Abstract
Purpose
The purpose of this study was to compare the survival of patients with and without BAT activity on FDG PET/CT.
Methods
PET/CT exams from 3937 breast cancer patients were retrospectively reviewed for bilateral symmetric elongated FDG activity in the neck and chest, typical of BAT activation. A control group of age-matched (± 1 year) breast cancer patients who underwent PET/CT the same week was also enrolled for comparison. Kaplan–Meier curves of progression-free survival (PFS) and overall survival (OS) for BAT positive patients and the control group were calculated. Further sub-analysis was performed to account for the hormonal changes associated with menopause.
Results
2.0% (80/3937) of the breast cancer patients who underwent PET/CT demonstrated BAT activation, and 80 additional patients were analyzed for comparison as the group without BAT activity. Mean follow-up was 76 months (range 1–225 months). There were 4 recurrences in the BAT group, compared to 12 in the control. The mean PFS for the BAT group was 127 months, which was significantly lower than the mean PFS of 180 months in the control (p = 0.047). Sub-analysis of premenopausal women again showed longer PFS for the BAT group (129 vs. 196 months, p = 0.095) while no difference was found in postmenopausal women (mean 102 vs. 135 months, p = 0.360). Presence of BAT activity was also a significant predictor variable for PFS on Cox regression.
Conclusion
Patients with BAT activity showed longer progression-free survival than those without, emphasizing the need for further evaluation of its role in metabolism, treatment response, tumor microenvironment and long-term prognosis.
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References
Aukema TS, Vogel WV, Hoefnagel CA, Valdés Olmos RA (2010) Prevention of brown adipose tissue activation in <sup>18</sup>F-FDG PET/CT of breast cancer patients receiving neoadjuvant systemic therapy. J Nucl Med Technol 38:24. https://doi.org/10.2967/jnmt.109.065557
Bakker LEH, Boon MR, van der Linden RAD et al (2014) Brown adipose tissue volume in healthy lean south Asian adults compared with white Caucasians: a prospective, case-controlled observational study. Lancet Diabetes Endocrinol 2:210–217. https://doi.org/10.1016/S2213-8587(13)70156-6
Bauwens M, Wierts R, van Royen B, Bucerius J, Backes W, Mottaghy F, Brans B (2014) Molecular imaging of brown adipose tissue in health and disease. Eur J Nucl Med Mol Imaging 41:776–791. https://doi.org/10.1007/s00259-013-2611-8
Berstein LM (2012) Cancer and heterogeneity of obesity: a potential contribution of brown fat. Future Oncol 8:1537–1548. https://doi.org/10.2217/fon.12.150
Cao Q, Hersl J, La H et al (2014) A pilot study of FDG PET/CT detects a link between brown adipose tissue and breast cancer. BMC Cancer 14:126. https://doi.org/10.1186/1471-2407-14-126
Fujii T, Yajima R, Tatsuki H, Oosone K, Kuwano H (2017) Implication of atypical supraclavicular F18-fluorodeoxyglucose uptake in patients with breast cancer: association between brown adipose tissue and breast cancer. Oncol Lett 14:7025–7030. https://doi.org/10.3892/ol.2017.6768
Gantov M, Pagnotta P, Lotufo C, Rindone GM, Riera MF, Calvo JC, Toneatto J (2021) Beige adipocytes contribute to breast cancer progression. Oncol Rep 45:317–328. https://doi.org/10.3892/or.2020.7826
Huang Y-C, Chen T-B, Hsu C-C et al (2011) The relationship between brown adipose tissue activity and neoplastic status: an 18F-FDG PET/CT study in the tropics. Lipids Health Dis 10:238. https://doi.org/10.1186/1476-511X-10-238
Lee P, Greenfield JR, Ho KKY, Fulham MJ (2010) A critical appraisal of the prevalence and metabolic significance of brown adipose tissue in adult humans. Am J Physiol-Endocrinol Metab 299:E601–E606. https://doi.org/10.1152/ajpendo.00298.2010
Pace L, Nicolai E, Basso L, Garbino N, Soricelli A, Salvatore M (2020) Brown adipose tissue in breast cancer evaluated by [18F] FDG-PET/CT. Mol Imag Biol 22:1111–1115. https://doi.org/10.1007/s11307-020-01482-z
Rousseau C, Bourbouloux E, Campion L et al (2006) Brown fat in breast cancer patients: analysis of serial 18F-FDG PET/CT scans. Eur J Nucl Med Mol Imaging 33:785–791. https://doi.org/10.1007/s00259-006-0066-x
Zingaretti MC, Crosta F, Vitali A et al (2009) The presence of UCP1 demonstrates that metabolically active adipose tissue in the neck of adult humans truly represents brown adipose tissue. FASEB J 23:3113–3120. https://doi.org/10.1096/fj.09-133546
Zukotynski KA, Fahey FH, Laffin S, Davis R, Treves ST, Grant FD, Drubach LA (2009) Constant ambient temperature of 24°C significantly reduces FDG uptake by brown adipose tissue in children scanned during the winter. Eur J Nucl Med Mol Imaging 36:602–606. https://doi.org/10.1007/s00259-008-0983-y
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This work was supported by the Technology Innovation Program (20015632) funded by the Ministry of Trade, Industry & Energy (MOTIE, Korea).
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by SYP and YAC. The first draft of the manuscript was written by SYP and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Park, S.Y., Choi, E.K., Oh, J.K. et al. Brown fat activation demonstrated on FDG PET/CT predicts survival outcome. J Cancer Res Clin Oncol 149, 4847–4851 (2023). https://doi.org/10.1007/s00432-022-04390-7
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DOI: https://doi.org/10.1007/s00432-022-04390-7