PET-derived metabolic–immunonutritional SUVmax–lactate dehydrogenase–albumin–lymphocyte index for survival prediction in human epidermal growth factor receptor 2-positive metastatic breast cancer receiving pertuzumab-based therapy
Emine Bihter Eniseler, Ferhat Ekinci, Mustafa Şahbazlar, Atike Pinar ErdoğanObjective
To evaluate the prognostic value of the PET-derived SUVmax–lactate dehydrogenase–albumin–lymphocyte (SUV-LAL) index in human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer treated with pertuzumab.
Methods
This retrospective single-center study included patients with HER2-positive metastatic breast cancer treated with pertuzumab-containing regimens between January 2018 and October 2025. Baseline clinical, pathological, laboratory, and 18 F-fluorodeoxyglucose PET/computed tomography data were retrospectively collected. The SUV-LAL index was calculated as (primary tumor maximum standardized uptake value × lactate dehydrogenase)/(albumin × absolute lymphocyte count). Overall survival (OS) and progression-free survival (PFS) were evaluated using Cox proportional hazards regression analyses. Kaplan–Meier survival analysis, receiver operating characteristic (ROC) analysis, and time-dependent ROC analyses were performed to assess prognostic performance.
Results
A total of 80 patients were included, of whom 36 (45.0%) died during follow-up. The SUV-LAL index remained an independent prognostic factor for OS in multivariate analysis [hazard ratio = 1.755, 95% confidence interval (CI) = 1.053–2.927;
Conclusion
The PET-derived SUV-LAL index independently predicts OS in HER2-positive metastatic breast cancer treated with pertuzumab.