Body Mass Index with Tumor ¹⁸F-FDG Uptake Improves Risk Stratification in Patients with Breast Cancer

<div><p>Purpose</p><p>To investigate the combined prognostic impact of body mass index (BMI) and tumor standardized uptake value (SUV) measured on pretreatment ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in patients with breast cancer.</p><p>Methods</p><p>We evaluated a cohort of 332 patients with newly diagnosed breast cancer (stage I-III) who underwent pretreatment FDG PET/CT followed by curative resection. Patients were categorized as overweight (BMI ≥ 23 kg/m²) or normal weight (BMI < 23 kg/m²). Primary tumor maximum SUV was measured by FDG PET/CT. Associations between BMI and tumor SUV with disease recurrence were assessed using Cox regression models.</p><p>Results</p><p>Median follow-up was 39 months. There were 76 recurrences and 15 cancer-related deaths. Multivariable Cox regression analysis demonstrated that high tumor SUV (hazard ratio [HR] = 1.75; 95% CI, 1.02–3.02; <i>P</i> = 0.044) and overweight (HR = 1.84; 95% CI, 1.17–2.89; <i>P</i> = 0.008) were independent poor prognostic factors. Positive hormone receptor status was an independent predictor of favorable outcome (HR = 0.42; 95% CI, 0.26–0.68; <i>P</i> < 0.001). Overweight patients with high tumor SUV had a two-fold risk of recurrence compared to patients with normal weight or low tumor SUV after adjusting for clinical stage and tumor subtype (HR = 2.06; 95% CI, 1.30–3.27; <i>P</i> = 0.002).</p><p>Conclusions</p><p>In patients with breast cancer, higher tumor SUV was associated with a more adverse outcome particularly in overweight women. BMI status combined with tumor SUV data allows better risk-stratification of breast cancer, independent of clinical stage and tumor subtype.</p></div

Kaplan-Meier survival curves for recurrence-free survival according to BMI with tumor SUV in patients with HER2-positive (A) and triple-negative disease (B).

<p>BMI, body mass index; SUV, standardized uptake value.</p

Univariable and multivariable Cox regression analysis of recurrence-free survival (n = 332).

<p>Univariable and multivariable Cox regression analysis of recurrence-free survival (n = 332).</p

Clinical characteristics of study subjects with breast cancer (n = 332).

<p>Clinical characteristics of study subjects with breast cancer (n = 332).</p

Kaplan-Meier survival curves for recurrence-free survival according to BMI with tumor SUV in patients with hormone receptor-positive (A) and-negative disease (B).

<p>BMI, body mass index; SUV, standardized uptake value.</p

Influence of Body Mass Index on the Prognostic Value of Tumor ¹⁸F-FDG Uptake in Stage I Non-Small Cell Lung Cancer

<div><p>Background</p><p>The impact of host energy balance status on outcome of lung cancer has not been fully explored. It is also unknown if there is a potential modifying effect of body mass index (BMI) on tumor cell behavior in patients with early-stage non-small cell lung cancer (NSCLC). We therefore investigated the interactive effects of tumor [¹⁸F]-fluorodeoxyglucose (FDG) avidity and BMI.</p><p>Methods</p><p>We investigated 1,197 patients with stage I NSCLC who underwent preoperative FDG positron emission tomography followed by curative resection. The primary outcome measure was disease-free survival (DFS). A multivariable Cox proportional hazards model was used to assess the potential independent effects of the prognostic variables. A stratified Cox regression analysis was also performed to assess the potential modifying effects of BMI on the relationship between tumor FDG uptake and patient survival.</p><p>Results</p><p>There were 145 tumor recurrences and 19 deaths during a median follow-up of 30 months. Tumor-related variables, including tumor size, maximum standardized uptake value (SUVmax), histologic cell type, differentiation, lymphovascular invasion, and visceral pleural invasion, did not differ significantly according to BMI status. In multivariable Cox regression analysis, overweight or obesity [hazard ratio (HR), 0.59; 95% CI, 0.43–0.81; <i>P</i> = 0.001] and tumor SUVmax (HR, 1.72; 95% CI, 1.43–2.07; <i>P</i> < 0.001) were significantly associated with DFS. There was a significant modifying effect of BMI (<i>P</i> for interaction < 0.001 in multivariable analysis). High tumor SUVmax was more strongly associated with worse DFS in normal weight patients (HR, 4.72; 95% CI, 2.77–8.06; <i>P</i> < 0.001) than in overweight or obese patients (HR, 2.61; 95% CI, 1.58–4.31; <i>P</i> < 0.001).</p><p>Conclusions</p><p>Tumor FDG avidity is an independent predictor of DFS in patients with early-stage NSCLC and this prognostic value was strengthened in normal weight patients than in overweight or obese patients. These results suggest that the host-tumor interaction between host energy balance status and tumor glucose metabolism plays an important role in the outcome of early-stage NSCLC.</p></div

Results of univariable and multivariable analyses of factors associated with the presence of sarcopenia in lung cancer patients.

<p>Results of univariable and multivariable analyses of factors associated with the presence of sarcopenia in lung cancer patients.</p

Disease-free survival curves of (A) 697 overweight/obese and (B) 500 normal weight patients with stage I NSCLC according to tumor FDG uptake.

<p>NSCLC, non-small cell lung cancer; SUVbw, maximum standardized uptake value normalized to body weight.</p

Disease-free survival curves of 1,197 patients with stage I NSCLC according to (A) BMI, (B) tumor SUVbw, and (C) tumor SUVbsa.

<p>NSCLC, non-small cell lung cancer; BMI, body mass index; SUVbw, maximum standardized uptake value normalized to body weight; SUVbsa, maximum standardized uptake value normalized to body surface area.</p

Single cross-sectional area of skeletal muscle at the third lumbar vertebrae in patients with lung cancer.

<p>(A) In this 71-year-old male patient (stage III, squamous cell carcinoma, Charlson comorbidity score of 5, BMI 22.2 kg/m²) with sarcopenia, the CT-measured L3 muscle (blue color) index was 33.0 cm²/m². (B) In this 54-year-old male patient (stage I, adenocarcinoma, Charlson comorbidity score of 3, BMI 29.8 kg/m²) without sarcopenia, the CT-measured L3 muscle (blue color) index was 86.9 cm²/m².</p