Abstract
A comprehensive systematic review of the literature was conducted on parameters from 18 F-FDG PET and a meta-analysis of the prognostic value of the maximal standard uptake value (SUVmax), metabolic tumor volume (MTV) and total lesional glycolysis (TLG) in patients with breast cancer (BC). Relevant English articles from PubMed, EMBASE, and the Cochrane Library were retrieved. Pooled hazard ratios (HRs) were used to assess the prognostic value of SUVmax, MTV, and TLG. A total of 20 primary studies with 3115 patients with BC were included. The combined HRs (95% confidence interval [CI] of higher SUVmax and higher TLG for event-free survival (EFS) were 1.53 (95% CI, 1.25-1.89, P = 0.0006) and 5.94 (95% CI, 2.57-13.71, P = 0.97), respectively. Regarding the overall survival (OS), the combined HRs were 1.22 (95%CI, 1.02-1.45, P = 0.0006) with higher SUVmax, and 2.91(95% CI, 1.75-4.85, P = 0.44) with higher MTV. Higher MTV showed no correlation with EFS [1.31(95% CI, 0.65-2.65, P = 0.18)] and similarly higher TLG showed no correlation with OS [1.20(95% CI, 0.65-2.23, P = 0.45)]. Subgroup analysis showed that SUVmax, with a median value of 5.55 was considered as a significant risk factor for both EFS and OS in BC patients. Despite clinically heterogeneous BC patients and adoption of various methods between studies, the present meta-analysis results confirmed that patients with high SUVmax are at high risk of adverse events or death in BC patients, high MTV predicted a high risk of death and high TLG predicted a high risk of adverse events.
Highlights
Breast cancer (BC) is the most common malignancy in women
The combined hazard ratios (HRs) (95% confidence interval [CI] of higher SUVmax and higher total lesional glycolysis (TLG) for event-free survival (EFS) were 1.53 and 5.94, respectively
Regarding the overall survival (OS), the combined HRs were 1.22 (95%CI, 1.02–1.45, P = 0.0006) with higher SUVmax, and 2.91(95% CI, 1.75–4.85, P = 0.44) with higher metabolic tumor volume (MTV)
Summary
Breast cancer (BC) is the most common malignancy in women. new imaging tools and assisted systemic therapy have improved the survival rate of patients with BC, patients with early invasive BC are still at risk of recurrence or death. It is crucial to identify patients experiencing a risk of relapse or progression, as there is no clinical method for accurate assessment of the prognosis and survival of BC patients till date. According to the latest report, tumor size, nuclear grade, axillary lymph node involvement, hormone receptor (e.g., estrogen receptor (ER) progesterone) status receptor (PR) and human epidermal growth factor receptor 2 (HER2), and ki-67 proliferation index might act as effective factors in predicting the recurrence or progression in patients at high risk.[1] A growing body of evidence suggests that fluoro18-fluorodeoxyglucose (18F- FDG) positron emission tomography (PET/CT) has a great prognostic significance in predicting malignant tumors, TNM staging, evaluation of therapeutic effects, FDG parameter SUV Max, metabolic tumor volume (MTV) and total lesional glycolysis (TLG), as a parameter of tumor metabolism and volume have received more and more attention. MTV is the size of the tumor tissue, which actively ingests 18F- FDG, and TLG is the median SUV value in the region of interest MTV [2,3,4,5]
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