Prognostic impact of (18)FDG-PET-CT findings in clinical stage III and IIB breast cancer.

Prognostic impact of (18)FDG-PET-CT findings in clinical stage III and IIB breast cancer.
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DOI:
10.1093/jnci/djs451
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发表时间:
2012-12-19
期刊:
Journal of the National Cancer Institute
影响因子:
--
通讯作者:
Espié M
Espié M
中科院分区:
其他
文献类型:
--
作者:
Groheux D;Hindié E;Delord M;Giacchetti S;Hamy AS;de Bazelaire C;de Roquancourt A;Vercellino L;Toubert ME;Merlet P;Espié M

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本研究前瞻性评估临床II期和III期乳腺癌患者的氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描(18FDG-PET-CT)的产率以及PET-CT结果对预后的影响。在 71 个月的过程中,连续 254 名临床 II 期和 III 期乳腺癌患者(基于临床检查、乳房 X 光检查、乳腺磁共振成像和局部超声检查)接受了 18FDG-PET-CT。对整个人群和每个美国癌症联合委员会亚组的产量进行了评估。分析了 PET-CT 结果的预后影响。统计显着性检验是双向的。 18FDG-PET-CT 改变了 254 名患者中 77 名的临床分期(30.3%;95% 置信区间 [CI] = 25.0% 至 36.2%)。结果显示,40 名患者存在未怀疑的 N3 疾病(锁骨下、锁骨上或内乳淋巴结),53 名患者存在远处转移。PET-CT 显示临床 IIA 期患者中有 2.3%(44 人中的 1 人)有远处转移,IIB 期患者有 10.7%(56 人中的 6 人),IIIA 期患者有 17.5%(63 人中的 11 人),36.5%(63 人中的 27 人)有远处转移。 74)的 IIIB 期患者和 47.1%(17 人中的 8 人)的 IIIC 期患者。在 189 名临床分期为 IIB 或更高疾病且进行充分随访的患者中,与评分为 M0 的患者相比,18FDG-PET-CT 评分为 M1 的 47 名患者的疾病特异性生存率在统计学上显着缩短,三年疾病特异性生存率为 57% vs 88% (P < .001)。在多变量分析中,只有 PET-CT 上的远处病变和三阴性表型是具有统计学意义的预后因素。 M1 与 M0 患者的相对死亡风险为 26.60(95% CI = 6.60 至 102.62)。在临床 IIB 期或以上乳腺癌患者中,18FDG-PET-CT 的检出率似乎很高。在这些患者中,18FDG-PET-CT 提供了强有力的预后分层。
This study prospectively evaluated the yield of fluorodeoxyglucose positron emission tomography/computed tomography (18FDG-PET-CT) in patients with clinical stages II and III breast cancer and the impact of PET-CT results on prognosis. In the course of 71 months, 254 consecutive patients with clinical stages II and III breast cancer (based on clinical examination, mammography, breast magnetic resonance imaging, and locoregional ultrasonography) underwent 18FDG-PET-CT. The yield was assessed in the whole population and for each American Joint Committee on Cancer subgroup. The prognostic impact of PET-CT findings was analyzed. Tests of statistical significance were two-sided. 18FDG-PET-CT changed the clinical stage in 77 of 254 patients (30.3%; 95% confidence interval [CI] = 25.0% to 36.2%). It showed unsuspected N3 disease (infraclavicular, supraclavicular, or internal mammary nodes) in 40 patients and distant metastases in 53. PET-CT revealed distant metastases in 2.3% (1 of 44) of clinical stage IIA, 10.7% (6 of 56) of stage IIB, 17.5% (11 of 63) of stage IIIA, 36.5% (27 of 74) of stage IIIB, and 47.1% (8 of 17) of stage IIIC patients. Among 189 patients with clinical stage IIB or higher disease and adequate follow-up, disease-specific survival was statistically significantly shorter in the 47 patients scored M1 on 18FDG-PET-CT in comparison with those scored M0, with a three-year disease-specific survival of 57% vs 88% (P < .001). In multivariable analysis, only distant disease on PET-CT and triple-negative phenotype were statistically significant prognostic factors. The relative risk of death was 26.60 (95% CI = 6.60 to 102.62) for M1 vs M0 patients. The yield of 18FDG-PET-CT appeared substantial in patients with clinical stage IIB or higher breast cancer. In these patients, 18FDG-PET-CT provided powerful prognostic stratification.
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