Abstract
BackgroundWe performed a systematic review and meta-analysis to evaluate the prognostic significance of 18F-FDG PET and PET/CT for evaluation of responses to neoadjuvant chemotherapy (NAC) in breast cancer patients.MethodsWe searched PubMed, Embase, and the Cochrane Library databases until June 2020 to identify studies that assessed the prognostic value of 18F-FDG PET scans during or after NAC with regard to overall (OS) and disease-free survival (DFS). Hazard ratios (HRs) and their 95% confidence intervals (CIs) were pooled meta-analytically using a random-effects model.ResultsTwenty-one studies consisting of 1630 patients were included in the qualitative synthesis. Twelve studies investigated the use of PET scans for interim response evaluation (during NAC) and 10 studies assessed post-treatment PET evaluation (after NAC). The most widely evaluated parameter distinguishing metabolic responders from poor responders on interim or post-treatment PET scans was %ΔSUVmax, defined as the percent reduction of SUVmax compared to baseline PET, followed by SUVmax and complete metabolic response (CMR). For the 17 studies included in the meta-analysis, the pooled HR of metabolic responses on DFS was 0.21 (95% confidence interval [CI], 0.14–0.32) for interim PET scans and 0.31 (95% CI, 0.21–0.46) for post-treatment PET scans. Regarding the influence of metabolic responses on OS, the pooled HRs for interim and post-treatment PET scans were 0.20 (95% CI, 0.09–0.44) and 0.26 (95% CI, 0.14–0.51), respectively.ConclusionsThe currently available literature suggests that the use of 18F-FDG PET or PET/CT for evaluation of response to NAC provides significant predictive value for disease recurrence and survival in breast cancer patients and might allow risk stratification and guide rational management.
Highlights
Neoadjuvant chemotherapy (NAC) is the initial therapy for patients with inoperable or locally advanced breast cancer [1] and enables more patients with operable but large primary tumours to be treated with breastconserving surgery [2]
We included only studies where Hazard ratios (HRs) for metabolic responses assessed by PET scans either during or after neoadjuvant chemotherapy (NAC) were available
In clinical practice, it is plausible that 18F-FDG PET or PET/CT is highly likely to have an incremental prognostic value on pathological response of breast cancer given (1) PET scans enable early assessment of patient responses to NAC, which may support decisions to cease ineffective treatment and select alternative treatment options, whereas pathological response can only be assessed after completion of surgical resection; (2) twelve of 15 included studies in which either multivariate Cox regression analyses or subgroup analyses were performed reported the metabolic response as having independent prognostic significance to pathological response [13,14,15,16,17, 19, 22,23,24,25,26,27,28,29, 31]
Summary
Neoadjuvant chemotherapy (NAC) is the initial therapy for patients with inoperable or locally advanced breast cancer [1] and enables more patients with operable but large primary tumours to be treated with breastconserving surgery [2]. Accumulating evidence has suggested that assessment of the metabolic response using 18F-FDG PET or PET/CT has prognostic significance in breast cancer patients who underwent NAC [12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32]. We performed a systematic review and meta-analysis to evaluate the prognostic significance of 18FFDG PET and PET/CT for evaluation of responses to neoadjuvant chemotherapy (NAC) in breast cancer patients
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