Predictive ability of 18F-fluorodeoxyglucose positron emission tomography/computed tomography for pathological complete response and prognosis after neoadjuvant chemotherapy in triple-negative breast cancer patients

Document Type : Original Article

Authors

1 Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan

2 Department of Diagnostic Radiology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan

3 Department of Clinical Laboratory, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan

4 Section of Cancer Prevention and Epidemiology, Clinical Research Center, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan

5 Department of Radiology, Ehime University, Matsuyama, Japan

Abstract

Objective The mortality of patients with locally advanced triple-negative breast cancer (TNBC) is high, and pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) is associated with improved prognosis. This retrospective study was designed and powered to investigate the ability of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) to predict pathological response to NAC and prognosis after NAC.
Methods The data of 32 consecutive women with clinical stage II or III TNBC from January 2006 to December 2013 in our institution who underwent FDG-PET/CT at baseline and after NAC were retrospectively analyzed. The maximum standardized uptake value (SUVmax) in the primary tumor at each examination and the change in SUVmax (ΔSUVmax) between the two scans were measured. Correlations between PET parameters and pathological response, and correlations between PET parameters and disease-free survival (DFS) were examined.
Results At the completion of NAC, surgery showed pCR in 7 patients, while 25 had residual tumor, so-called non-pCR. Median follow-up was 39.0 months. Of the non-pCR patients, 9 relapsed at 3 years. Of all assessed clinical, biological, and PET parameters, N-stage, clinical stage, and ΔSUVmax were predictors of pathological response (p=0.0288, 0.0068, 0.0068; Fischer’s exact test). The cut-off value of ΔSUVmax to differentiate pCR evaluated by the receiver operating characteristic (ROC) curve analysis was 81.3%. Three-year disease-free survival (DFS) was lower in patients with non-pCR than in patients with pCR (p=0.328, log-rank test). The cut-off value of ΔSUVmax to differentiate 3-year DFS evaluated by the ROC analysis was 15.9%. In all cases, 3-year DFS was lower in patients with ΔSUVmax <15.9% than in patients with ΔSUVmax ≥15.9% (p=0.0078, log-rank test). In non-pCR patients, 3-year DFS was lower in patients with ΔSUVmax <15.9% than in patients with ΔSUVmax ≥15.9% (p=0.0238, log-rank test).
Conclusions FDG-PET/CT at baseline and after NAC could predict pathological response to NAC before surgery and the clinical outcome after surgery in locally advanced TNBC patients.

Keywords

Main Subjects

References

 
1.  Foulkes WD, Smith IE, Reis-Filho JS. Triple-negative breast cancer. N Engl J Med. 2010;363(20):1938-48.
2.  Boyle P. Triple-negative breast cancer: epidemiological considerations and recommendations. Ann Oncol. 2012;23(Suppl 6):vi7-12.
3. Liedtke C, Mazouni C, Hess KR, André F, Tordai A, Mejia JA, et al. Response to neoadjuvant therapy and long-term survival in patients with triple-negative breast cancer. J Clin Oncol. 2012;26(8):1275-81.
4. Von Minckwitz G, Untch M, Blohmer JU, Costa SD, Eidtmann H, Fasching PA, et al. Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol. 2012;30(15):1796-804.
5. Fuster D, Duch J, Paredes P, Velasco M, Muñoz M, Santamarí􀆴a G, et al. Preoperative staging of large primary breast cancer with [18F]fluorodeoxyglucose positron emission tomography/computed tomog-raphy compared with conventional imaging procedures. J Clin Oncol. 2008;26(29):4746-51.
6. Groheux D, Hindié E, Delord M, Giacchetti S, Hamy AS, de Bazelaire C, et al. Prognostic impact of (18)FDG-PET-CT findings in clinical stage III and IIB breast cancer. J Natl Cancer Inst. 2012;104(24):1879-87.
7. Schwarz-Dose J, Untch M, Tiling R, Sassen S, Mahner S, Kahlert S, et al. Monitoring primary systemic therapy of large and locally advanced breast cancer by using sequential positron emission tomography imaging with [18F] fluorodeoxyglucose.J Clin Oncol. 2009;27(4):535-41.
8. Groheux D, Giacchetti S, Espié M, Rubello D, Moretti JL, Hindié E. Early monitoring of response to neoadjuvant chemotherapy in breast cancer with 18F-FDG PET/CT: defining a clinical aim. Eur J Nucl Med Mol Imaging. 2011;38(3):419-25.
9. Nakajima N, Sugawara Y, Kataoka M, Hamamoto Y, Ochi T, Sakai S, et al. Differentiation of tumor recurrence from radiation-induced pulmonary fibrosis after stereotactic ablative radiotherapy for lung cancer: characterization of 18F-FDG PET/CT findings. Ann Nucl Med. 2013;27(3):261-70.
10. Groheux D, Hindié E, Giacchetti S, Hamy AS, Berger F, Merlet P, et al. Early assessment with 18F-fluorodeoxyglucose positron emission tomography /computed tomography can help predict the outcome of neoadjuvant chemotherapy in triple negative breast cancer. Eur J Cancer. 2014; 50(11): 1864-71.
11. Nagao T, Kinoshita T, Hojo T, Tsuda H, Tamura K, Fujiwara Y. The differences in the histological types of breast cancer and the response to neoadjuvant chemotherapy: the relationship between the outcome and the clinicopathological characteristics. Breast. 2012;21(3):289-95.
12. Cortazar P, Zhang L, Untch M, Mehta K, Costantino JP, Wolmark N, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014;384(9938):164-72.
13. Groheux D, Giacchetti S, Delord M, de Roquancourt A, Merlet P, Hamy AS, et al.Prognostic impact of 18F-FDG PET/CT staging and of pathological response to neoadjuvant chemotherapy in triple-negative breast cancer. Eur J Nucl Med Mol Imaging. 2015;42(3):377-85.
14. Groheux D, Hindié E, Giacchetti S, Delord M, Hamy AS, de Roquancourt A, et al. Triple-negative breast cancer: early assessment with 18F-FDG PET/ CT during neoadjuvant chemotherapy identifies patients who are unlikely to achieve a pathologic complete response and are at a high risk of early relapse. J Nucl Med. 2012;53(2):249-54.
15. Von Minckwitz G, Loibl S, Untch M, Eidtmann H, Rezai M, Fasching PA, et al. Survival after neoadjuvant chemotherapy with or without bevacizumab or everolimus for HER2-negative primary breast cancer (GBG 44-GeparQuinto). Ann Oncol. 2014;25(12):2363-72.
16. Groheux D, Espié M, Giacchetti S, Hindié E. Performance of FDG PET/CT in the clinical management of breast cancer. Radiology. 2 0 1 3 ; 2 6 6 ( 2 ) : 3 8 8 - 4 0 5 .
17. Groheux D, Giacchetti S, Moretti JL, Porcher R, Espié M, Lehmann-Che J, et al. Correlation of high 18F-FDG uptake to clinical, pathological and biological prognostic factors in breast cancer. Eur J Nucl Med Mol Imaging. 2011;38(3):426-35.
18. Groheux D, Majdoub M, Sanna A, de Cremoux P, Hindié E, Giacchetti S, et al. Early metabolic response to neoadjuvant treatment: FDG PET/ CT criteria according to breast cancer subtype. Radiology. 2015;27:141638.
19. Cheng G, Torigian DA, Zhuang H, Alavi A. When should we recommend use of dual time-point and delayed time-point imaging techniques in FDG PET? Eur J Med Mol Imaging. 2013;40(5):779-87.  
 
 

Files

Share

How to cite

Statistics