Background Breast cancer demonstrates heterogeneous clinical behavior, underscoring the need for reliable prognostic biomarkers. Semi-quantitative parameters derived from fluorine‑18 fluorodeoxyglucose PET/CT, including spleen maximum standardized uptake value (SUVmax) and spleen-to-liver SUVmax ratio (SLR), may reflect systemic inflammatory activity and predict outcomes. Objective To assess the prognostic significance of baseline spleen SUVmax and SLR, compared with other PET/computed tomography (CT)-derived parameters, in predicting disease-free survival (DFS) in nonmetastatic breast cancer. Methods Ninety-two female patients with pathologically confirmed invasive breast cancer underwent baseline fluorine‑18 fluorodeoxyglucose PET/CT before treatment. SUVmax values for primary tumor, spleen, and bone marrow were measured, and SLR and bone marrow-to-liver SUVmax ratios were calculated. Associations with clinicopathological features were analyzed using chi-square and ANOVA tests. DFS predictors were evaluated using Cox regression and Kaplan–Meier analysis. Results Higher spleen SUVmax and SLR were significantly associated with larger tumor size, advanced stage, higher grade, hormone receptor negativity, and triple-negative subtype ( P < 0.05). Patients with progressive disease had higher spleen SUVmax (2.93 ± 0.50) and SLR (0.87 ± 0.06) than those with complete remission ( P < 0.001). In univariate Cox regression, SLR remained a strong predictor of DFS hazard ratio = 6.12, 95% confidence interval (CI): 2.05–18.25, P = 0.001. In multivariate analysis including SLR, Ki-67, stage, nodal status, and molecular subtype, only SLR remained independently significant (hazard ratio = 6.12, 95% CI: 2.05–18.25, P = 0.001). Patients with SLR greater than 0.7083 had significantly shorter mean survival (14.5 vs. 31.6 months, P < 0.001). Conclusion Baseline SLR is a strong prognostic marker in nonmetastatic breast cancer along with tumor SUVmax and spleen SUVmax, and may aid in risk stratification and treatment planning.
Elsayed et al. (Tue,) studied this question.