局部晚期乳腺癌^(18)F-FDG PET/CT显像和分子分型与预后相关性研究

Association of ^(18)F-FDG PET/CT imaging and molecular subtypes with prognosis of locally advanced breast cancer

目的乳腺癌18F-脱氧葡萄糖(^(18)F-fluorodeoxy glucose,^(18)F-FDG)的摄取率反映了肿瘤代谢程度,本研究旨在探讨不同分子亚型局部晚期乳腺癌患者治疗前病灶^(18)F-FDG最大标准摄取值(maximum standardized uptake value,SUV_(max))与预后的相关性。方法选择2010-08-23-2014-10-31在佛山市第一人民医院行^(18)F-FDG正电子发射计算机断层扫描(positron emission tomography/computed tomography,PET/CT)的初治局部晚期乳腺癌患者119例,根据免疫组化结果将其分成Luminal A型、Luminal B/HER2+型、Luminal B/HER2-型、HER2+型和三阴性乳腺癌(tripe negative breast cancer,TNBC)5种分子亚型。结果入组患者术后总复发转移率为32.8%。根据是否发生术后局部复发或远处转移分为事件组(n=39)与无事件组(n=80),两组治疗前病灶SUV_(max)分别为9.68±3.83和7.71±4.39,差异有统计学意义,Z=2.681,P=0.007。单因素分析显示,3年无事件生存率(event free survival,EFS)与治疗前SUV_(max)、T分期、N分期及AJCC临床分期有关,P值分别为0.012、0.022、0.013和0.008;多因素分析显示,SUV_(max)是影响患者预后的独立因素。当SUV_(max)≥8.9时,患者转移复发率明显增高,无病生存时间缩短,SUV_(max)≥8.9组与SUV_(max)<8.9组生存曲线差异有统计学意义,χ~2=6.309,P=0.012。Luminal A型SUV_(max)≥8.9组EFS低于SUV_(max) <8.9组,χ~2=6.494,P=0.011,Luminal B/HER2-型SUV_(max)≥8.9组EFS低于SUV_(max)<8.9组,χ~2=3.962,P=0.047,而TNBC、HER2+型、LuminalB/HER2+分子亚型组SUV_(max)不同分组间EFS差异无统计学意义,χ~2值分别为0.767、0.057和0.271,P值分别为0.603、0.811和0.381。结论局部晚期乳腺癌治疗前^(18)F-FDG SUV_(max)较高是预测患者预后不良的重要因素之一,SUV_(max)≥8.9时Luminal A和Luminal B/HER2-分子亚型乳腺癌患者的无病生存期较短。

OBJECTIVE 18F-fluorodeoxy glucose(18F-FDG)uptake in breast cancer indicates the degree of tumor metabolism.This study aimed to explore the correlation between the 18F-FDG maximum standardized uptake value(SUVmax)of primary lesions before treatment and the prognosis in different molecular subtypes of locally advanced breast cancer patients.METHODS Totally 119 patients with locally advanced breast cancer underwent 18F-FDG positron emission tomography/computed tomography scan(PET/CT)were recruited in this study from August 23 th,2010 to October31 th,2014.They were classified by immunohistochemical assays into five molecular subtypes as follows:Luminal A type,Luminal B/HER2+type,Luminal B/HER2-type,HER2 postive type and Triple-negative breast cancer(TNBC)type.RESULTS The total rate of recurrence or metastasis was 32.8%.After operation,patients were followed-up and they were divided into two groups(with and without recurrence events),SUVmaxof primary lesions before treatment in two groups were 9.68±3.83(events group,n=39)and 7.71±4.39(no events group,n=80)respectively,and the difference was statistically significant(Z=2.681,P=0.007).In the univariate analysis,baseline SUVmax,T staging,lymph node staging and clinical stage(according to American Joint Committee on Cancer staging system)were significant predictors for 3-year event free survival(EFS)(Pwere 0.012,0.022,0.013 and 0.008).Multivariate regression analysis showed that SUVmax was independent prognostic factors(P <0.001).While the cut-off point of SUVmax was set as 8.9,highSUVmaxat baseline was associated with shorter EFS(X^=6.309,P=0.012).EFS was shorter in Luminal A and Luminal B/HER2-molecular subtypes breast cancer patients with baseline tumor SUVmax≥8.9(X^=6.494,P=0.011 for Luminal A,X^=3.962,P=0.047 for Luminal B/HER2-),but SUVmaxcould not predict the recurrence or metastasis in TNBC type,HER2 positive type,LuminalB/HER2+type molecular subtypes(P were 0.603,0.811 and 0.381).CONCLUSIONS A high 18F-FDG SUVmaxof primary lesions before treatment is one of the important predicting poor prognosis factors in locally advanced breast cancer.Luminal A,Luminal B/HER2-breast cancer with bigger SUVmax(SUVmax≥8.9)may have lower survival rate.