title: Body Mass Index with Tumor 18F-FDG Uptake Improves Risk Stratification in Patients with Breast Cancer.
abstract: OBJECTIVE
  To investigate the combined prognostic impact of body mass index (BMI) and tumor standardized uptake value (SUV) measured on pretreatment 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in patients with breast cancer.
  
  
  METHODS
  We evaluated a cohort of 332 patients with newly diagnosed breast cancer (stage I-III) who underwent pretreatment FDG PET/CT followed by curative resection. Patients were categorized as overweight (BMI ≥ 23 kg/m2) or normal weight (BMI < 23 kg/m2). Primary tumor maximum SUV was measured by FDG PET/CT. Associations between BMI and tumor SUV with disease recurrence were assessed using Cox regression models.
  
  
  RESULTS
  Median follow-up was 39 months. There were 76 recurrences and 15 cancer-related deaths. Multivariable Cox regression analysis demonstrated that high tumor SUV (hazard ratio [HR] = 1.75; 95% CI, 1.02-3.02; P = 0.044) and overweight (HR = 1.84; 95% CI, 1.17-2.89; P = 0.008) were independent poor prognostic factors. Positive hormone receptor status was an independent predictor of favorable outcome (HR = 0.42; 95% CI, 0.26-0.68; P < 0.001). Overweight patients with high tumor SUV had a two-fold risk of recurrence compared to patients with normal weight or low tumor SUV after adjusting for clinical stage and tumor subtype (HR = 2.06; 95% CI, 1.30-3.27; P = 0.002).
  
  
  CONCLUSIONS
  In patients with breast cancer, higher tumor SUV was associated with a more adverse outcome particularly in overweight women. BMI status combined with tumor SUV data allows better risk-stratification of breast cancer, independent of clinical stage and tumor subtype.
authors: Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Seung Hyup
authors: SH
authors: Hyun
authors: Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea.
authors: Hee Kyung
authors: HK
authors: Ahn
authors: Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Joo Hee
authors: JH
authors: Lee
authors: Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Joon Young
authors: JY
authors: Choi
authors: Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Byung-Tae
authors: BT
authors: Kim
authors: Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Yeon Hee
authors: YH
authors: Park
authors: Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Young-Hyuck
authors: YH
authors: Im
authors: Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Jeong Eon
authors: JE
authors: Lee
authors: Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Seok Jin
authors: SJ
authors: Nam
authors: Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Kyung-Han
authors: KH
authors: Lee
mesh_terms: D000328:Adult; D014408:Biomarkers, Tumor; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000378:metabolism* / Q000401:mortality / Q000628:therapy; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D000072078:Positron Emission Tomography Computed Tomography; D011379:Prognosis; D016016:Proportional Hazards Models; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors
chemical_list: D014408:Biomarkers, Tumor; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18