title: Prognostic significance of preoperative18F-FDG PET/CT for breast cancer subtypes.
abstract: Adjuvant treatments for operable breast cancers are determined according to subtypes defined based on estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2) status. The ER+/HER2- subtype can be divided into luminal A and luminal B usually by Ki67 expression levels. Although tumor size, lymph node metastasis and tumor grade have been widely accepted in daily clinical practice, the identification of further prognostic indicators especially in the ER+/HER2- subtype is warranted. A total of 387 operated breast cancers for which maximum standardized uptake value (SUVmax) on the18F-fluorodeoxyglucose positron-emission tomography/computed tomography (FDG PET/CT) were available at baseline were retrospectively analyzed. The optimal cutoff value of SUVmax for relapse-free survival (RFS) was determined to be 3.585 by means of the receiver operating characteristics curve with an area under the curve of 0.6795 (95% CI: 0.5972 to 0.7618, p = 0.0006, sensitivity: 78.8%, specificity: 57.1%). The RFS of patients with SUVmax-high (n = 178) was significantly (p = 0.0003) worse compared with those with SUVmax-low (n = 209). This significant association was prominently recognized in the ER+/HER2- subtype. By multivariable analysis, SUVmax (hazard ratio: 3.83, 95% confidence interval: 1.28-11.51, p = 0.017), tumor size (4.22, 1.39-12.82, p = 0.011) and lymph node metastasis (4.44, 1.81-10.87, p = 0.0012) were significant and independent prognostic factors for RFS. The ER+/HER2- subtype demonstrated consistently worse RFS in the SUVmax-high patients both in the luminal A (p = 0.037) and luminal B (p = 0.047) subtypes. Combination of Ki67 and SUVmax appears to be useful for selecting patients who have inferior prognosis and need further adjuvant treatment of the ER+/HER2- subtype.
authors: Division of Breast and Endocrine, Department of Surgery, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya, Hyogo 663-8501, Japan.
authors: Tomoko
authors: T
authors: Higuchi
authors: Division of Breast and Endocrine, Department of Surgery, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya, Hyogo 663-8501, Japan.
authors: Arisa
authors: A
authors: Nishimukai
authors: Division of Breast and Endocrine, Department of Surgery, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya, Hyogo 663-8501, Japan.
authors: Hiromi
authors: H
authors: Ozawa
authors: Division of Breast and Endocrine, Department of Surgery, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya, Hyogo 663-8501, Japan.
authors: Yukie
authors: Y
authors: Fujimoto
authors: Division of Breast and Endocrine, Department of Surgery, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya, Hyogo 663-8501, Japan.
authors: Ayako
authors: A
authors: Yanai
authors: Division of Breast and Endocrine, Department of Surgery, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya, Hyogo 663-8501, Japan.
authors: Yoshimasa
authors: Y
authors: Miyagawa
authors: Division of Breast and Endocrine, Department of Surgery, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya, Hyogo 663-8501, Japan.
authors: Keiko
authors: K
authors: Murase
authors: Division of Breast and Endocrine, Department of Surgery, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya, Hyogo 663-8501, Japan.
authors: Michiko
authors: M
authors: Imamura
authors: Division of Breast and Endocrine, Department of Surgery, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya, Hyogo 663-8501, Japan.
authors: Yuichi
authors: Y
authors: Takatsuka
authors: Department of Nuclear Medicine and PET Center, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya, Hyogo 663-8501, Japan.
authors: Kazuhiro
authors: K
authors: Kitajima
authors: Department of Nuclear Medicine and PET Center, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya, Hyogo 663-8501, Japan.
authors: Kazuhito
authors: K
authors: Fukushima
authors: Division of Breast and Endocrine, Department of Surgery, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya, Hyogo 663-8501, Japan. Electronic address: ymiyoshi@hyo-med.ac.jp.
authors: Yasuo
authors: Y
authors: Miyoshi
mesh_terms: D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D047072:Aromatase Inhibitors / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000628:therapy; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000628:therapy; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D019394:Ki-67 Antigen / Q000378:metabolism; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D000072078:Positron Emission Tomography Computed Tomography; D057234:Preoperative Period; D011379:Prognosis; D016016:Proportional Hazards Models; D019275:Radiopharmaceuticals; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D012189:Retrospective Studies; D013629:Tamoxifen / Q000627:therapeutic use; D047368:Tumor Burden
chemical_list: D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D019788:Fluorodeoxyglucose F18; D007987:Gonadotropin-Releasing Hormone; D019394:Ki-67 Antigen; D019275:Radiopharmaceuticals; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D013629:Tamoxifen; C508053:ERBB2 protein, human
keywords: Breast cancer; FDG; PET–CT; Prognostic factor; SUVmax