Multidisciplinary analysis of cancer-related fatigue at the time of diagnosis: preliminary results of the BIOCARE FActory cohort

PURPOSE

Cancer-related fatigue (CRF) is a common side effect of cancer and cancer treatment that significantly impairs the quality of life and can persist for years after treatment completion. Although fatigue is often associated with cancer treatment, it is also a result of the disease itself, even before intervention. CRF at the time of diagnosis may affect treatment timing or completion and is a consistent predictor of post-treatment fatigue at any time. The mechanisms underlying CRF are multidimensional and not well understood, particularly at the time of diagnosis.

METHODS

Sixty-five breast cancer patients at the time of diagnosis were included. The participants completed self-assessment questionnaires about CRF, sleep disturbances, and emotional symptoms and wore an accelerometer to assess levels of spontaneous physical activity and sleep quality. During the experimental session, the participants underwent cognitive, neuromuscular, and exercise metabolism evaluations.

RESULTS

Using augmented backward elimination regression, this study found that emotional symptoms and perceived sleep disturbances were the strongest predictors of CRF (adjusted r2 = 0.51). Neuromuscular fatigability and sleep disturbance were also associated with physical dimensions, whereas cognitive performance was associated with cognitive dimensions.

CONCLUSION

At the time of diagnosis, emotional and cognitive dimensions are over-represented compared to the general population, and specific subdimensions have specific predictors that support the idea of distinct mechanisms. Evaluating CRF subdimensions and their potential mechanisms at the time of diagnosis would be particularly relevant for identifying high-risk patients and offering them appropriate interventions.

TRIAL REGISTRATION

This study was registered at ClinicalTrials.gov (NCT04391543) in May, 2020.

Prognostic Value of Metabolic, Volumetric and Textural Parameters of Baseline [18F]FDG PET/CT in Early Triple-Negative Breast Cancer

Simple Summary

The aim of this study was to evaluate PET/CT parameters to determine different prognostic groups in TNBC, in order to select patients with a high risk of relapse, for whom therapeutic escalation can be considered. We have demonstrated that the MTV, TLG and entropy of the primary breast lesion could be of interest to predict the prognostic outcome of TNBC patients.

Abstract

(1) Background: triple-negative breast cancer (TNBC) remains a clinical and therapeutic challenge primarily affecting young women with poor prognosis. TNBC is currently treated as a single entity but presents a very diverse profile in terms of prognosis and response to treatment. Positron emission tomography/computed tomography (PET/CT) with ¹⁸F-fluorodeoxyglucose ([¹⁸F]FDG) is gaining importance for the staging of breast cancers. TNBCs often show high [¹⁸F]FDG uptake and some studies have suggested a prognostic value for metabolic and volumetric parameters, but no study to our knowledge has examined textural features in TNBC. The objective of this study was to evaluate the association between metabolic, volumetric and textural parameters measured at the initial [¹⁸F]FDG PET/CT and disease-free survival (DFS) and overall survival (OS) in patients with nonmetastatic TBNC. (2) Methods: all consecutive nonmetastatic TNBC patients who underwent a [¹⁸F]FDG PET/CT examination upon diagnosis between 2012 and 2018 were retrospectively included. The metabolic and volumetric parameters (SUV_max, SUV_mean, SUV_peak, MTV, and TLG) and the textural features (entropy, homogeneity, SRE, LRE, LGZE, and HGZE) of the primary tumor were collected. (3) Results: 111 patients were enrolled (median follow-up: 53.6 months). In the univariate analysis, high TLG, MTV and entropy values of the primary tumor were associated with lower DFS (p = 0.008, p = 0.006 and p = 0.025, respectively) and lower OS (p = 0.002, p = 0.001 and p = 0.046, respectively). The discriminating thresholds for two-year DFS were calculated as 7.5 for MTV, 55.8 for TLG and 2.6 for entropy. The discriminating thresholds for two-year OS were calculated as 9.3 for MTV, 57.4 for TLG and 2.67 for entropy. In the multivariate analysis, lymph node involvement in PET/CT was associated with lower DFS (p = 0.036), and the high MTV of the primary tumor was correlated with lower OS (p = 0.014). (4) Conclusions: textural features associated with metabolic and volumetric parameters of baseline [¹⁸F]FDG PET/CT have a prognostic value for identifying high-relapse-risk groups in early TNBC patients.

Abstract PS3-19: Prognostic value of textural associated with metabolic parameters of baseline 18FDG-PET/CT in early triple-negative breast cancer (TNBC)

Background : Triple negative breast cancer (TNBC) represents 10-17 % of all diagnosed early breast cancers, occurs more frequently in young women (< 50 years old) and has a poor prognosis. TNBC remains a clinical and therapeutic challenge dealing with a paradox: a high-risk of metastatic relapse despite a high rate of clinical and histological response after neoadjuvant chemotherapy with contrasting but disappointing results of targeted therapies. However, TNBCs are treated as a single entity and due to their phenotypic heterogeneity and various molecular pathogenesis, this subtype has a very different profile in terms of prognosis and response to treatment. Positron emission tomography/computed tomography (PET/CT) with 18F-fluorodeoxyglucose (18FDG) is gaining importance for the staging of patients with large or locally advanced breast cancer. TNBCs often show high 18FDG uptake and several studies demonstrate correlations between standard uptake value (SUV) and histoprognostic factors such as grade or KI67%. Recently, a new approach is growing interest in medical imaging: textural analysis. Some studies have shown correlations between metabolic parameters with overall survival (OS) and disease free survival (DFS) in other carcinoma, such as lung and head-and-neck cancers. Few studies analyzed textural features with potentially promising prognostic value that has to be confirmed. The objective of this study is to evaluate the association between metabolic and textural parameters measured at the initial 18FDG-PET/CT, disease-free survival (DFS) and overall survival (OS) in patients with non-metastatic TBNC. Patients and Methods: All consecutive non-metastatic TNBC women who underwent 18FDG-PET/CT at diagnosis between 2012 and 2018 were retrospectively included. Metabolic parameters (SUVmax, SUVmean, SUVpeak, MTV, TLG) in the primary tumor and lymph nodes and textural features (entropy, homogeneity, SRE, LRE, LGZE, HGZE) in the primary tumor were collected. Regression models were used to assess the correlations between PET parameters and histoprognostic factors. Cox regression models were computed to identify association with DFS and OS. Results : One hundred and eleven patients were enrolled. The median follow-up was 53.6 months. Thirty-six patients experienced relapse and 20 died. Homogeneity was associated with no axillary lymph node involvement and lower grade. Entropy was associated with higher grade, lymph node involvement and inflammatory tumors. SRE was only associated with higher grade. TLG and MTV were highly correlated (r =0.98, 95%CI = 0.97-0.99). TLG, MTV and Entropy of the primary tumor were associated with lower DFS (p = 0.008, p = 0.006, and p = 0.025, respectively) and lower OS (p = 0.002, p = 0.001 and p = 0.046, respectively). In the 50 patients with positive PET axillary lymph nodes, all metabolic parameters except SUVmean were correlated with DFS whereas no correlation was seen with OS. Conclusion: Textural associated with metabolic features of baseline 18FDG-PET/CT add prognosis value interesting to identify high risk group of relapse in early TNBC patients.

Citation Format: Clément Bouron, Clara Mathie, Valérie Seegers, Camille Guillerminet, Mario Campone, Olivier Morel, Pascal Jézéquel, Anne Patsouris, Aude Testard. Prognostic value of textural associated with metabolic parameters of baseline 18FDG-PET/CT in early triple-negative breast cancer (TNBC) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS3-19.