FDG avidity and tumor burden

Survival outcomes for patients with recurrent breast cancer

Mehdi Taghipour, Rick Arthur Wray, Sara Sheikhbahaei, Jean L. Wright, Rathan M. Subramaniam

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

OBJECTIVE: The objective of this study was to assess the value of quantitative PET parameters in the prediction of survival for patients with recurrent breast cancer. MATERIALS AND METHODS: We conducted a retrospective study of 78 women who had recurrent breast cancer identified by biopsy or follow-up examinations from 2000 to 2012. The maximum and peak standardized uptake values (SUVmax and SUVpeak, respectively), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were measured for each recurrent lesion at primary, nodal, and distant metastatic sites, with the use of the gradient segmentation method. The optimum cutoff point (i.e., the value with the maximum Youden index, defined as sensitivity plus specificity minus 1) was calculated using the ROC curve. The median follow-up duration was 28.5 months (range, 0-94 months). The primary outcome measure was overall survival (OS). Kaplan-Meier survival plots and Cox regression analyses were performed. RESULTS: The mean (± SD) values noted for the study population were as follows: an SUVmax of 6.70 ± 4.1, an SUVpeak of 5.12 ± 3.4, total lesion glycolysis of all recurrent lesions (TLGtotal) of 359.73 ± 1114.4 g, and metabolic tumor volume of all recurrent lesions (MTVtotal) of 68.04 ± 144.9 mL. The mean OS for patients who died was 25.5 months, whereas for patients who survived, it was 36.7 months (p = 0.04). Univariate analysis showed that age (p = 0.02), optimum SUVmax (p = 0.006), SUVpeak (p = 0.006), and TLGtotal (p = 0.034) were associated with OS; however, none of the factors remained statistically significant in multivariate analysis. Kaplan-Meier survival analysis was performed, and the SUVmax (threshold, 2.9; hazard ratio [HR], 5.2 [95% CI, 1.6-16.7]; p = 0.002), SUVpeak (threshold, 2.34; HR, 4.3 [95% CI, 1.5-12]; p = 0.002), and TLG (threshold, 11.85 g; HR, 2.8 [95% CI, 1.0-7.1]; p = 0.025) were statistically significant predictors of death during follow-up. An integrated risk stratification model with FDG avidity (SUVmax) and MTVtotal divided into three subgroups of patients predicted patient survival outcomes (HR, 2.48 [95% CI, 1.38-4.46]; p = 0.005, by log-rank test). CONCLUSION: FDG PET-determined SUVmax, SUVpeak, and TLG values and an integrated risk stratification scheme using FDG avidity and total tumor burden appear to provide prognostic survival information for patients with recurrent breast cancer.

Original languageEnglish (US)
Pages (from-to)846-855
Number of pages10
JournalAmerican Journal of Roentgenology
Volume206
Issue number4
DOIs
StatePublished - Apr 1 2016
Externally publishedYes

Fingerprint

Tumor Burden
Breast Neoplasms
Glycolysis
Survival
Kaplan-Meier Estimate
Survival Analysis
ROC Curve
Multivariate Analysis
Retrospective Studies
Regression Analysis
Outcome Assessment (Health Care)
Biopsy
Sensitivity and Specificity
Population

Keywords

  • Breast cancer
  • PET
  • Recurrence
  • Surveillance
  • Survival

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

FDG avidity and tumor burden : Survival outcomes for patients with recurrent breast cancer. / Taghipour, Mehdi; Wray, Rick Arthur; Sheikhbahaei, Sara; Wright, Jean L.; Subramaniam, Rathan M.

In: American Journal of Roentgenology, Vol. 206, No. 4, 01.04.2016, p. 846-855.

Research output: Contribution to journalArticle

Taghipour, Mehdi ; Wray, Rick Arthur ; Sheikhbahaei, Sara ; Wright, Jean L. ; Subramaniam, Rathan M. / FDG avidity and tumor burden : Survival outcomes for patients with recurrent breast cancer. In: American Journal of Roentgenology. 2016 ; Vol. 206, No. 4. pp. 846-855.
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abstract = "OBJECTIVE: The objective of this study was to assess the value of quantitative PET parameters in the prediction of survival for patients with recurrent breast cancer. MATERIALS AND METHODS: We conducted a retrospective study of 78 women who had recurrent breast cancer identified by biopsy or follow-up examinations from 2000 to 2012. The maximum and peak standardized uptake values (SUVmax and SUVpeak, respectively), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were measured for each recurrent lesion at primary, nodal, and distant metastatic sites, with the use of the gradient segmentation method. The optimum cutoff point (i.e., the value with the maximum Youden index, defined as sensitivity plus specificity minus 1) was calculated using the ROC curve. The median follow-up duration was 28.5 months (range, 0-94 months). The primary outcome measure was overall survival (OS). Kaplan-Meier survival plots and Cox regression analyses were performed. RESULTS: The mean (± SD) values noted for the study population were as follows: an SUVmax of 6.70 ± 4.1, an SUVpeak of 5.12 ± 3.4, total lesion glycolysis of all recurrent lesions (TLGtotal) of 359.73 ± 1114.4 g, and metabolic tumor volume of all recurrent lesions (MTVtotal) of 68.04 ± 144.9 mL. The mean OS for patients who died was 25.5 months, whereas for patients who survived, it was 36.7 months (p = 0.04). Univariate analysis showed that age (p = 0.02), optimum SUVmax (p = 0.006), SUVpeak (p = 0.006), and TLGtotal (p = 0.034) were associated with OS; however, none of the factors remained statistically significant in multivariate analysis. Kaplan-Meier survival analysis was performed, and the SUVmax (threshold, 2.9; hazard ratio [HR], 5.2 [95{\%} CI, 1.6-16.7]; p = 0.002), SUVpeak (threshold, 2.34; HR, 4.3 [95{\%} CI, 1.5-12]; p = 0.002), and TLG (threshold, 11.85 g; HR, 2.8 [95{\%} CI, 1.0-7.1]; p = 0.025) were statistically significant predictors of death during follow-up. An integrated risk stratification model with FDG avidity (SUVmax) and MTVtotal divided into three subgroups of patients predicted patient survival outcomes (HR, 2.48 [95{\%} CI, 1.38-4.46]; p = 0.005, by log-rank test). CONCLUSION: FDG PET-determined SUVmax, SUVpeak, and TLG values and an integrated risk stratification scheme using FDG avidity and total tumor burden appear to provide prognostic survival information for patients with recurrent breast cancer.",
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T2 - Survival outcomes for patients with recurrent breast cancer

AU - Taghipour, Mehdi

AU - Wray, Rick Arthur

AU - Sheikhbahaei, Sara

AU - Wright, Jean L.

AU - Subramaniam, Rathan M.

PY - 2016/4/1

Y1 - 2016/4/1

N2 - OBJECTIVE: The objective of this study was to assess the value of quantitative PET parameters in the prediction of survival for patients with recurrent breast cancer. MATERIALS AND METHODS: We conducted a retrospective study of 78 women who had recurrent breast cancer identified by biopsy or follow-up examinations from 2000 to 2012. The maximum and peak standardized uptake values (SUVmax and SUVpeak, respectively), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were measured for each recurrent lesion at primary, nodal, and distant metastatic sites, with the use of the gradient segmentation method. The optimum cutoff point (i.e., the value with the maximum Youden index, defined as sensitivity plus specificity minus 1) was calculated using the ROC curve. The median follow-up duration was 28.5 months (range, 0-94 months). The primary outcome measure was overall survival (OS). Kaplan-Meier survival plots and Cox regression analyses were performed. RESULTS: The mean (± SD) values noted for the study population were as follows: an SUVmax of 6.70 ± 4.1, an SUVpeak of 5.12 ± 3.4, total lesion glycolysis of all recurrent lesions (TLGtotal) of 359.73 ± 1114.4 g, and metabolic tumor volume of all recurrent lesions (MTVtotal) of 68.04 ± 144.9 mL. The mean OS for patients who died was 25.5 months, whereas for patients who survived, it was 36.7 months (p = 0.04). Univariate analysis showed that age (p = 0.02), optimum SUVmax (p = 0.006), SUVpeak (p = 0.006), and TLGtotal (p = 0.034) were associated with OS; however, none of the factors remained statistically significant in multivariate analysis. Kaplan-Meier survival analysis was performed, and the SUVmax (threshold, 2.9; hazard ratio [HR], 5.2 [95% CI, 1.6-16.7]; p = 0.002), SUVpeak (threshold, 2.34; HR, 4.3 [95% CI, 1.5-12]; p = 0.002), and TLG (threshold, 11.85 g; HR, 2.8 [95% CI, 1.0-7.1]; p = 0.025) were statistically significant predictors of death during follow-up. An integrated risk stratification model with FDG avidity (SUVmax) and MTVtotal divided into three subgroups of patients predicted patient survival outcomes (HR, 2.48 [95% CI, 1.38-4.46]; p = 0.005, by log-rank test). CONCLUSION: FDG PET-determined SUVmax, SUVpeak, and TLG values and an integrated risk stratification scheme using FDG avidity and total tumor burden appear to provide prognostic survival information for patients with recurrent breast cancer.

AB - OBJECTIVE: The objective of this study was to assess the value of quantitative PET parameters in the prediction of survival for patients with recurrent breast cancer. MATERIALS AND METHODS: We conducted a retrospective study of 78 women who had recurrent breast cancer identified by biopsy or follow-up examinations from 2000 to 2012. The maximum and peak standardized uptake values (SUVmax and SUVpeak, respectively), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were measured for each recurrent lesion at primary, nodal, and distant metastatic sites, with the use of the gradient segmentation method. The optimum cutoff point (i.e., the value with the maximum Youden index, defined as sensitivity plus specificity minus 1) was calculated using the ROC curve. The median follow-up duration was 28.5 months (range, 0-94 months). The primary outcome measure was overall survival (OS). Kaplan-Meier survival plots and Cox regression analyses were performed. RESULTS: The mean (± SD) values noted for the study population were as follows: an SUVmax of 6.70 ± 4.1, an SUVpeak of 5.12 ± 3.4, total lesion glycolysis of all recurrent lesions (TLGtotal) of 359.73 ± 1114.4 g, and metabolic tumor volume of all recurrent lesions (MTVtotal) of 68.04 ± 144.9 mL. The mean OS for patients who died was 25.5 months, whereas for patients who survived, it was 36.7 months (p = 0.04). Univariate analysis showed that age (p = 0.02), optimum SUVmax (p = 0.006), SUVpeak (p = 0.006), and TLGtotal (p = 0.034) were associated with OS; however, none of the factors remained statistically significant in multivariate analysis. Kaplan-Meier survival analysis was performed, and the SUVmax (threshold, 2.9; hazard ratio [HR], 5.2 [95% CI, 1.6-16.7]; p = 0.002), SUVpeak (threshold, 2.34; HR, 4.3 [95% CI, 1.5-12]; p = 0.002), and TLG (threshold, 11.85 g; HR, 2.8 [95% CI, 1.0-7.1]; p = 0.025) were statistically significant predictors of death during follow-up. An integrated risk stratification model with FDG avidity (SUVmax) and MTVtotal divided into three subgroups of patients predicted patient survival outcomes (HR, 2.48 [95% CI, 1.38-4.46]; p = 0.005, by log-rank test). CONCLUSION: FDG PET-determined SUVmax, SUVpeak, and TLG values and an integrated risk stratification scheme using FDG avidity and total tumor burden appear to provide prognostic survival information for patients with recurrent breast cancer.

KW - Breast cancer

KW - PET

KW - Recurrence

KW - Surveillance

KW - Survival

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