Prognostic value of SUV(max) in breast cancer and comparative analyses of molecular subtypes: A systematic review and meta-analysis

BACKGROUND: To assess the prognostic capability of the maximum standardized uptake values (SUV(max)) measured in the primary tumor and axillary lymph nodes (ALNs) by pretreatment fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography and analyze outcomes according to the molecular breast cancer subtypes. METHODS: The databases were systematically searched using keywords for breast cancer, positron emission tomography/computed tomography, and SUV(max); the extracted studies reported at least 1 form of survival data, event-free survival (EFS) and overall survival. Comparative analyses of the pooled hazard ratios (HRs) for EFS and overall survival were performed to assess their correlations with SUV(max). The pooled HR was estimated using random-effects model according to the results of heterogeneity. RESULTS: Thirteen eligible studies comprising 3040 patients with breast cancer were included. The pooled HRs of high SUV(max) in the primary tumor and ALN were 3.01 (95% CI 1.83–4.97, P < .00001; I2 = 82%) and 3.72 (95% CI 1.15–12.01; I2 = 92%; P = .03), respectively. Patients with higher SUV(max) demonstrated a poorer survival prognosis. Furthermore, comparative analyses according to the molecular subtypes demonstrated that the SUV(max) in the primary tumor or ALN can be a predictive parameter in patients with the luminal subtype disease. Subtype analysis results indicated a significant association of the luminal group, with a HR of 2.65 (95% CI 1.31–5.37; I2 = 27%; P = .007). CONCLUSIONS: SUV(max) from pretreatment is a significant prognostic factor for EFS in patients with breast cancer. Despite several limitations, correlation with molecular subtype (luminal type) was demonstrated. Further large-scale studies are required to investigate the precise prognostic capability of SUV(max).