Prognostic value of 18F-FDG PET and PET/CT for assessment of treatment response to neoadjuvant chemotherapy in breast cancer: a systematic review and meta-analysis

Sangwon Han, Joon Young Choi, Sangwon Han, Joon Young Choi

Abstract

Background: We performed a systematic review and meta-analysis to evaluate the prognostic significance of 18F-FDG PET and PET/CT for evaluation of responses to neoadjuvant chemotherapy (NAC) in breast cancer patients.

Methods: We searched PubMed, Embase, and the Cochrane Library databases until June 2020 to identify studies that assessed the prognostic value of 18F-FDG PET scans during or after NAC with regard to overall (OS) and disease-free survival (DFS). Hazard ratios (HRs) and their 95% confidence intervals (CIs) were pooled meta-analytically using a random-effects model.

Results: Twenty-one studies consisting of 1630 patients were included in the qualitative synthesis. Twelve studies investigated the use of PET scans for interim response evaluation (during NAC) and 10 studies assessed post-treatment PET evaluation (after NAC). The most widely evaluated parameter distinguishing metabolic responders from poor responders on interim or post-treatment PET scans was %ΔSUVmax, defined as the percent reduction of SUVmax compared to baseline PET, followed by SUVmax and complete metabolic response (CMR). For the 17 studies included in the meta-analysis, the pooled HR of metabolic responses on DFS was 0.21 (95% confidence interval [CI], 0.14-0.32) for interim PET scans and 0.31 (95% CI, 0.21-0.46) for post-treatment PET scans. Regarding the influence of metabolic responses on OS, the pooled HRs for interim and post-treatment PET scans were 0.20 (95% CI, 0.09-0.44) and 0.26 (95% CI, 0.14-0.51), respectively.

Conclusions: The currently available literature suggests that the use of 18F-FDG PET or PET/CT for evaluation of response to NAC provides significant predictive value for disease recurrence and survival in breast cancer patients and might allow risk stratification and guide rational management.

Keywords: Breast neoplasms; Fluorodeoxyglucose F18; Neoadjuvant therapy; Positron emission tomography; Prognosis.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow chart showing the study selection process
Fig. 2
Fig. 2
Quality assessment using the QUIPS tool
Fig. 3
Fig. 3
Forest plots showing the pooled HRs of the PET response on interim (a) and post-treatment (b) 18F-FDG PET scans for disease-free survival
Fig. 4
Fig. 4
Funnel plots of studies assessing the PET response on interim (a) and post-treatment (b) 18F-FDG PET scans for disease-free survival
Fig. 5
Fig. 5
Forest plots showing the pooled HRs of the PET response on interim (a) and post-treatment (b) 18F-FDG PET scans for overall survival

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