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Abstract：
BACKGROUND: Exploring the value of baseline and early 18F-FDG PET/CT evaluations in prediction PFS in ER+/HER2- metastatic breast cancer patients treated with a cyclin-dependent kinase inhibitor in combination with an endocrine therapy.
METHODS: Sixty-six consecutive breast cancer patients who underwent a pre-therapeutic 18F-FDG PET/CT and a second PET/CT within the first 6 months of treatment were retrospectively included. Metabolic tumour volume (MTV) and total lesion glycolysis (TLG) and Dmax, which represents tumour dissemination and is defined as the distance between the two most distant lesions, were computed. The variation in these parameters between baseline and early evaluation PET as well as therapeutic evaluation using PERCIST were assessed as prognosticators of PFS at 18 months.
RESULTS: The median follow-up was equal to 22.5 months. Thirty progressions occurred (45.4%). The average time to event was 17.8 ± 10.4 months. At baseline, Dmax was the only predictive metabolic parameter. Patients with a baseline Dmax ≤ 18.10 cm had a significantly better 18 m-PFS survival than the others: 69.2% (7.7%) versus 36.7% (8.8%), p = 0.017. There was no association between PERCIST evaluation and 18 m-PFS status (p = 0.149) and there was no difference in 18 m-PFS status between patients classified as complete, partial metabolic responders or having stable metabolic disease.
CONCLUSIONS: Disease spread at baseline PET, as assessed by Dmax, is predictive of an event occurring within 18 months. In the absence of early metabolic progression, which occurs in 15% of patients, treatment should be continued regardless of the quality of the initial response to treatment.
METHODS: Sixty-six consecutive breast cancer patients who underwent a pre-therapeutic 18F-FDG PET/CT and a second PET/CT within the first 6 months of treatment were retrospectively included. Metabolic tumour volume (MTV) and total lesion glycolysis (TLG) and Dmax, which represents tumour dissemination and is defined as the distance between the two most distant lesions, were computed. The variation in these parameters between baseline and early evaluation PET as well as therapeutic evaluation using PERCIST were assessed as prognosticators of PFS at 18 months.
RESULTS: The median follow-up was equal to 22.5 months. Thirty progressions occurred (45.4%). The average time to event was 17.8 ± 10.4 months. At baseline, Dmax was the only predictive metabolic parameter. Patients with a baseline Dmax ≤ 18.10 cm had a significantly better 18 m-PFS survival than the others: 69.2% (7.7%) versus 36.7% (8.8%), p = 0.017. There was no association between PERCIST evaluation and 18 m-PFS status (p = 0.149) and there was no difference in 18 m-PFS status between patients classified as complete, partial metabolic responders or having stable metabolic disease.
CONCLUSIONS: Disease spread at baseline PET, as assessed by Dmax, is predictive of an event occurring within 18 months. In the absence of early metabolic progression, which occurs in 15% of patients, treatment should be continued regardless of the quality of the initial response to treatment.
摘要：
背景：探索基线和早期18F-FDGPET/CT评估在预测ER+/HER2-转移性乳腺癌患者接受细胞周期蛋白依赖性激酶抑制剂联合内分泌治疗的PFS中的价值。
方法：回顾性纳入66例连续乳腺癌患者，这些患者在治疗的前6个月内接受了治疗前18F-FDGPET/CT和第二次PET/CT。代谢性肿瘤体积（MTV）和总病变糖酵解（TLG）和Dmax，它代表肿瘤播散，定义为两个最远病变之间的距离，是计算的。这些参数在基线和早期评估PET以及使用PERCIST的治疗性评估之间的变化被评估为18个月时PFS的预测因子。
结果：中位随访时间等于22.5个月。发生了30例进展（45.4%）。事件发生的平均时间为17.8±10.4个月。在基线,Dmax是唯一的预测代谢参数。基线Dmax≤18.10cm的患者的18m-PFS生存率明显优于其他患者：69.2％（7.7％）对36.7％（8.8％），p=0.017。PERCIST评估与18m-PFS状态之间没有关联（p=0.149），并且分类为完全的患者之间的18m-PFS状态没有差异，部分代谢反应者或有稳定的代谢疾病。
结论：基线PET时疾病传播，根据Dmax的评估，可以预测18个月内发生的事件。在没有早期代谢进展的情况下，发生在15%的患者中，无论初始治疗反应的质量如何,均应继续治疗.
方法：回顾性纳入66例连续乳腺癌患者，这些患者在治疗的前6个月内接受了治疗前18F-FDGPET/CT和第二次PET/CT。代谢性肿瘤体积（MTV）和总病变糖酵解（TLG）和Dmax，它代表肿瘤播散，定义为两个最远病变之间的距离，是计算的。这些参数在基线和早期评估PET以及使用PERCIST的治疗性评估之间的变化被评估为18个月时PFS的预测因子。
结果：中位随访时间等于22.5个月。发生了30例进展（45.4%）。事件发生的平均时间为17.8±10.4个月。在基线,Dmax是唯一的预测代谢参数。基线Dmax≤18.10cm的患者的18m-PFS生存率明显优于其他患者：69.2％（7.7％）对36.7％（8.8％），p=0.017。PERCIST评估与18m-PFS状态之间没有关联（p=0.149），并且分类为完全的患者之间的18m-PFS状态没有差异，部分代谢反应者或有稳定的代谢疾病。
结论：基线PET时疾病传播，根据Dmax的评估，可以预测18个月内发生的事件。在没有早期代谢进展的情况下，发生在15%的患者中，无论初始治疗反应的质量如何,均应继续治疗.
