¹⁸F-FDG PET/CT is a prognostic biomarker in patients affected by bone metastases from breast cancer in comparison with ¹⁸F-NaF PET/CT

Summary

Aim: To compare ¹⁸F-FDG PET/CT and ¹⁸F-NaF PET/CT with respect to disease prognostication and outcome in patients affected by bone metastases from breast cancer (BC). Patients, methods: We retrospectively investigated 32 women with BC and documented bone metastases. Semi-quantitative parameters were applied to ¹⁸F-FDG PET/CT and ¹⁸F-Na PET/CT in order to evaluate disease extent and tumour metabolism. We used time-to-event analyses (Kaplan Meier and COX proportional hazard methods) to estimate progression-free (PFS) and overall survival (OS) in order to assess the independent prognostic value of ¹⁸F-FDG PET/CT and ¹⁸F-Na PET/CT. Results: The sensitivity of ¹⁸F-NaF PET/CT (100%) was higher (p < 0.05) than that of ¹⁸F-FDG PET/CT (72% and 72%). None of the ¹⁸F-FDG PET/CT-negative patients showed disease progression at the end of follow-up. After adjustment for age, Ki-67 levels, presence of visceral metastases, hormone therapy, duration of bone disease and response to first-line therapy, only ¹⁸F-FDG SUV mean [HR 15.7, 95% confidence interval (CI) 1.15-214.5] and ¹⁸F-FDG whole-body bone metabolic burden (WB-B-MB) (HR 16.9; 95%CI 1.87-152.2) were independently and significantly associated with OS. None of the ¹⁸F-NaF PET/CT parameters were associated with OS. None of the conventional clinical prognostic parameters remained significantly associated with OS after the inclusion of PET/ CT parameters in the model. Conclusion: ¹⁸F-FDG PET/CT is independently associated with OS in BC patients with bone metastases and its prognostic impact seems to be higher than conventional clinical and biological prognostic factors. Although ¹⁸F-NaF PET/CT has a higher diagnostic sensitivity than ¹⁸F-FDG PET/ CT, it is not independently associated with OS.

Zusammenfassung

Ziel: Der Vergleich von F-FDG-PET/CT und F-NaF-PET/CT in Bezug auf Krankheitsprognose und -ausgang bei Patientinnen mit Brustkrebs (BK), die von Knochenmetastasen betroffen sind. Wir haben rückwirkend 32 Frauen mit Brustkrebs und nachgewiesenen Knochenmetastasen untersucht. Semiquantitative Parameter wurden auf F-FDG-PET/CT und F-NaF-PET/CT angewandt, um das Krankheitsausmaß und den Tumorstoffwechsel zu evaluieren. Hierfür verwendeten wir die Ereigniszeitanalyse (time-to-event-analyse) – (Kaplan Meier und COX proportionale Hazard- Methode) um die progressionsfreie Überlebenszeit und Gesamtüberlebenszeit einzuschätzen und den unabhängig prognostischen Wert von F-FDG-PET/CT und NaF-PET/ CT beurteilen zu können. Ergebnisse: Die Empfindlichkeit von F-NaF-PET/CT (100%) war höher (p < 0,05) als die der F-FDG-PET/ CT (72% und 72%). Keiner der F-FDG-PET/ CT-negativen Patienten zeigte eine Krankheitsprogression bis zum Ende der Verlaufskontrolle. Nach dem Bereinigen der Daten für Faktoren wie Alter, Ki-67-Level, Präsenz viszeraler Metastasen, Hormontherapie, Dauer der Knochenerkrankung und Ansprechen auf die Erstbehandlung konnten nur der F-FDG-SUVMittelwert (HR 15,7, 95% Konfidenzintervall 1,15–214,5) und die ¹⁸F-FDG-Ganzkörpermetabolische Knochenbelastung (WB-B-MB) (HR 16,9, 95% KI 1,87–152,2) in unabhängiger und erheblicher Weise mit der Gesamtüberlebenszeit in Verbindung gebracht werden. Keiner der F-NaF-PET/CT-Parameter konnte mit der Gesamtüberlebenszeit assoziiert werden. Keiner der konventionellen klinischen Prognoseparameter konnte nach Einbeziehung der PET/CT-Parameter in das Modell weiterhin signifikant mit der Gesamtüberlebenszeit in Zusammenhang gebracht werden. Schlussfolgerungen: F-FDG-PET/CT ist unabhängig mit der Gesamtüberlebenszeit von Brustkrebspatientinnen mit Knochenmetastasen assoziierbar und seine prognostische Bedeutung scheint höher zu sein, als die von konventionellen klinischen und biologischen Prognosefaktoren. Obwohl der F-NaF-PET/CT eine höhere Diagnosesensibilität als F-FDG-PET/CT aufweist, ist er nicht unabhängig assoziierbar mit der Gesamtüberlebenszeit.

Keywords

Prognostic value - bone metastases - breast cancer - ¹⁸F-FDG - ¹⁸F-NaF - PET/CT

Schlüsselwörter

Prognosewert - Knochenmetastasen - Brustkrebs - ¹⁸F-FDG - ¹⁸F-NaF - PET/CT

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