title: Prognostic value of FDG PET/CT-based metabolic tumor volumes in metastatic triple negative breast cancer patients.
abstract: FDG PET/CT-based measures of tumor burden show promise to predict survival in patients with metastatic breast cancer, but the patient populations studied so far are heterogeneous. The reports may have been confounded by the markedly different prognosis of the various subtypes of breast cancer. The purpose of this study is to evaluate the correlation between tumor burden on FDG PET/CT and overall survival (OS) in patients within a defined population: metastatic triple negative breast cancer (MTNBC). FDG PET/CT scans of 47 consecutive MTNBC patients (54±12 years-old) with no other known malignancies were analyzed. A total 393 lesions were identified, and maximum standardized uptake value (SUVmax), mean SUV, metabolic tumor volume (MTV), total lesion number (TLN) and total lesion glycolysis (TLG), were measured and correlated with patient survival by Mantel-Cox tests and Cox regression analysis. At a median follow-up time of 12.4 months, 41 patients died with a median OS of 12.1 months. Patients with MTV less than 51.5 ml lived nearly three times longer (22 vs 7.1 months) than those with a higher MTV (χ(2)=21.3, P<0.0001). In a multivariate Cox regression analysis only TLN and MTV were significantly correlated with survival. Those with an MTV burden in the 75(th) percentile versus the 25(th) percentile had a hazard ratio of 6.94 (p=0.001). In patients with MTNBC, MTV appears to be a strong prognostic factor. If validated in prospective studies, MTV may be a valuable tool for risk stratification of MTNBC patients in clinical trials and to guide patient management.
authors.affiliation: Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center1275 York Avenue, NY 10065, New York; Icahn School of Medicine at Mount SinaiOne Gustave Place, NY 10029, New York.
authors.forename: Brett
authors.initials: B
authors.lastname: Marinelli
authors.affiliation: Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center 1275 York Avenue, NY 10065, New York.
authors.forename: Carina
authors.initials: C
authors.lastname: Espinet-Col
authors.affiliation: Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center1275 York Avenue, NY 10065, New York; Weill Cornell Medical College1300 York Ave, NY 10065, New York.
authors.forename: Gary A
authors.initials: GA
authors.lastname: Ulaner
authors.affiliation: Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center 300 East 66th Street, NY 10065, New York.
authors.forename: Heather L
authors.initials: HL
authors.lastname: McArthur
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center 1275 York Avenue, NY 10065, New York.
authors.forename: Mithat
authors.initials: M
authors.lastname: Gonen
authors.affiliation: Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center1275 York Avenue, NY 10065, New York; Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center300 East 66th Street, NY 10065, New York.
authors.forename: Maxine
authors.initials: M
authors.lastname: Jochelson
authors.affiliation: Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center 1275 York Avenue, NY 10065, New York.
authors.forename: Wolfgang A
authors.initials: WA
authors.lastname: Weber
keywords: FDG PET/CT; Triple-negative metastatic breast cancer; breast cancer prognosis; metabolic tumor volume