ArticleAnnals of nuclear medicine2026
The anatomical distribution of metabolic tumor burden provides prognostic information beyond whole-body ¹⁸F-FDG PET/CT metrics in de novo metastatic HER2-positive breast cancer.
Article in Annals of nuclear medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveWhole-body PET metrics quantify the magnitude of metastatic burden but ignore its anatomical distribution. Whether resolving metabolic burden according to anatomical compartment provides incremental prognostic information beyond conventional whole-body PET metrics remains unknown. We therefore tested whether the anatomical distribution of metabolic burden carries prognostic information beyond aggregate whole-body load in de novo metastatic HER2-positive breast cancer.
methodsFifty-seven consecutive treatment-naive patients who underwent baseline ¹⁸F-FDG PET/CT before first-line anti-HER2 therapy were retrospectively analyzed. Compartment-specific metabolic parameters and clinical variables were evaluated using multivariable Cox regression. Model discrimination was internally validated over 1000 bootstrap resamples, and the incremental value of compartment-specific burden over whole-body metrics was evaluated with likelihood-ratio tests.
resultsTwenty patients (35.1%) died during a median follow-up of 50.4 months. LN_MTV, Bone_TLG, and HR status independently predicted OS, yielding a model with a modest optimism-corrected C-index of 0.685 when the entire variable-selection sequence was repeated within each bootstrap resample. Adding compartment-specific metabolic burden improved models based on whole-body MTV or TLG (p = 0.003 and p = 0.001, respectively), whereas whole-body MTV provided no additional prognostic information once compartment-specific burden was considered (p = 0.90). Bone_TLG, but not binary bone involvement, independently predicted OS, and its prognostic contribution increased over time.
conclusionIn this exploratory analysis, the anatomical distribution of metabolic tumor burden appeared to carry prognostic information beyond conventional whole-body PET metrics. These findings are hypothesis-generating, and prospective multicenter validation is warranted before compartment-specific metabolic phenotyping could inform clinical risk stratification in HER2-positive metastatic breast cancer.
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