Mohammad Naghavi-Behzad1,2,3,4, Marianne Vogsen1,2,3,4,5, Rasmus Mølgård Vester1, Maiken Madsen Bjerregaard Olsen1, Hjalte Oltmann1, Poul-Erik Braad1,2, Jon Thor Asmussen6, Oke Gerke1,2, Werner Vach7, Kristian Kidholm8, Annette Raskov Kodahl1,5, Wolfgang Weber9,10, Malene Grubbe Hildebrandt11,12,13,14,15. 1. Department of Clinical Research, University of Southern Denmark, Odense, Denmark. 2. Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark. 3. Centre for Personalized Response Monitoring in Oncology, Odense University Hospital, Odense, Denmark. 4. Open Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark. 5. Department of Oncology, Odense University Hospital, Odense, Denmark. 6. Department of Radiology, Odense University Hospital, Odense, Denmark. 7. Basel Academy for Quality and Research in Medicine, Basel, Switzerland. 8. Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark. 9. Department of Nuclear Medicine, Technical University of Munich, Munich, Germany. 10. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA. 11. Department of Clinical Research, University of Southern Denmark, Odense, Denmark. Malene.Grubbe.Hildebrandt@rsyd.dk. 12. Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark. Malene.Grubbe.Hildebrandt@rsyd.dk. 13. Centre for Personalized Response Monitoring in Oncology, Odense University Hospital, Odense, Denmark. Malene.Grubbe.Hildebrandt@rsyd.dk. 14. Open Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark. Malene.Grubbe.Hildebrandt@rsyd.dk. 15. Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark. Malene.Grubbe.Hildebrandt@rsyd.dk.
Abstract
BACKGROUND: We compared overall survival for metastatic breast cancer (MBC) patients monitored with CE-CT, FDG-PET/CT or a combination of them in an observational setting. METHODS: Patients with biopsy-verified (recurrent or de novo) MBC (n = 300) who were treated at Odense university hospital (Denmark) and response monitored with FDG-PET/CT (n = 83), CE-CT (n = 144), or a combination of these (n = 73) were followed until 2019. Survival was compared between the scan groups, and were adjusted for clinico-histopathological variables representing potential confounders in a Cox proportional-hazard regression model. RESULTS: The study groups were mostly comparable regarding baseline characteristics, but liver metastases were reported more frequently in CE-CT group (38.9%) than in FDG-PET/CT group (19.3%) and combined group (24.7%). Median survival was 30.0 months for CE-CT group, 44.3 months for FDG-PET/CT group and 54.0 months for Combined group. Five-year survival rates were significantly higher for FDG-PET/CT group (41.9%) and combined group (43.3%), than for CE-CT group (15.8%). Using the CE-CT group as reference, the hazard ratio was 0.44 (95% CI: 0.29-0.68, P = 0.001) for the FDG-PET/CT group after adjusting for baseline characteristics. FDG-PET/CT detected the first progression 4.7 months earlier than CE-CT, leading to earlier treatment change. CONCLUSIONS: In this single-center, observational study, patients with metastatic breast cancer who were response monitored with FDG-PET/CT alone or in combination with CE-CT had longer overall survival than patients monitored with CE-CT alone. Confirmation of these findings by further, preferably randomised clinical trials is warranted.
BACKGROUND: We compared overall survival for metastatic breast cancer (MBC) patients monitored with CE-CT, FDG-PET/CT or a combination of them in an observational setting. METHODS: Patients with biopsy-verified (recurrent or de novo) MBC (n = 300) who were treated at Odense university hospital (Denmark) and response monitored with FDG-PET/CT (n = 83), CE-CT (n = 144), or a combination of these (n = 73) were followed until 2019. Survival was compared between the scan groups, and were adjusted for clinico-histopathological variables representing potential confounders in a Cox proportional-hazard regression model. RESULTS: The study groups were mostly comparable regarding baseline characteristics, but liver metastases were reported more frequently in CE-CT group (38.9%) than in FDG-PET/CT group (19.3%) and combined group (24.7%). Median survival was 30.0 months for CE-CT group, 44.3 months for FDG-PET/CT group and 54.0 months for Combined group. Five-year survival rates were significantly higher for FDG-PET/CT group (41.9%) and combined group (43.3%), than for CE-CT group (15.8%). Using the CE-CT group as reference, the hazard ratio was 0.44 (95% CI: 0.29-0.68, P = 0.001) for the FDG-PET/CT group after adjusting for baseline characteristics. FDG-PET/CT detected the first progression 4.7 months earlier than CE-CT, leading to earlier treatment change. CONCLUSIONS: In this single-center, observational study, patients with metastatic breast cancer who were response monitored with FDG-PET/CT alone or in combination with CE-CT had longer overall survival than patients monitored with CE-CT alone. Confirmation of these findings by further, preferably randomised clinical trials is warranted.
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