18F-Fluorodeoxyglucose Positron Emission Tomography for Estimating Outcomes After Initial Treatment for Metastatic Breast Cancer: A Nonrandomized Clinical Cohort Trial.

IF 20.1 1区医学 Q1 ONCOLOGY

JAMA Oncology Pub Date : 2026-04-16 DOI:10.1001/jamaoncol.2026.0767

Jasper J L van Geel,Bertha Eisses,Sjoerd G Elias,Adrienne H Brouwers,Frederike Bensch,Sophie L Gerritse,Lindsay Angus,Andor W J M Glaudemans,Evelien J M Kuip,Agnes Jager,Daniela E Oprea-Lager,Daniëlle J Vugts,Jasper Emmering,Anne I J Arens,Wim J G Oyen,Bert van der Vegt,Marjolijn N Lub-de Hooge,C Willemien Menke-van der Houven van Oord,Elisabeth G E de Vries,Carolina P Schröder,

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引用次数: 0

Abstract

Importance Optimizing treatment decisions in metastatic breast cancer (MBC) can alleviate patients' burden and improve quality of life. Whether 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) can be used to better estimate outcomes is unknown. Objective To evaluate clinical utility of early metabolic change on FDG-PET for improving outcome estimation compared with standard diagnostic evaluation in patients with newly diagnosed MBC. Design, Setting, and Participants The multicenter IMPACT-MBC clinical cohort trial enrolled patients with nonrapidly progressive, newly diagnosed MBC from August 2013 to May 2018, before initiation of first-line systemic therapy. Baseline assessment included metastasis biopsy procedure and FDG-PET and CT imaging. Early FDG-PET was performed after 2 weeks of treatment, and CT response evaluation after 8 weeks. Clinical utility was defined as the ability of early FDG-PET to estimate progressive disease (PD) on CT, progression-free survival (PFS), and overall survival (OS). Data were analyzed from October 19, 2025, to February 13, 2026. Intervention Early FDG-PET or standard-of-care (SOC) biopsy-based treatment. Main Outcomes and Measures Clinical utility of molecular imaging to improve outcome estimation of standard diagnostics defined as the capacity to identify poor patient outcomes. Measures were PD at 8 weeks, PFS, and OS. Results The analysis included 200 patients (median [range] age, 61 [32-84] years; 198 females [99%] and 2 males [1%]). Non-PD on early FDG-PET had a negative predictive value (NPV) of 94.7% (95% CI, 89.5%-97.4%) for non-PD on 8-week CT. This was similar in all MBC subtypes and bone-only disease. Patients with SOC treatment and non-PD on early FDG-PET (n = 133) had a median PFS of 19.4 (95% CI, 15.2-22.8) months and OS of 39.4 (95% CI, 33.7-48.3) months compared to 4.1 (95% CI, 3.3-15.5) months and 18.5 (95% 3 CI, 7.0-33.0) months, respectively (P < .001 for both). Patients with non-PD on 8-week CT but with PD on early FDG-PET had a median (IQR) PFS and OS of 9.5 (4.1-18.1) and 19.4 (8.7-33.0) months compared to 22.3 (15.3-96.1) months and 40.1 (23.4-72.7) months without PD. Conclusions and Relevance In this clinical cohort trial of patients with nonrapidly progressive, newly diagnosed MBC before initiation of first-line systemic therapy, early FDG-PET after only 2 weeks of treatment identified patients with MBC with distinct long-term outcomes. Incorporating early FDG-PET can improve outcome estimation of standard CT assessment. Trial Registration ClinicalTrials.gov Identifier: NCT01957332.

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18f -氟脱氧葡萄糖正电子发射断层扫描用于估计转移性乳腺癌初始治疗后的结果：一项非随机临床队列试验

优化转移性乳腺癌（MBC）的治疗决策可以减轻患者的负担，提高生活质量。18f -氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）是否可以更好地估计结果尚不清楚。目的评价FDG-PET早期代谢变化对改善新诊断MBC患者预后评估的临床应用价值。设计、环境和参与者：多中心IMPACT-MBC临床队列试验纳入了2013年8月至2018年5月开始一线全身治疗前的非快速进展、新诊断的MBC患者。基线评估包括转移活检、FDG-PET和CT成像。治疗2周后进行早期FDG-PET检查，8周后进行CT反应评价。临床效用被定义为早期FDG-PET评估CT上疾病进展（PD）、无进展生存期（PFS）和总生存期（OS）的能力。数据分析时间为2025年10月19日至2026年2月13日。干预：早期FDG-PET或标准护理（SOC）活检治疗。主要结果和测量分子成像的临床应用，以改善标准诊断的结果估计，定义为识别不良患者结果的能力。测量指标为8周PD、PFS和OS。结果纳入200例患者，中位年龄61岁（32 ~ 84岁），其中女性198例（99%），男性2例（1%）。早期FDG-PET非pd对8周CT非pd的阴性预测值（NPV）为94.7% （95% CI, 89.5%-97.4%）。这在所有MBC亚型和仅骨疾病中是相似的。SOC治疗和早期FDG-PET非pd患者（n = 133）的中位PFS为19.4 （95% CI, 15.2-22.8）个月，OS为39.4 （95% CI, 33.7-48.3）个月，而4.1 （95% CI, 3.3-15.5）个月和18.5 （95% CI, 7.0-33.0）个月（P < 0.05）。两者都是001)。在8周CT上未发现PD，但在FDG-PET上发现PD的患者的中位（IQR） PFS和OS分别为9.5（4.1-18.1）和19.4（8.7-33.0）个月，而没有PD的患者的中位PFS和OS分别为22.3（15.3-96.1）个月和40.1（23.4-72.7）个月。结论和相关性在这项针对非快速进展的、在开始一线全身治疗前新诊断的MBC患者的临床队列试验中，仅在治疗2周后的早期FDG-PET就识别出了具有明显长期预后的MBC患者。早期结合FDG-PET可以改善标准CT评估的结果估计。临床试验注册号：NCT01957332。

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来源期刊

JAMA Oncology Medicine-Oncology

自引率

1.80%

发文量

423

期刊介绍： JAMA Oncology is an international peer-reviewed journal that serves as the leading publication for scientists, clinicians, and trainees working in the field of oncology. It is part of the JAMA Network, a collection of peer-reviewed medical and specialty publications.