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¹⁸F-FDG PET Provides High-Impact and Powerful Prognostic Stratification in Staging Newly Diagnosed Non–Small Cell Lung Cancer

Department of Diagnostic Imaging, Division of Radiation Oncology, and Pratt Foundation Statistical Centre, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia

Survival of lung cancer patients remains poor despite increasingly aggressive treatment. Conventional staging has well-described limitations. ¹⁸F-FDG PET has been shown to stage lung cancer more accurately than does CT scanning, but the impact on patient treatment and outcome is poorly defined. This study evaluated this impact in routine clinical practice within a tertiary oncology facility. Methods: For 153 consecutive patients with newly diagnosed non–small cell lung cancer, the treatment plan based on conventional staging methods was compared with the treatment plan based on incorporation of PET findings. Survival was analyzed using the Cox proportional hazards regression model. Results: For broad groupings of stage, 10% of cases were downstaged and 33% upstaged by PET. When assessable, the PET stage was confirmed in 89% of patients. PET had a high impact on 54 patients (35%), including 34 whose therapy was changed from curative to palliative, 6 whose therapy was changed from palliative to curative, and 14 whose treatment modality was changed but not the treatment intent. For 39 patients (25%), a previously selected therapy was altered because of the PET findings. The Cox model indicated that the pre-PET stage was significantly associated with survival (P = 0.013) but that the post-PET stage provided much stronger prognostic stratification (P < 0.0001) and remained significant after adjustment for treatment delivered. Conclusion: Staging that incorporated PET provided a more accurate prognostic stratification than did staging based on conventional investigations. Further, the additional information provided by PET significantly and appropriately changed management in the majority of patients.

Key Words: FDG • PET • lung cancer • staging • prognosis • impact

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