Stratifying triple-negative breast cancer prognosis using 18F-FDG-PET/CT imaging.
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.
Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA. yong.yue@cshs.org.
Yong
Y
Yue
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
Xiaojiang
X
Cui
Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
Shikha
S
Bose
Department of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
William
W
Audeh
Biostatistics and Bioinformatics Core, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
Xiao
X
Zhang
Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
Benedick
B
Fraass
D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D064726:Triple Negative Breast Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D047368:Tumor Burden
D014408:Biomarkers, Tumor; D019788:Fluorodeoxyglucose F18
Basal-like Breast Cancer; Biomarker; Imaging; PET/CT