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Heterogeneity of targeted lung lesion predicts platinum-based first-line therapy outcomes and overall survival for metastatic triple-negative breast cancer patients with lung metastasis: a “PET biopsy” method
Background: Platinum-based chemotherapy is widely used as first-line therapy for metastatic triple-negative breast cancer (mTNBC). Intratumor heterogeneity derived from fluorine-18 fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) is a potential predictor of tr...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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2019
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6612961/ https://www.ncbi.nlm.nih.gov/pubmed/31308743 http://dx.doi.org/10.2147/CMAR.S204364 |
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author | Xie, Yizhao Gu, Bingxin Hu, Xichun Zhang, Yingjian Zhang, Jian Wang, Zhonghua Zhao, Yannan Gong, Chengcheng Li, Yi Yang, Zhongyi Wang, Biyun |
author_facet | Xie, Yizhao Gu, Bingxin Hu, Xichun Zhang, Yingjian Zhang, Jian Wang, Zhonghua Zhao, Yannan Gong, Chengcheng Li, Yi Yang, Zhongyi Wang, Biyun |
author_sort | Xie, Yizhao |
collection | PubMed |
description | Background: Platinum-based chemotherapy is widely used as first-line therapy for metastatic triple-negative breast cancer (mTNBC). Intratumor heterogeneity derived from fluorine-18 fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) is a potential predictor of treatment outcomes and the prognosis of breast cancer. However, the presence of multiple lesions and complex calculation methods leads to difficulties in the clinical use of this parameter for metastatic breast cancer. The aim of this study is to provide a convenient and effective measurement of intratumor heterogeneity to predict treatment outcomes for mTNBC patients with lung metastasis. Patients and methods: We enrolled mTNBC patients with lung metastasis who underwent (18)F-FDG PET/CT scans before first‐line therapy from three clinical trials (NCT01287624, NCT02341911 and NCT02546934). Apart from the regular FDG parameters, including standard uptake value (SUV), total lesion glycolysis (TLG) and metabolic tumor volume (MTV), we defined the lung index as the SUVmean divided by the difference between the SUVmax and SUVmean for the targeted lung lesion. The MTV was automatically exported from the manual delineation using software based on an adaptive threshold of SUV intensity >2.5 within the contouring margin. The TLG was calculated using the following formula: TLG=SUVmean×MTV. Progression‐free survival (PFS) and overall survival were estimated by the Kaplan–Meier method, and univariate and multivariate analyses were performed using the Cox proportional hazard model. Results: The data from 31 patients were available for analysis. The median PFS of low-lung index (LI) patients was 8.1 months, which was significantly longer than that of high-LI patients (HR=3.3, 95% CI 1.5–7.3, p=0.003). Patients with low TLG had a significantly better PFS than those with high TLG (HR=2.6, 95% CI 1.2–5.8, p=0.014). Patients with low TLG had significantly longer overall survival than those with high TLG (31.2 months vs 13.9 months, HR=3.1, 95% CI 1.2–8.6, p=0.029). Multivariate analysis confirmed the predictive value of LI and TLG. Conclusions: This study proposed a new “PET biopsy” method to evaluate the intratumor heterogeneity of mTNBC on pretreatment (18)F-FDG PET/CT scans and indicated the predictive value of LI and TLG for first-line platinum-based treatment outcomes and overall survival. These findings could help clinicians recognize patients who are likely to not only have a favorable response to platinum-based therapy but also a good prognosis. |
format | Online Article Text |
id | pubmed-6612961 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Dove |
record_format | MEDLINE/PubMed |
spelling | pubmed-66129612019-07-15 Heterogeneity of targeted lung lesion predicts platinum-based first-line therapy outcomes and overall survival for metastatic triple-negative breast cancer patients with lung metastasis: a “PET biopsy” method Xie, Yizhao Gu, Bingxin Hu, Xichun Zhang, Yingjian Zhang, Jian Wang, Zhonghua Zhao, Yannan Gong, Chengcheng Li, Yi Yang, Zhongyi Wang, Biyun Cancer Manag Res Original Research Background: Platinum-based chemotherapy is widely used as first-line therapy for metastatic triple-negative breast cancer (mTNBC). Intratumor heterogeneity derived from fluorine-18 fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) is a potential predictor of treatment outcomes and the prognosis of breast cancer. However, the presence of multiple lesions and complex calculation methods leads to difficulties in the clinical use of this parameter for metastatic breast cancer. The aim of this study is to provide a convenient and effective measurement of intratumor heterogeneity to predict treatment outcomes for mTNBC patients with lung metastasis. Patients and methods: We enrolled mTNBC patients with lung metastasis who underwent (18)F-FDG PET/CT scans before first‐line therapy from three clinical trials (NCT01287624, NCT02341911 and NCT02546934). Apart from the regular FDG parameters, including standard uptake value (SUV), total lesion glycolysis (TLG) and metabolic tumor volume (MTV), we defined the lung index as the SUVmean divided by the difference between the SUVmax and SUVmean for the targeted lung lesion. The MTV was automatically exported from the manual delineation using software based on an adaptive threshold of SUV intensity >2.5 within the contouring margin. The TLG was calculated using the following formula: TLG=SUVmean×MTV. Progression‐free survival (PFS) and overall survival were estimated by the Kaplan–Meier method, and univariate and multivariate analyses were performed using the Cox proportional hazard model. Results: The data from 31 patients were available for analysis. The median PFS of low-lung index (LI) patients was 8.1 months, which was significantly longer than that of high-LI patients (HR=3.3, 95% CI 1.5–7.3, p=0.003). Patients with low TLG had a significantly better PFS than those with high TLG (HR=2.6, 95% CI 1.2–5.8, p=0.014). Patients with low TLG had significantly longer overall survival than those with high TLG (31.2 months vs 13.9 months, HR=3.1, 95% CI 1.2–8.6, p=0.029). Multivariate analysis confirmed the predictive value of LI and TLG. Conclusions: This study proposed a new “PET biopsy” method to evaluate the intratumor heterogeneity of mTNBC on pretreatment (18)F-FDG PET/CT scans and indicated the predictive value of LI and TLG for first-line platinum-based treatment outcomes and overall survival. These findings could help clinicians recognize patients who are likely to not only have a favorable response to platinum-based therapy but also a good prognosis. Dove 2019-07-02 /pmc/articles/PMC6612961/ /pubmed/31308743 http://dx.doi.org/10.2147/CMAR.S204364 Text en © 2019 Xie et al. http://creativecommons.org/licenses/by-nc/3.0/ This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). |
spellingShingle | Original Research Xie, Yizhao Gu, Bingxin Hu, Xichun Zhang, Yingjian Zhang, Jian Wang, Zhonghua Zhao, Yannan Gong, Chengcheng Li, Yi Yang, Zhongyi Wang, Biyun Heterogeneity of targeted lung lesion predicts platinum-based first-line therapy outcomes and overall survival for metastatic triple-negative breast cancer patients with lung metastasis: a “PET biopsy” method |
title | Heterogeneity of targeted lung lesion predicts platinum-based first-line therapy outcomes and overall survival for metastatic triple-negative breast cancer patients with lung metastasis: a “PET biopsy” method |
title_full | Heterogeneity of targeted lung lesion predicts platinum-based first-line therapy outcomes and overall survival for metastatic triple-negative breast cancer patients with lung metastasis: a “PET biopsy” method |
title_fullStr | Heterogeneity of targeted lung lesion predicts platinum-based first-line therapy outcomes and overall survival for metastatic triple-negative breast cancer patients with lung metastasis: a “PET biopsy” method |
title_full_unstemmed | Heterogeneity of targeted lung lesion predicts platinum-based first-line therapy outcomes and overall survival for metastatic triple-negative breast cancer patients with lung metastasis: a “PET biopsy” method |
title_short | Heterogeneity of targeted lung lesion predicts platinum-based first-line therapy outcomes and overall survival for metastatic triple-negative breast cancer patients with lung metastasis: a “PET biopsy” method |
title_sort | heterogeneity of targeted lung lesion predicts platinum-based first-line therapy outcomes and overall survival for metastatic triple-negative breast cancer patients with lung metastasis: a “pet biopsy” method |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6612961/ https://www.ncbi.nlm.nih.gov/pubmed/31308743 http://dx.doi.org/10.2147/CMAR.S204364 |
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