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. 2014 May;41(5):906-14.
doi: 10.1007/s00259-013-2672-8. Epub 2014 Jan 18.

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

Satoshi Takeuchi  1 , Benjapa Khiewvan, Patricia S Fox, Stephen G Swisher, Eric M Rohren, Roland L Bassett Jr, Homer A Macapinlac
Affiliations

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

Satoshi Takeuchi et al. Eur J Nucl Med Mol Imaging. 2014 May.

Abstract

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.

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