (≤15 %) and high (>15 %) risk groups. Further, SUVmax was used as a variable to stratify the two EGFR groups. In the high EGFR group, patients with high FDG uptake (SUVmax > 3.5) had worse survival outcome (median DFS = 7.6 months) than those patients with low FDG uptake (SUVmax ≤ 3.5, median DFS = 11.6 months). In the low EGFR group, high SUVmax also indicated worse survival outcome (17.2 months) than low SUVmax (22.8 months). The risk stratification with integrative EGFR and PET was statistically significant with log-rank p ≪ 0.001. Pre-treatment 18F-FDG-PET/CT imaging has significant prognostic value for predicting survival outcome of TNBC patients. Integrated with basal-biomarker EGFR, PET imaging can further stratify patient risks in the pre-treatment stage and help select appropriate treatment strategies for individual patients.

No MeSH data available.


Related in: MedlinePlus