Prognostic value of ⁶⁸Ga-NOTA-RGD PET/CT for predicting disease-free survival for patients with breast cancer undergoing neoadjuvant chemotherapy and surgery

Purpose We performed pretreatment angiogenesis imaging (68 Ga-NOTA-arginyl-glycyl-aspartic acid [RGD] PET/CT) to compare its prognostic value to dynamic contrast-enhanced (DCE) MRI in breast cancer patients. Methods Forty-four female patients with stage II or III breast cancer (aged 47.3 ± 8.1 years) were prospectively enrolled and underwent 68 Ga-NOTA-RGD PET/CT and DCE-MRI imaging. All patients received neoadjuvant chemotherapy and underwent surgery. With pretreatment 68 Ga-NOTA-RGD PET/CT, SUVmax of the tumor in the torso (-T) and regional (-R) images were measured. With pretreatment DCE-MRI, the largest diameter of the tumor and maximum enhancement index (EImax; EImax = [highest signal / baseline signal] - 1) of the tumor were assessed. Results Ten patients (22.7%) were found to have breast cancer recurrence after 17.9 ± 11.2 months. The SUVmax-R (P = 0.017, cutoff >2.79) of 68 Ga-NOTA-RGD PET/CT, the largest diameter of tumor (P = 0.017, cutoff >6.3 cm), and the EImax (P = 0.008, cutoff >5.38) of DCE-MRI showed significant results by univariate analysis. The 3-year disease-free survival of SUVmax-R was 91.7% versus 59.1% by Kaplan-Meier analysis (hazard ratio, 5.379). Multivariable analysis demonstrated that SUVmax-R with tumor diameter or EImax were the significant parameters. In addition, the combined parameters of SUVmax-R and EImax revealed better predictive value for prediction of breast cancer recurrence (75.0%) than each parameter of SUVmax-R (64.2%) and EImax (68.7%). Conclusions Increased angiogenic activity of regional 68 Ga-NOTA-RGD PET/CT (SUVmax-R) can be an early prognostic marker for the prediction of breast cancer recurrence.