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首页> 美国卫生研究院文献>Cancer Management and Research >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
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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

机译：靶向肺病变的异质性可预测以铂为基础的一线治疗结果和转移性三阴性乳腺癌伴肺转移的患者的总生存期：一种 PET活检方法

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>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 (18F-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 18F-FDG PET/CT scans before first‐line therapy from three clinical trials (, and ). 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 18F-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.
机译：>背景：基于铂的化学疗法被广泛用作转移性三阴性乳腺癌（mTNBC）的一线治疗。氟18氟脱氧葡萄糖（ 18 F-FDG）正电子发射断层扫描/计算机断层扫描（PET / CT）引起的肿瘤内异质性可能预示着治疗结果和乳腺癌的预后。然而，多种病变和复杂的计算方法的存在导致该参数在转移性乳腺癌的临床使用中的困难。这项研究的目的是提供一种方便有效的肿瘤内异质性测量方法，以预测mTNBC肺转移患者的治疗结果。>患者和方法：我们招募了进行过的mTNBC肺转移患者。一线治疗前的18项F-FDG PET / CT扫描来自三个临床试验（和）。除了常规的FDG参数（包括标准摄取值（SUV），总病变糖酵解（TLG）和代谢肿瘤体积（MTV））以外，我们将肺指数定义为SUVmean除以目标肺的SUVmax和SUVmean之差病变。根据轮廓轮廓内SUV强度> 2.5的自适应阈值，使用软件从手动轮廓自动导出MTV。使用以下公式计算TLG：TLG = SUVmean×MTV。通过Kaplan–Meier方法评估无进展生存期（PFS）和总生存期，并使用Cox比例风险模型进行单因素和多因素分析。>结果： 31名患者的数据可用于分析。低肺指数（LI）患者的中位PFS为8.1个月，显着长于高LI指数患者（HR = 3.3，95％CI 1.5-7.3，p = 0.003）。 TLG值低的患者的PFS明显高于TLG值高的患者（HR = 2.6，95％CI 1.2-5.8，p = 0.014）。低TLG患者的总生存期明显高于高TLG患者（31.2个月vs 13.9个月，HR = 3.1，95％CI 1.2-8.6，p = 0.029）。多变量分析证实了LI和TLG的预测价值。>结论：本研究提出了一种新的“ PET活检”方法，以评估mTNBC预处理 18 F-FDG的肿瘤内异质性PET / CT扫描显示LI和TLG对基于铂的一线治疗结果和总体生存率的预测价值。这些发现可以帮助临床医生识别不仅可能对基于铂的治疗有良好反应而且预后良好的患者。

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