title: Prognostic value of quantitative fluorodeoxyglucose measurements in newly diagnosed metastatic breast cancer.
abstract: The aim of this study was to determine the prognostic value of quantitative fluorodeoxyglucose (FDG) measurements (maximum standardized uptake value [SUVmax ], metabolic tumor volume [MTV], and total lesion glycolysis [TLG]) in patients with newly diagnosed metastatic breast cancer (MBC). An IRB-approved retrospective review was performed of patients who underwent FDG positron emission tomography (PET)/computed tomography (CT) from 1/02 to 12/08 within 60 days of diagnosis MBC. Patients with FDG-avid lesions without receiving chemotherapy in the prior 30 days were included. Target lesions in bone, lymph node (LN), liver, and lung were analyzed for SUVmax , MTV, and TLG. Medical records were reviewed for patient characteristics and overall survival (OS). Cox regression was used to test associations between quantitative FDG measurements and OS. A total of 253 patients were identified with disease in bone (n = 150), LN (n = 162), liver (n = 48), and lung (n = 66) at the time of metastatic diagnosis. Higher SUVmax tertile was associated with worse OS in bone metastases (highest vs. lowest tertile hazard ratio [HR] = 3.1, P < 0.01), but not in LN, liver or lung (all P > 0.1). Higher MTV tertile was associated with worse OS in LN (HR = 2.4, P < 0.01) and liver (HR = 3.0, P = 0.02) metastases, but not in bone (P = 0.22) or lung (P = 0.14). Higher TLG tertile was associated with worse OS in bone (HR = 2.2, P = 0.02), LN (HR = 2.3, P < 0.01), and liver (HR = 4.9, P < 0.01) metastases, but not in lung (P = 0.19). We conclude measures of FDG avidity are prognostic biomarkers in newly diagnosed MBC. SUVmax and TLG were both predictors of survival in breast cancer patients with bone metastases. TLG may be a more informative biomarker of OS than SUVmax for patients with LN and liver metastases.
authors.affiliation: Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Radiology, Weill Cornell Medical College, New York, New York.
authors.forename: Gary A
authors.initials: GA
authors.lastname: Ulaner
authors.forename: Anne
authors.initials: A
authors.lastname: Eaton
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Morris
authors.forename: Joshua
authors.initials: J
authors.lastname: Lilienstein
authors.forename: Komal
authors.initials: K
authors.lastname: Jhaveri
authors.forename: Sujata
authors.initials: S
authors.lastname: Patil
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fazio
authors.forename: Steven
authors.initials: S
authors.lastname: Larson
authors.forename: Clifford A
authors.initials: CA
authors.lastname: Hudis
authors.forename: Maxine S
authors.initials: MS
authors.lastname: Jochelson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D005260:Female; D019788:Fluorodeoxyglucose F18; D006019:Glycolysis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D008207:Lymphatic Metastasis; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods; D011379:Prognosis; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D047368:Tumor Burden
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Breast cancer; FDG PET/CT; SUV
  max; mean tumor volume; total lesion glycolysis