Open Access Highly Accessed Research article

Prognostic value of metabolic response in breast cancer patients receiving neoadjuvant chemotherapy

Maria D Cao18*, Guro F Giskeødegård1, Tone F Bathen12, Beathe Sitter12, Anna Bofin3, Per E Lønning45, Steinar Lundgren167 and Ingrid S Gribbestad1

Author affiliations

1 Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), 7489 Trondheim, Norway

2 St Olavs University Hospital, Trondheim, Norway

3 Department of Laboratory Medicine, Children's and Women's Health, NTNU, 7489 Trondheim, Norway

4 Department of Oncology, Haukeland University Hospital, 5021 Bergen, Norway

5 Section of Oncology, Institute of medicine, University of Bergen, 5020 Bergen, Norway

6 Department of Oncology, St. Olavs Hospital, University Hospital of Trondheim, 7006 Trondheim, Norway

7 Department of Cancer Research and Molecular Medicine, NTNU, 7489 Trondheim, Norway

8 Department of Circulation and Medical Imaging, The Faculty of Medicine, NTNU, MTFS, Postboks 8905, N-7489 Trondheim, Norway

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Citation and License

BMC Cancer 2012, 12:39  doi:10.1186/1471-2407-12-39

Published: 25 January 2012



Today's clinical diagnostic tools are insufficient for giving accurate prognosis to breast cancer patients. The aim of our study was to examine the tumor metabolic changes in patients with locally advanced breast cancer caused by neoadjuvant chemotherapy (NAC), relating these changes to clinical treatment response and long-term survival.


Patients (n = 89) participating in a randomized open-label multicenter study were allocated to receive either NAC as epirubicin or paclitaxel monotherapy. Biopsies were excised pre- and post-treatment, and analyzed by high resolution magic angle spinning magnetic resonance spectroscopy (HR MAS MRS). The metabolite profiles were examined by paired and unpaired multivariate methods and findings of important metabolites were confirmed by spectral integration of the metabolite peaks.


All patients had a significant metabolic response to NAC, and pre- and post-treatment spectra could be discriminated with 87.9%/68.9% classification accuracy by paired/unpaired partial least squares discriminant analysis (PLS-DA) (p < 0.001). Similar metabolic responses were observed for the two chemotherapeutic agents. The metabolic responses were related to patient outcome. Non-survivors (< 5 years) had increased tumor levels of lactate (p = 0.004) after treatment, while survivors (≥ 5 years) experienced a decrease in the levels of glycine (p = 0.047) and choline-containing compounds (p ≤ 0.013) and an increase in glucose (p = 0.002) levels. The metabolic responses were not related to clinical treatment response.


The differences in tumor metabolic response to NAC were associated with breast cancer survival, but not to clinical response. Monitoring metabolic responses to NAC by HR MAS MRS may provide information about tumor biology related to individual prognosis.