PET/CT with 18F-FDG predicts short-term outcome in stage II/III breast cancer patients upstaged to N2/3 nodal disease. Issue 4 (April 2017)

• Record Type: Journal Article
• Authors: Teixeira, S.C.; Koolen, B.B.; Elkhuizen, P.H.M.; Vrancken Peeters, M.-J.T.F.D.; Stokkel, M.P.M.; Rodenhuis, S.; van der Noort, V.; Rutgers, E.J.T.; Valdés Olmos, R.A.
• Is Part Of: European journal of surgical oncology. Volume 43:Issue 4(2017:Apr.)
• Page Start: 625
• Page End: 635
• Publication Date: 2017-04
• Subjects: PET/CT -- Radiotherapy -- Breast cancer -- Survival -- Upstaging; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2016.10.012
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Introduction: 18 F-FDG PET/CT has high positive predictive value for the detection of avid lymph node metastases in breast cancer patients. We analysed the effect of upstaging lymph nodes by PET/CT on short-term outcome in stage II/III breast cancer patients. Patients and methods: A total of 278 stage II/III primary breast cancer patients (mean age 48.9 years, range 19–75 years) were re-staged with 18 F-FDG PET/CT before start of pre-operative systemic treatment (PST). Patients were divided in three groups based on risk for local recurrence: a low – (T2N0), intermediate – (T0-2N1 and T3N0) and a high-risk group (T0-3N2–3, T3N1 and T4). Within these groups we looked at local recurrence-free survival (LRFS), recurrence-free survival (RFS) and overall survival (OS) within the first 3 years of follow-up. Results: With a median follow-up (FU) of 50 months the RFS, LRFS and OS were 87%, 88% and 92% respectively for the whole group. PET/CT upstaged 43 patients from the low- and intermediate risk group to the high-risk group, based on detection of ≥4 avid axillary nodes or occult N2/3-disease. Patients upstaged with PET/CT had more events for all three analyses compared to the original risk groups, which resulted in a significantly worse RFS (69.8%; p = 0.03) a nearly significantly worse LRFS (p = 0.052) and no effect in OS (p = 0.433). Discussion: Additional PET/CT staging allows breast cancer patients to be treated according to the true stage, still stage II/III breast cancer patients upstaged to N2/3 by PET/CT have worse short-term outcome, despite adjustment of treatment, than patients staged high-risk with conventional imaging.