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

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Our objective was to determine the impact of initial 18F-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.

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References

  1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012;62:10–29.

    Article  PubMed  Google Scholar 

  2. Goldstraw P, Ball D, Jett JR, Le Chevalier T, Lim E, Nicholson AG, et al. Non-small-cell lung cancer. Lancet. 2011;378:1727–40.

    Article  PubMed  Google Scholar 

  3. Dillemans B, Deneffe G, Verschakelen J, Decramer M. Value of computed tomography and mediastinoscopy in preoperative evaluation of mediastinal nodes in non-small cell lung cancer. A study of 569 patients. Eur J Cardiothorac Surg. 1994;8:37–42.

    Article  CAS  PubMed  Google Scholar 

  4. Hicks RJ, Kalff V, MacManus MP, Ware RE, Hogg A, McKenzie AF, et al. (18)F-FDG PET provides high-impact and powerful prognostic stratification in staging newly diagnosed non-small cell lung cancer. J Nucl Med. 2001;42:1596–604.

    CAS  PubMed  Google Scholar 

  5. Kalff V, Hicks RJ, MacManus MP, Binns DS, McKenzie AF, Ware RE, et al. Clinical impact of (18)F fluorodeoxyglucose positron emission tomography in patients with non-small-cell lung cancer: a prospective study. J Clin Oncol. 2001;19:111–8.

    CAS  PubMed  Google Scholar 

  6. Vansteenkiste JF, Stroobants SG, De Leyn PR, Dupont PJ, Bogaert J, Maes A, et al. Lymph node staging in non-small-cell lung cancer with FDG-PET scan: a prospective study on 690 lymph node stations from 68 patients. J Clin Oncol. 1998;16:2142–9.

    CAS  PubMed  Google Scholar 

  7. Pfister DG, Johnson DH, Azzoli CG, Sause W, Smith TJ, Baker Jr S, et al. American Society of Clinical Oncology treatment of unresectable non-small-cell lung cancer guideline: update 2003. J Clin Oncol. 2004;22:330–53.

    Article  PubMed  Google Scholar 

  8. van Tinteren H, Hoekstra OS, Smit EF, van den Bergh JH, Schreurs AJ, Stallaert RA, et al. Effectiveness of positron emission tomography in the preoperative assessment of patients with suspected non-small-cell lung cancer: the PLUS multicentre randomised trial. Lancet. 2002;359:1388–93.

    Article  PubMed  Google Scholar 

  9. Reed CE, Harpole DH, Posther KE, Woolson SL, Downey RJ, Meyers BF, et al. Results of the American College of Surgeons Oncology Group Z0050 trial: the utility of positron emission tomography in staging potentially operable non-small cell lung cancer. J Thorac Cardiovasc Surg. 2003;126:1943–51.

    Article  PubMed  Google Scholar 

  10. Buck AK, Herrmann K, Schreyogg J. PET/CT for staging lung cancer: costly or cost-saving? Eur J Nucl Med Mol Imaging. 2011;38:799–801.

    Article  PubMed  Google Scholar 

  11. Schreyogg J, Weller J, Stargardt T, Herrmann K, Bluemel C, Dechow T, et al. Cost-effectiveness of hybrid PET/CT for staging of non-small cell lung cancer. J Nucl Med. 2010;51:1668–75.

    Article  PubMed  Google Scholar 

  12. Delbeke D, Schoder H, Martin WH, Wahl RL. Hybrid imaging (SPECT/CT and PET/CT): improving therapeutic decisions. Semin Nucl Med. 2009;39:308–40.

    Article  PubMed  Google Scholar 

  13. NCCN Clinical Practice Guidelines in Oncology. Non-Small Cell Lung Cancer. Version 3.2012. http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf. Accessed 31 Aug 2012.

  14. Shankar LK, Hoffman JM, Bacharach S, Graham MM, Karp J, Lammertsma AA, et al. Consensus recommendations for the use of 18F-FDG PET as an indicator of therapeutic response in patients in National Cancer Institute Trials. J Nucl Med. 2006;47:1059–66.

    CAS  PubMed  Google Scholar 

  15. Rami-Porta R, Ball D, Crowley J, Giroux DJ, Jett J, Travis WD, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the T descriptors in the forthcoming (seventh) edition of the TNM classification for lung cancer. J Thorac Oncol. 2007;2:593–602.

    Article  PubMed  Google Scholar 

  16. Goldstraw P, Crowley J, Chansky K, Giroux DJ, Groome PA, Rami-Porta R, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol. 2007;2:706–14.

    Article  PubMed  Google Scholar 

  17. Gregory DL, Hicks RJ, Hogg A, Binns DS, Shum PL, Milner A, et al. Effect of PET/CT on management of patients with non-small cell lung cancer: results of a prospective study with 5-year survival data. J Nucl Med. 2012;53:1007–15.

    Article  PubMed  Google Scholar 

  18. Hillner BE, Siegel BA, Liu D, Shields AF, Gareen IF, Hanna L, et al. Impact of positron emission tomography/computed tomography and positron emission tomography (PET) alone on expected management of patients with cancer: initial results from the National Oncologic PET Registry. J Clin Oncol. 2008;26:2155–61.

    Article  PubMed  Google Scholar 

  19. Hillner BE, Siegel BA, Shields AF, Liu D, Gareen IF, Hunt E, et al. Relationship between cancer type and impact of PET and PET/CT on intended management: findings of the national oncologic PET registry. J Nucl Med. 2008;49:1928–35.

    Article  PubMed  Google Scholar 

  20. Seltzer MA, Yap CS, Silverman DH, Meta J, Schiepers C, Phelps ME, et al. The impact of PET on the management of lung cancer: the referring physician’s perspective. J Nucl Med. 2002;43:752–6.

    PubMed  Google Scholar 

  21. Nawara C, Rendl G, Wurstbauer K, Lackner B, Rettenbacher L, Datz L, et al. The impact of PET and PET/CT on treatment planning and prognosis of patients with NSCLC treated with radiation therapy. Q J Nucl Med Mol Imaging. 2012;56:191–201.

    CAS  PubMed  Google Scholar 

  22. Win T, Miles K, Janes SM, Ganeshan B, Shastry M, Endozo R, et al. Tumor heterogeneity as measured on the CT component of PET/CT predicts survival in patients with potentially curable non-small cell lung cancer. Clin Cancer Res. 2013;19:1–9.

    Article  Google Scholar 

  23. Kanzaki R, Higashiyama M, Fujiwara A, Tokunaga T, Maeda J, Okami J, et al. Occult mediastinal lymph node metastasis in NSCLC patients diagnosed as clinical N0-1 by preoperative integrated FDG-PET/CT and CT: risk factors, pattern, and histopathological study. Lung Cancer. 2011;71:333–7.

    Article  PubMed  Google Scholar 

  24. Fischer B, Lassen U, Mortensen J, Larsen S, Loft A, Bertelsen A, et al. Preoperative staging of lung cancer with combined PET-CT. N Engl J Med. 2009;361:32–9.

    Article  CAS  PubMed  Google Scholar 

  25. Shim SS, Lee KS, Kim BT, Chung MJ, Lee EJ, Han J, et al. Non-small cell lung cancer: prospective comparison of integrated FDG PET/CT and CT alone for preoperative staging. Radiology. 2005;236:1011–9.

    Article  PubMed  Google Scholar 

  26. Song JW, Oh YM, Shim TS, Kim WS, Ryu JS, Choi CM. Efficacy comparison between (18)F-FDG PET/CT and bone scintigraphy in detecting bony metastases of non-small-cell lung cancer. Lung Cancer. 2009;65:333–8.

    Article  PubMed  Google Scholar 

  27. Maemondo M, Inoue A, Kobayashi K, Sugawara S, Oizumi S, Isobe H, et al. Gefitinib or chemotherapy for non-small-cell lung cancer with mutated EGFR. N Engl J Med. 2010;362:2380–8.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We thank all the patients, their families, and the investigators. We also thank the staff at MD Anderson Cancer Center for their assistance and especially Ms. Treva Greer, CNMT, PET, for data collection. This report was edited by Stephanie Deming in the Department of Scientific Publications at The University of Texas MD Anderson Cancer Center.

This work was supported in part by the MD Anderson Cancer Center James E. Anderson Distinguished Professorship in Nuclear Medicine (to Dr. Macapinlac), and by the Society of Nuclear Medicine and Molecular Imaging 2012/2014 Wagner-Torizuka Fellowship (to Dr. Takeuchi).

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None.

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Correspondence to Satoshi Takeuchi.

Additional information

Satoshi Takeuchi and Benjapa Khiewvan contributed equally to this work.

This work was presented in part at the American Society of Clinical Oncology Annual Meeting, Chicago, Illinois, May 31 through June 4, 2013.

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Takeuchi, S., Khiewvan, B., Fox, P.S. et al. Impact of initial PET/CT staging in terms of clinical stage, management plan, and prognosis in 592 patients with non-small-cell lung cancer. Eur J Nucl Med Mol Imaging 41, 906–914 (2014). https://doi.org/10.1007/s00259-013-2672-8

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  • DOI: https://doi.org/10.1007/s00259-013-2672-8

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