Article Figures & Data
Figures
- FIGURE 1.
Development of 2-y NOPR cohort (see text for details). Numbers represent PET scans, not individuals having scans.
Tables
Characteristic Value Age, y Mean 72.4 Interquartile range (25%−75%) 68–78 <65 4,120 (10.1) >85 2,123 (5.2) Females/males, % 50.2/49.8 No. of scans, no. (%) of patients One 29,832 (86.4) Two or more 4,704 (13.6) ECOG performance category (status) Asymptomatic: fully active (0) 16,188 (39.6) Symptomatic, fully ambulatory (1) 19,868 (48.6) Symptomatic in bed <50% of day (2) 3,721 (9.1) Symptomatic in bed >50% of day (3) 1,007 (2.5) Bedridden (4) 79 (0.2) Summary cancer stage before PET No evidence of disease 4,914 (12.0) Localized only 8,036 (19.7) Regional, by direct extension or lymph node involvement 5,630 (13.8) Metastatic (distant), with single suspected site 5,043 (12.3) Metastatic (distant), with multiple suspected sites 6,984 (17.1) Unknown or uncertain 10,256 (25.1) Scan type and facility location, % Integrated PET/CT 88.7 Non–hospital-based location 68.9 Fixed location 74.7 ECOG = Eastern Cooperative Oncology Group.
Results are reported as number (percentage) of scans unless otherwise indicated.
Cancer type No. of scans % of cases with change in management† 95% CI Odds ratio for change in management compared with that for other cancers‡ 95% CI Frequency of other imaging as plan before PET (%) Imaging-adjusted impact (%)§ 95% CI Prostate 5,309 35.1 33.8–36.4 0.86‖ 0.81–0.92 39.9 15.0 14.1–16.0 Ovary 4,509 41.4 40.0–42.9 1.17‖ 1.10–1.25 52.1 16.2 15.1–17.3 Bladder 3,578 37.9 36.3–39.5 0.99¶ 0.93–1.07 45.1 15.4 14.2–16.6 Pancreas 3,314 39.0 37.3–40.6 1.04¶ 0.97–1.12 42.7 14.8 13.6–16.1 Stomach 3,025 36.9 35.2–38.6 0.95¶ 0.88–1.03 45.2 14.5 13.2–15.7 Small cell lung 2,983 41.2 39.5–43.0 1.16# 1.07–1.25 49.7 13.1 11.9–14.3 Kidney 2,877 35.8 34.0–37.6 0.90¶ 0.83–0.98 48.9 16.0 14.7–17.4 Uterus 2,869 36.5 34.7–38.2 0.93¶ 0.86–1.01 47.6 15.1 13.8–16.4 Myeloma 1,784 48.7 46.3–51.0 1.58‖ 1.43–1.73 61.3 11.5 10.0–13.0 Connective tissue 1,350 36.4 33.8–38.9 0.93¶ 0.83–1.04 49.9 13.6 11.8–15.5 Nonmelanoma skin 1,057 31.4 28.6–34.2 0.74# 0.65–0.84 49.8 9.6 7.9–11.4 Liver and intrahepatic bile ducts 1,038 42.9 39.9–45.9 1.23¶ 1.08–1.39 44.3 15.8 13.6–18.0 Cervix 984 32.7 29.8–35.7 0.79# 0.69–0.90 48.4 11.9 9.9–13.9 Gallbladder 806 39.7 36.3–43.1 1.07¶ 0.93–1.24 43.8 15.4 12.9–17.9 Other female genital 709 37.1 33.5–40.7 0.96¶ 0.82–1.12 41.9 13.0 10.5–15.4 Thyroid 629 35.6 31.9–39.4 0.90¶ 0.76–1.06 53.6 13.4 10.7–16.0 All other 4,042 36.6 35.1–38.1 0.93¶ 0.87–1.00 49.2 15.7 14.5–16.8 Total 40,863 38.0 37.6–38.5 NA NA 47.3 14.7 14.3–15.0 ↵* Specific cancer types are listed when there were at least 500 cases for initial staging, restaging, and detection of suspected recurrence combined.
↵† Defined as change from treatment to nontreatment or as change from nontreatment to treatment.
↵‡ Odds ratio of 1 implies that chance of changing management is equal between an individual cancer and all other cancer groups. Odds ratio <1 implies that chance of changing management is lower for the individual cancer than for all the others. Odds ratio >1 implies that chance of changing management is higher for an individual cancer than for all the others. NA = not applicable.
↵§ No benefit from PET was assumed for cases with imaging plan before PET.
↵‖ Bonferroni-adjusted χ2 P value for chance of change in management was <10−4.
↵¶ Bonferroni-adjusted χ2 P value for chance of change in management was between 0.01 and 1.0.
↵# Bonferroni-adjusted χ2 P value for chance of change in management was between 0.0001 and 0.01.
- TABLE 3
Details and Alternative Endpoints of Impact of PET on Intended Management by Cancer Type*
Change in management details Change in treatment goals Change in treatment modes Cancer type Nontreatment to treatment Treatment to nontreatment Odds ratio† Change in goal of original treatment plan Change from treatment to supportive care or observation Major change in type of treatment relative to plan before PET Minor change in type of treatment relative to plan before PET Prostate 25.3 9.7 4.3 12.9 13.7 8.5 12.1 Ovary 34.2 7.2 3.1 12.5 19.2 6.4 19.2 Bladder 29.9 8.0 4.0 15.7 13.8 9.1 26.7 Pancreas 31.2 7.8 3.8 16.9 13.5 8.6 26.5 Stomach 28.2 8.7 4.0 16.0 14.4 8.6 31.5 Small cell lung 34.9 6.3 3.9 13.9 13.2 7.4 28.6 Kidney 27.7 8.1 3.8 12.6 20.7 9.7 19.2 Uterus 28.9 7.6 4.4 13.8 15.9 9.8 27.4 Myeloma 41.7 7.0 2.2 11.7 20.3 5.3 9.7 Connective tissue 29.7 6.7 4.9 12.4 11.8 10.1 29.0 Nonmelanoma skin 25.5 5.9 7.7 10.0 8.9 5.1 31.7 Liver and intrahepatic bile ducts 33.6 9.2 2.6 18.2 10.8 14.7 23.7 Cervix 25.4 7.3 5.9 13.5 13.8 7.4 34.7 Gallbladder 31.5 8.2 3.5 17.8 12.6 10.4 22.1 Other female genital 30.0 7.1 4.5 15.1 7.3 8.3 34.5 Thyroid 26.4 9.2 3.8 14.7 16.1 11.5 26.0 All other 27.6 9.0 3.7 14.5 20.0 8.9 22.6 Total 30.0 8.0 3.9 14.1 15.1 8.6 23.3 ↵* Specific cancer types are listed when there were at least 500 cases for initial staging, restaging, and detection of suspected recurrence combined.
↵† Odds ratios compare chance of having plan for treatment after PET with chance of having plan for treatment before PET. Because more participants had treatment plans after PET than before PET, values were consistently higher than one.
Except for odds ratios, data are reported as percentages of cases.
Cancer type No. of scans % of cases with change in management† 95% CI Imaging-adjusted impact (%)‡ 95% CI Prostate 2,042 32.0 30.0–34.1 13.5 12.0–15.0 Stomach 1,556 40.5 38.0–42.9 14.8 13.1–16.6 Pancreas 1,491 39.2 36.8–41.7 13.4 11.7–15.1 Bladder 1,461 39.9 37.4–42.4 14.2 12.4–16.0 Small cell lung 1,082 43.3 40.4–46.3 8.1 6.5–9.8 Kidney 895 41.1 37.9–44.3 17.1 14.6–19.6 Uterus 746 41.6 38.0–45.1 14.1 11.6–16.6 Liver and intrahepatic bile ducts 607 44.2 40.2–48.1 14.3 11.5–17.1 Connective tissue 534 44.6 40.4–48.8 15.9 12.8–19.0 Nonmelanoma skin 526 37.5 33.3–41.6 10.1 7.5–12.6 Gallbladder 409 41.3 36.5–46.1 14.2 10.8–17.6 Myeloma 402 52.2 47.4–57.1 10.2 7.2–13.2 Ovary 378 43.1 38.1–48.1 16.1 12.4–19.8 Cervix 341 36.1 31.0–41.2 9.1 6.0–12.1 Other female genital 331 37.8 32.5–43.0 10.6 7.3–13.9 All other 1,564 40.4 38.0–42.8 13.4 11.7–15.1 Total 14,365 39.8 39.0–40.6 13.4 12.8–13.9 Cancer type No. of scans % of cases with change in management† 95% CI Imaging-adjusted impact (%)‡ 95% CI Ovary 1,971 37.7 35.6–39.8 13.0 11.6–14.5 Prostate 1,477 34.0 31.6–36.4 13.5 11.7–15.2 Small cell lung 1,357 40.8 38.2–43.4 14.2 12.4–16.1 Bladder 1,239 36.4 33.7–39.1 13.6 11.7–15.5 Uterus 1,064 30.5 27.8–33.3 11.7 9.7–13.6 Pancreas 1,021 38.3 35.3–41.3 11.3 9.3–13.2 Myeloma 1,009 46.4 43.3–49.5 10.8 8.9–12.7 Kidney 979 34.4 31.4–37.4 12.8 10.7–14.9 Stomach 916 35.5 32.4–38.6 13.4 11.2–15.6 Connective tissue 450 28.0 23.9–32.1 9.1 6.5–11.8 Nonmelanoma skin 363 23.1 18.8–27.5 6.3 3.8–8.8 Cervix 353 26.9 22.3–31.5 10.5 7.3–13.7 Liver and intrahepatic bile ducts 260 41.9 35.9–47.9 16.2 11.7–20.6 Leukemia 229 36.7 30.4–42.9 14.8 10.2–19.5 Gallbladder 215 38.6 32.1–45.1 13.5 8.9–18.1 Thyroid 203 34.5 27.9–41.0 10.8 6.6–15.1 All other 1,478 33.2 30.8–35.6 12.9 11.1–14.6 Total 14,584 35.9 35.1–36.7 12.6 12.0–13.1 - TABLE 7
Impact of PET on Intended Management for Detection of Suspected Recurrence by Cancer Type*
Cancer type No. of scans % of cases with change in management† 95% CI Imaging-adjusted impact (%)‡ 95% CI Ovary 2,160 44.5 42.4–46.6 19.1 17.4–20.7 Prostate 1,790 39.4 37.2–41.7 18.0 16.3–19.8 Uterus 1,059 38.8 35.9–41.7 19.3 16.9–21.6 Kidney 1,003 32.4 29.5–35.3 18.2 15.9–20.6 Bladder 878 36.7 33.5–39.9 19.8 17.2–22.5 Pancreas 802 39.3 35.9–42.7 22.1 19.2–24.9 Stomach 553 29.3 25.5–33.1 15.2 12.2–18.2 Small cell lung 544 38.1 34.0–42.1 20.2 16.8–23.6 Myeloma 373 50.9 45.9–56.0 14.7 11.1–18.3 Connective tissue 366 34.7 29.8–39.6 15.8 12.1–19.6 Cervix 290 35.9 30.3–41.4 16.9 12.6–21.2 Thyroid 253 33.2 27.4–39.0 17.0 12.4–21.6 Primary brain 222 40.5 34.1–47.0 28.4 22.4–34.3 Other female genital 206 39.8 33.1–46.5 17.5 12.3–22.7 All other 1,415 35.1 32.6–37.5 19.4 17.3–21.4 Total 11,914 38.5 37.6–39.3 18.8 18.1–19.5
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