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目的:探讨治疗前n 18F-脱氧葡萄糖(FDG) PET/CT摄取异质性在人表皮生长因子受体2(HER2)阳性转移性乳腺癌靶向治疗效果预测中的作用。n 方法:回顾性分析2012年5月至2018年4月复旦大学附属肿瘤医院的29例HER2阳性转移性乳腺癌患者[均为女性，中位年龄52(32～69)岁]临床、病理及治疗前n 18F-FDG PET/CT影像资料，患者均接受曲妥珠单克隆抗体(简称单抗)一线治疗。对患者进行中位时间35(6～87)个月的随访。分析临床、病理相关特点及PET/CT代谢参数与患者无进展生存期(PFS)、总生存期(OS)之间的关系。通过Cox单因素分析筛选变量，将n P≤0.01的变量纳入多因素Cox比例风险回归模型进行分析。采用时间依赖性受试者工作特征(ROC)曲线评价Cox回归模型的预测效能。生存曲线依据Kaplan-Meier法绘制，采用log-rank检验进行比较。n 结果:29例患者中位OS为30(6～83)个月，中位PFS为10(2～29)个月。单因素分析结果示PET/CT瘤间摄取异质性指数，包括最大标准摄取值(SUVn max)最高病灶与最低病灶的SUVn max比值[SUVn max-R；风险比(n HR)＝8.6(95% n CI: 2.7～27.8)，n P0.05)。多因素分析结果显示SUVn max-R为影响PFS的独立危险因素[n HR＝6.8(95% n CI: 1.8～26.1)，n P<0.01]。SUVn max-R的ROC曲线下面积为0.747，以1.8作为界值，SUVn max-R可以有效地区分曲妥珠单抗受益与非受益人群(PFS：15.0与7.0个月；n χ2＝18.68，n P<0.01)。n 结论:PET/CT瘤间摄取异质性指数SUVn max-R是HER2阳性转移性乳腺癌患者靶向治疗的独立预后因素，能够早期预测靶向治疗效果。n “,”Objective:To evaluate the value of pretreatment n 18F-fluorodeoxyglucose (FDG) PET/CT-based heterogeneity for early prediction of targeted therapy outcome in patients with human epidermal growth factor receptor 2 (HER2) positive metastatic breast cancer.n Methods:From May 2012 to April 2018, 29 patients (all females, median age: 52 (32-69) years) who had HER2 positive metastatic breast cancer and underwent pretreatment n 18F-FDG PET/CT in Fudan University Shanghai Cancer Center were retrospectively enrolled. All patients received trastuzumab as first-line treatment and were followed up for 6-87 (median time: 35) months. The relations between clinicopathologic parameters or PET/CT-based parameters and progression-free survival (PFS)/overall survival (OS) were analyzed with Cox univariate analysis. The parameters with n P≤0.01 were further analyzed with Cox multivariate analysis. Optimal cut-off values were determined by time-dependent receiver operating characteristic (ROC) curve analysis. The survival analyses were estimated by Kaplan-Meier method and log-rank test.n Results:The median OS of the 29 patients was 30 (6-83) months, and the median PFS was 10 (2-29) months. The PET/CT-based heterogeneity index(HI), including the maximum standardized uptake value (SUVn max) ratio (SUVn max-R; hazard ratio (n HR)=8.6, 95% n CI: 2.7-27.8, n P0.05). Multivariate analysis showed that the SUVn max-R was the only independent predictor for PFS (n HR=6.8, 95% n CI: 1.8-26.1, n P<0.01). Area under the ROC curve for SUVn max-R was 0.747. With a cut-off value of 1.8, SUVn max-R could effectively distinguish the benefit from non-benefit population treated with trastuzumab (15.0 n vs 7.0 months; n χ2=18.68, n P<0.01).n Conclusion:Pretreatment n 18F-FDG PET/CT-based HI has potential value for early prediction of first-line trastuzumab treatment outcome in patients with HER2 positive metastatic breast cancer.n