Abstract：
OBJECTIVE: Endocrine therapy (ET) with or without CDK4/6 inhibitors is the primary treatment choice for patients with estrogen receptor (ER)-positive and HER2-negative subtype of metastatic breast cancer (MBC). We examined the metabolic parameters identified using 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) in terms of sensitivity, since no predictive factors exist.
METHODS: We included 136 patients with MBC treated with ET alone (n=107) or combined with CDK4/6 inhibitor (n=29) and examined using FDG-PET before treatment began. The highest maximum value of the standard uptake value (SUVmax), whole-body metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were calculated.
RESULTS: Progression-free survival (PFS) was significantly longer in patients with low levels of MTV, TLG, and SUVmax than those with higher levels (median PFS 49.5 vs. 20.7 months, p=0.001 for MTV, 49.5 vs. 20.7 months, p=0.0016 for TLG, 37.0 vs. 20.7 months, p=0.012 for SUVmax). Multivariable analysis revealed that TLG (hazard ratio=6.383, 95% confidence interval=1.167-34.913, p=0.033) was independently and significantly associated with PFS. The relationship between TLG levels and PFS was significant in patients treated with ET with (p=0.0054) and without (p=0.0188) CDK4/6 inhibitor.
CONCLUSIONS: TLG at baseline was a significant predictor for sensitivity to ET alone or combined with CDK4/6 inhibitor. These data may be useful to identify patients that would benefit from ET.
METHODS: We included 136 patients with MBC treated with ET alone (n=107) or combined with CDK4/6 inhibitor (n=29) and examined using FDG-PET before treatment began. The highest maximum value of the standard uptake value (SUVmax), whole-body metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were calculated.
RESULTS: Progression-free survival (PFS) was significantly longer in patients with low levels of MTV, TLG, and SUVmax than those with higher levels (median PFS 49.5 vs. 20.7 months, p=0.001 for MTV, 49.5 vs. 20.7 months, p=0.0016 for TLG, 37.0 vs. 20.7 months, p=0.012 for SUVmax). Multivariable analysis revealed that TLG (hazard ratio=6.383, 95% confidence interval=1.167-34.913, p=0.033) was independently and significantly associated with PFS. The relationship between TLG levels and PFS was significant in patients treated with ET with (p=0.0054) and without (p=0.0188) CDK4/6 inhibitor.
CONCLUSIONS: TLG at baseline was a significant predictor for sensitivity to ET alone or combined with CDK4/6 inhibitor. These data may be useful to identify patients that would benefit from ET.
摘要：
目的：有或没有CDK4/6抑制剂的内分泌治疗（ET）是雌激素受体（ER）阳性和HER2阴性亚型转移性乳腺癌（MBC）患者的主要治疗选择。我们检查了使用18F-氟代脱氧葡萄糖-正电子发射断层扫描（FDG-PET）确定的代谢参数，因为不存在预测因素。
方法：我们纳入了136例MBC患者，这些患者仅接受ET治疗（n=107）或联合CDK4/6抑制剂治疗（n=29），并在治疗开始前使用FDG-PET进行检查。标准吸收值的最高最大值（SUVmax），全身代谢性肿瘤体积（MTV），计算总病变糖酵解(TLG)。
结果：无进展生存期（PFS）在MTV水平低的患者中明显更长，TLG,和SUVmax高于水平较高的人群(PFS中位数49.5vs.20.7个月，对于MTV，p=0.001，49.5vs.20.7个月，对于TLG，p=0.0016，37.0vs.20.7个月，对于SUVmax,p=0.012)。多变量分析显示，TLG（风险比=6.383，95％置信区间=1.167-34.913，p=0.033）与PFS独立且显着相关。在使用（p=0.0054）和不使用（p=0.0188）CDK4/6抑制剂的ET治疗的患者中，TLG水平与PFS之间的关系显着。
结论：基线时的TLG是对ET单独或与CDK4/6抑制剂联合使用的敏感性的重要预测因子。这些数据可能有助于确定受益于ET的患者。
方法：我们纳入了136例MBC患者，这些患者仅接受ET治疗（n=107）或联合CDK4/6抑制剂治疗（n=29），并在治疗开始前使用FDG-PET进行检查。标准吸收值的最高最大值（SUVmax），全身代谢性肿瘤体积（MTV），计算总病变糖酵解(TLG)。
结果：无进展生存期（PFS）在MTV水平低的患者中明显更长，TLG,和SUVmax高于水平较高的人群(PFS中位数49.5vs.20.7个月，对于MTV，p=0.001，49.5vs.20.7个月，对于TLG，p=0.0016，37.0vs.20.7个月，对于SUVmax,p=0.012)。多变量分析显示，TLG（风险比=6.383，95％置信区间=1.167-34.913，p=0.033）与PFS独立且显着相关。在使用（p=0.0054）和不使用（p=0.0188）CDK4/6抑制剂的ET治疗的患者中，TLG水平与PFS之间的关系显着。
结论：基线时的TLG是对ET单独或与CDK4/6抑制剂联合使用的敏感性的重要预测因子。这些数据可能有助于确定受益于ET的患者。
