18F-FDG Uptake by Metastatic Axillary Lymph Nodes on Pretreatment PET/CT as a Prognostic Factor for Recurrence in Patients with Invasive Ductal Breast Cancer
18F-FDG Uptake by Metastatic Axillary Lymph Nodes on Pretreatment PET/CT as a Prognostic Factor for Recurrence in Patients with Invasive Ductal Breast Cancer
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DOI：
10.2967/jnumed.111.098640
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发表时间：
2012-09-01
影响因子：
9.3
通讯作者：
Lee, Jaetae
中科院分区：
文献类型：
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作者：
Song, Bong-Il;Lee, Sang-Woo;Lee, Jaetae
本研究评估了浸润性导管乳腺癌 (IDC) 患者转移性腋窝淋巴结的最大标准化摄取值，以确定 F-18-FDG PET/CT 对无病生存 (DFS) 的治疗前预后价值。方法：纳入65例接受F-18-FDG PET/CT预处理且病理证实腋窝淋巴结受累且无远处转移的女性IDC患者。所有患者在一线治疗后均表现出完全缓解。为了获得节点 SUVmax，仔细选择代表最高 F-18-FDG 摄取的横轴图像，并在 F-18-FDG 累积病变上手动绘制感兴趣区域。分析了年龄、TNM 分期、雌激素受体状态、孕激素受体状态、人表皮生长因子受体 2 状态以及 PET 上原发肿瘤和淋巴结 SUVmax 等临床病理参数在预测复发方面的有用性。使用多变量 Cox 比例风险模型检查单变量分析显着的变量之间的组合效应和相互作用。结果：65 名患者中有 12 名 (18.5%) 在随访期间出现复发（中位随访时间为 36 个月；范围为 21-57 个月）。复发患者的淋巴结 SUVmax 显着高于无病患者（复发组：5.2 +/- 2.3，对比无病组：1.9 +/- 1.9，P < 0.0001）。接受者操作特征曲线表明，节点 SUVmax 2.8（敏感性，91.7%；特异性，86.8%；曲线下面积，0.890）是预测 DFS 的最佳截止值。单变量分析显示，T 分期、N 分期、雌激素受体状态以及原发肿瘤和淋巴结 SUVmax 与 DFS 显着相关。在这 5 个变量中，通过多变量分析发现只有节点 SUVmax 是 DFS 的单一决定因素（风险比，31.54；95% 置信区间，2.66-373.39；P = 0.0065）。结论：治疗前 F-18-FDG PET/CT 的淋巴结 SUVmax 可能是 IDC 患者疾病复发的独立预后因素。
This study assessed the maximum standardized uptake value of metastatic axillary lymph nodes in patients with invasive ductal breast cancer (IDC) to determine the pretreatment prognostic value of F-18-FDG PET/CT for disease-free survival (DFS). Methods: Sixty-five female IDC patients who had undergone pretreatment F-18-FDG PET/CT and had pathologically confirmed axillary lymph node involvement without distant metastasis were enrolled. All patients showed complete remission after first-line treatment. To obtain nodal SUVmax, a transaxial image representing the highest F-18-FDG uptake was carefully selected and a region of interest was manually drawn on the F-18-FDG-accumulating lesion. Clinicopathologic parameters such as age, TNM stage, estrogen receptor status, progesterone receptor status, human epidermal growth factor receptor 2 status, and primary-tumor and nodal SUVmax on PET were analyzed for their usefulness in predicting recurrence. Combinatorial effects and interactions between variables that were significant by univariate analysis were examined using multivariate Cox proportional-hazards models. Results: Twelve of 65 patients (18.5%) experienced recurrence during follow-up (median follow-up, 36 mo; range, 21-57 mo). Nodal SUVmax was significantly higher in patients with recurrence than in those who were disease-free (recurrence group: 5.2 +/- 2.3, vs. disease-free group: 1.9 +/- 1.9, P < 0.0001). A receiver-operating-characteristic curve demonstrated a nodal SUVmax of 2.8 (sensitivity, 91.7%; specificity, 86.8%; area under the curve, 0.890) to be the optimal cutoff for predicting DFS. Univariate analysis revealed that T stage, N stage, estrogen receptor status, and primary-tumor and nodal SUVmax correlated significantly with DFS. Among these 5 variables, only nodal SUVmax was found to be a single determinant of DFS by multivariate analysis (hazard ratio, 31.54; 95% confidence interval, 2.66-373.39; P = 0.0065). Conclusion: Nodal SUVmax on pretreatment F-18-FDG PET/CT may be an independent prognostic factor for disease recurrence in patients with IDC.