title: Efficiency of fluorodeoxyglucose positron emission tomography/computed tomography to predict prognosis in breast cancer patients received neoadjuvant chemotherapy.
abstract: Neoadjuvant chemotherapy (NAC) has become a standard therapy for patients with advanced breast cancer. Pathological complete response (pCR) after NAC is an important prognostic indicator, but some patients with pCR continue to experience recurrence. So new predictive and prognostic markers in addition to pCR are needed following NAC for breast cancer. Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) can evaluate metastases in the entire body simultaneously, and has several potential advantages over conventional imaging modalities. The purpose of this study was to evaluate whether FDG-PET/CT can determine NAC response and whether FDG-PET/CT can be a new prognostic marker. We imaged 83 breast cancer tumors with FDG-PET/CT, ultrasound (US), and magnetic resonance imaging (MRI) to evaluate NAC efficacy. As we previously analyzed 110 breast cancers with FDG PET/CT, we defined a threshold of >1.7 maximum standardized uptake value (SUVmax) as abnormal fluorodeoxyglucose (FDG) uptake. After NAC, 16 (19.3 %) tumors had a complete response, 54 (65.1 %) had a partial response, 11 (13.3 %) showed stable disease, and 2 (2.4 %) showed progressive disease. One of the two patients with progressive disease had bone metastasis detected by FDG-PET/CT and was not operated on. Remote metastases were evident in 2.4 % of patients after NAC as determined by FDG-PET/CT. Overall, 17 patients had pathological complete response (pCR). The sensitivity of abnormal FDG uptake after NAC for non-pCR was 20.3 % and the specificity was 94.7 %. Patients with abnormal FDG uptake after NAC experienced significantly more recurrences (P = 0.004) and more of them died (P = 0.010). Moreover, the difference in disease-free survival was more significant in the estrogen receptor (ER)-negative group. FDG-PET after NAC may be more effective for predicting prognosis than for evaluating treatment response. This tendency was particularly remarkable in ER-negative breast cancer tumors. FDG-PET/CT is useful for reevaluating surgical applicability after NAC.
authors.affiliation: Department of Breast Surgery, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan ; Liquid Genomics, Inc., 1725 Del Amo Blvd. Torrance, Torrance, 90501 CA USA ; Department of Biochemistry and Molecular Biology, University of Southern California/Norris Comprehensive Cancer Center, 1975 Zonal Ave, Los Angeles, 90089-9151 CA USA.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Ishiba
authors.affiliation: Department of Breast Surgery, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Nakagawa
authors.affiliation: Department of Breast Surgery, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan.
authors.forename: Takanobu
authors.initials: T
authors.lastname: Sato
authors.affiliation: Department of Breast Surgery, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Nagahara
authors.affiliation: Department of Breast Surgery, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan.
authors.forename: Goshi
authors.initials: G
authors.lastname: Oda
authors.affiliation: Department of Breast Surgery, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sugimoto
authors.affiliation: Department of Breast Surgery, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan.
authors.forename: Mai
authors.initials: M
authors.lastname: Kasahara
authors.affiliation: Department of Breast Surgery, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan.
authors.forename: Tokuko
authors.initials: T
authors.lastname: Hosoya
authors.affiliation: Department of Radiology, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kubota
authors.affiliation: Department of Radiology, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Fujioka
authors.affiliation: Department of Biochemistry and Molecular Biology, University of Southern California/Norris Comprehensive Cancer Center, 1975 Zonal Ave, Los Angeles, 90089-9151 CA USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Danenberg
authors.affiliation: Liquid Genomics, Inc., 1725 Del Amo Blvd. Torrance, Torrance, 90501 CA USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Danenberg
authors.affiliation: Department of Surgical Specialities, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Uetake
keywords: Breast cancer; FDG-PET/CT; Metastases; Neoadjuvant chemotherapy; Prognostic marker