Impact of initial PET/CT staging in terms of clinical stage, management plan, and prognosis in 592 patients with non-small-cell lung cancer

• Published in: European journal of nuclear medicine and molecular imaging Vol. 41; no. 5; pp. 906 - 914
• Main Authors: Takeuchi, Satoshi, Khiewvan, Benjapa, Fox, Patricia S., Swisher, Stephen G., Rohren, Eric M., Bassett, Roland L., Macapinlac, Homer A.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2014; Springer Nature B.V
• Subjects: Aged; Carcinoma, Non-Small-Cell Lung - diagnostic imaging; Cardiology; Clinical trials; Female; Humans; Imaging; Lung cancer; Lung Neoplasms - diagnostic imaging; Male; Medical diagnosis; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Multimodal Imaging; Neoplasm Staging; Nuclear Medicine; Oncology; Original Article; Orthopedics; Positron-Emission Tomography; Predictive Value of Tests; Prognosis; Radiology; Tomography, X-Ray Computed; Impact; Prognostic value; Clinical stage; F-FDG PET/CT; Management plan; Non-small-cell lung cancer; Initial
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-013-2672-8

Purpose Our objective was to determine the impact of initial 18 F-FDG PET/CT (PET/CT) staging on clinical stage and the management plan and the prognostic value of PET/CT in patients with non-small-cell lung cancer (NSCLC). Methods We retrospectively reviewed the records of 592 patients with NSCLC who were referred to The University of Texas MD Anderson Cancer Center during 2002/2011 and had both PET/CT and conventional CT for initial staging. Clinical stages and management plans were compared between PET/CT and CT. The impact of PET/CT on management plans was considered medium/high when PET/CT changed the planned treatment modality or treatment intent. PET/CT and CT stages were compared with all-cause mortality and survival rates. We also assessed potential prognostic factors for progression-free survival (PFS) and overall survival (OS). Results PET/CT changed the stage in 170 patients (28.7 %; 16.4 % upstaged, 12.3 % downstaged). PET/CT had a medium/high impact on the management plan in 220 patients (37.2 %). PFS and OS were significantly worse in patients with upstaged disease than in patients with no change in stage (median PFS 29.0 vs. 53.8 months, P  < 0.001; median OS:64.7 vs. 115.9 months, P  = 0.006). PFS and OS were significantly worse in patients with medium/high impact of PET/CT than in patients with no/low impact of PET/CT (median PFS 24.7 vs. 60.6 months, P  < 0.001; median OS 64.7 vs. 115.9 months, P  < 0.001). In multivariate analysis, a medium/high impact of PET/CT was an independent predictor of worse PFS (hazard ratio, HR, 1.73; 95 % CI 1.30 – 2.29; P  = 0.0002) and OS (HR 1.84; 95 % CI 1.26 – 2.69; P  = 0.002). Conclusion Initial PET/CT staging not only impacts stage and management plan but also has prognostic value.