Abstract
PurposeTo investigate the combined prognostic impact of body mass index (BMI) and tumor standardized uptake value (SUV) measured on pretreatment 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in patients with breast cancer.MethodsWe evaluated a cohort of 332 patients with newly diagnosed breast cancer (stage I-III) who underwent pretreatment FDG PET/CT followed by curative resection. Patients were categorized as overweight (BMI ≥ 23 kg/m2) or normal weight (BMI < 23 kg/m2). Primary tumor maximum SUV was measured by FDG PET/CT. Associations between BMI and tumor SUV with disease recurrence were assessed using Cox regression models.ResultsMedian follow-up was 39 months. There were 76 recurrences and 15 cancer-related deaths. Multivariable Cox regression analysis demonstrated that high tumor SUV (hazard ratio [HR] = 1.75; 95% CI, 1.02–3.02; P = 0.044) and overweight (HR = 1.84; 95% CI, 1.17–2.89; P = 0.008) were independent poor prognostic factors. Positive hormone receptor status was an independent predictor of favorable outcome (HR = 0.42; 95% CI, 0.26–0.68; P < 0.001). Overweight patients with high tumor SUV had a two-fold risk of recurrence compared to patients with normal weight or low tumor SUV after adjusting for clinical stage and tumor subtype (HR = 2.06; 95% CI, 1.30–3.27; P = 0.002).ConclusionsIn patients with breast cancer, higher tumor SUV was associated with a more adverse outcome particularly in overweight women. BMI status combined with tumor SUV data allows better risk-stratification of breast cancer, independent of clinical stage and tumor subtype.
Highlights
Obesity and overweight are recognized to play a prominent role in the incidence and progression of various malignancies
Multivariable Cox regression analysis demonstrated that high tumor standardized uptake value (SUV) and overweight (HR = 1.84; 95% confidence intervals (CIs), 1.17– 2.89; P = 0.008) were independent poor prognostic factors
Positive hormone receptor status was an independent predictor of favorable outcome (HR = 0.42; 95% CI, 0.26–0.68; P < 0.001)
Summary
Obesity and overweight are recognized to play a prominent role in the incidence and progression of various malignancies. Obesity is suggested as a risk factor for cancer development [1, 2], but the association may differ according to tumor subtype and hormone dependence. Breast cancer patients who are overweight or obese are more likely to have poor outcome [8,9,10,11,12,13]. High BMI has been associated with worse outcome in hormone receptor-positive breast cancers [12, 13]. A link between high BMI and poor prognosis in triple-negative breast cancers has been shown in some studies [8, 9, 15, 16], whereas others did not observe such an association [13, 17]
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