Limits...
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

Kaplan-Meier curves of disease-free survival of basal biomarkers for TNBC patients with pre-treatment PET/CT, a EGFR at cutoff level 15 % with log-rank p = 0.0008, and b CK5/6 at cutoff level 50 % with log-rank p = 0.011
© Copyright Policy - OpenAccess
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4589560&req=5

Fig3: Kaplan-Meier curves of disease-free survival of basal biomarkers for TNBC patients with pre-treatment PET/CT, a EGFR at cutoff level 15 % with log-rank p = 0.0008, and b CK5/6 at cutoff level 50 % with log-rank p = 0.011

Mentions: Basal biomarkers EGFR and CK5/6 were evaluated by univariate Cox analysis in both continuous and discrete status. The optimal cutoff values were estimated using time-dependent survival ROC analysis. As a result, an EGFR cutoff of 15 % maximized both sensitivity and specificity for the outcome with AUC = 0.788, and while for CK5/6, 50 % is the optimal cutoff point with AUC = 0.611. As shown in Table 2, EGFR and CK5/6 were both significant in univariate Cox analysis with p = 0.001 and 0.011, respectively. The stratification of patient risks is illustrated by Kaplan-Meier curves (Fig. 3), with log-ranks p = 0.0008 for EGFR and 0.011 for CK5/6, respectively. To remove the bias due to sample size, the same tests were also conducted in full cohort patients (n = 200), and produced the same results (p = 0.004 for EGFR, p = 0.018 for CK5/6) shown in Table 2.Fig. 3


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)

Kaplan-Meier curves of disease-free survival of basal biomarkers for TNBC patients with pre-treatment PET/CT, a EGFR at cutoff level 15 % with log-rank p = 0.0008, and b CK5/6 at cutoff level 50 % with log-rank p = 0.011
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig3: Kaplan-Meier curves of disease-free survival of basal biomarkers for TNBC patients with pre-treatment PET/CT, a EGFR at cutoff level 15 % with log-rank p = 0.0008, and b CK5/6 at cutoff level 50 % with log-rank p = 0.011
Mentions: Basal biomarkers EGFR and CK5/6 were evaluated by univariate Cox analysis in both continuous and discrete status. The optimal cutoff values were estimated using time-dependent survival ROC analysis. As a result, an EGFR cutoff of 15 % maximized both sensitivity and specificity for the outcome with AUC = 0.788, and while for CK5/6, 50 % is the optimal cutoff point with AUC = 0.611. As shown in Table 2, EGFR and CK5/6 were both significant in univariate Cox analysis with p = 0.001 and 0.011, respectively. The stratification of patient risks is illustrated by Kaplan-Meier curves (Fig. 3), with log-ranks p = 0.0008 for EGFR and 0.011 for CK5/6, respectively. To remove the bias due to sample size, the same tests were also conducted in full cohort patients (n = 200), and produced the same results (p = 0.004 for EGFR, p = 0.018 for CK5/6) shown in Table 2.Fig. 3

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