title: 18FDG-PET/CT for predicting the outcome in ER+/HER2- breast cancer patients: comparison of clinicopathological parameters and PET image-derived indices including tumor texture analysis.
abstract: This study investigated the value of some clinicopathological parameters and 18 F-fluorodeoxyglucose-positron emission tomography/computed tomography (18FDG-PET/CT) indices, including textural features, to predict event-free survival (EFS) in estrogen receptor-positive/human epidermal growth factor receptor 2-negative (ER+/HER2-) locally advanced breast cancer (BC) patients.
  
  
  
  FDG-PET/CT indices and clinicopathological parameters were assessed before neoadjuvant chemotherapy (NAC). After completion of chemotherapy, all patients had breast surgery with axillary lymph node dissection, followed by radiation therapy and endocrine therapy for 5 years. EFS was estimated using the Kaplan-Meier method. A Cox proportional hazard regression model was used for multivariate analysis.
  
  
  
  One hundred forty-three consecutive patients with stage II-III ER+/HER2- BC and without distant metastases at baseline PET were included. High standardized uptake values (SUVs), were associated with shorter EFS (HR = 3.51, P < 0.01 for SUVmax; HR = 2.76, P = 0.02 for SUVmean; and HR = 4.40 P < 0.01 for SUVpeak). Metabolically active tumor volume (MATV, HR = 3.47, P < 0.01) and total lesion glycolysis (TLG, HR = 3.10, P < 0.01) were also predictive of EFS. Homogeneity was not predictive (HR = 2.27, P = 0.07) and entropy had weak prediction (HR = 2.89, P = 0.02). Among clinicopathological parameters, EFS was shorter in progesterone receptor (PR)-negative tumor (vs. PR-positive tumor; HR = 3.25, P < 0.01); histology was predictive of EFS (lobular vs. ductal invasive carcinoma; HR = 3.74, P = 0.01) but not tumor grade (grade 3 vs. grade 1-2; HR = 1.64, P = 0.32). Pathological complete response after NAC was not correlated to the risk of relapse. Three parameters remained significantly associated with EFS in multivariate analysis. MATV (HR = 1.01, P < 0.01), progesterone receptor expression (HR = 2.90, P = 0.03) and tumor histology (HR = 3.80, P = 0.02).
  
  
  
  Baseline PET parameters measured before neoadjuvant treatment have prognostic values in ER+/HER2- locally advanced breast cancer patients. After multivariate analysis, metabolically active tumor volume remains significant while textural analysis of PET images is not of added value. Considering histopathological parameters, our study shows that patients with PR-negative or lobular invasive tumor have poorer prognosis than patients with PR-positive or ductal carcinoma, respectively.
authors.affiliation: Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France. dgroheux@yahoo.fr.|University Paris-Diderot, INSERM/CNRS UMR944/7212, Paris, France. dgroheux@yahoo.fr.
authors.forename: David
authors.identifier: 0000-0002-9541-9175
authors.initials: D
authors.lastname: Groheux
authors.affiliation: Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Martineau
authors.affiliation: University Paris-Diderot, INSERM/CNRS UMR944/7212, Paris, France.|Breast Diseases Unit, Saint-Louis Hospital, Paris, France.
authors.forename: Luis
authors.initials: L
authors.lastname: Teixeira
authors.affiliation: University Paris-Diderot, INSERM/CNRS UMR944/7212, Paris, France.|Breast Diseases Unit, Saint-Louis Hospital, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Espié
authors.affiliation: University Paris-Diderot, INSERM/CNRS UMR944/7212, Paris, France.|Department of Biochemistry, Saint-Louis Hospital, Paris, France.
authors.forename: Patricia
authors.initials: P
authors.lastname: de Cremoux
authors.affiliation: Department of Pathology, Saint-Louis Hospital, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Bertheau
authors.affiliation: Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Merlet
authors.affiliation: Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France.|University Paris-Diderot, INSERM/CNRS UMR944/7212, Paris, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Lemarignier
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000401:mortality* / Q000473:pathology; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007150:Immunohistochemistry; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D063868:Patient Outcome Assessment; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods; D049268:Positron-Emission Tomography; D011379:Prognosis; D016016:Proportional Hazards Models; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D047368:Tumor Burden
chemical_list: D019788:Fluorodeoxyglucose F18; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen
keywords: 18FDG-PET/CT; ER+/HER2- breast cancer; Metabolically active tumor volume; Prognosis; SUV; Textural parameters