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Observational Study
. 2021 Dec 1;156(12):e215340.
doi: 10.1001/jamasurg.2021.5340. Epub 2021 Dec 8.

18F-Fludeoxyglucose-Positron Emission Tomography/Computed Tomography and Laparoscopy for Staging of Locally Advanced Gastric Cancer: A Multicenter Prospective Dutch Cohort Study (PLASTIC)

Emma C Gertsen  1 , Hylke J F Brenkman  1 , Richard van Hillegersberg  1 , Johanna W van Sandick  2 , Mark I van Berge Henegouwen  3 , Suzanne S Gisbertz  3 , Misha D P Luyer  4 , Grard A P Nieuwenhuijzen  4 , Jan J B van Lanschot  5 , Sjoerd M Lagarde  5 , Bas P L Wijnhoven  5 , Wobbe O de Steur  6 , Henk H Hartgrink  6 , Jan H M B Stoot  7 , Karel W E Hulsewe  7 , Ernst J Spillenaar Bilgen  8 , Marc J van Det  9 , Ewout A Kouwenhoven  9 , Donald L van der Peet  10 , Freek Daams  10 , Nicole C T van Grieken  11 , Joos Heisterkamp  12 , Boudewijn van Etten  13 , Jan Willem van den Berg  13 , Jean Pierre Pierie  14 , Hasan H Eker  14 , Annemieke Y Thijssen  15 , Eric J T Belt  16 , Peter van Duijvendijk  17 , Eelco Wassenaar  17 , Hanneke W M van Laarhoven  18   19 , Kevin P Wevers  20 , Lieke Hol  21 , Frank J Wessels  22 , Nadia Haj Mohammad  23 , Miriam P van der Meulen  24 , Geert W J Frederix  24 , Erik Vegt  25 , Peter D Siersema  26 , Jelle P Ruurda  1 ; PLASTIC Study Group
Collaborators, Affiliations
Observational Study

18F-Fludeoxyglucose-Positron Emission Tomography/Computed Tomography and Laparoscopy for Staging of Locally Advanced Gastric Cancer: A Multicenter Prospective Dutch Cohort Study (PLASTIC)

Emma C Gertsen et al. JAMA Surg. .

Abstract

Importance: The optimal staging for gastric cancer remains a matter of debate.

Objective: To evaluate the value of 18F-fludeoxyglucose-positron emission tomography with computed tomography (FDG-PET/CT) and staging laparoscopy (SL) in addition to initial staging by means of gastroscopy and CT in patients with locally advanced gastric cancer.

Design, setting, and participants: This multicenter prospective, observational cohort study included 394 patients with locally advanced, clinically curable gastric adenocarcinoma (≥cT3 and/or N+, M0 category based on CT) between August 1, 2017, and February 1, 2020.

Exposures: All patients underwent an FDG-PET/CT and/or SL in addition to initial staging.

Main outcomes and measures: The primary outcome was the number of patients in whom the intent of treatment changed based on the results of these 2 investigations. Secondary outcomes included diagnostic performance, number of incidental findings on FDG-PET/CT, morbidity and mortality after SL, and diagnostic delay.

Results: Of the 394 patients included, 256 (65%) were men and mean (SD) age was 67.6 (10.7) years. A total of 382 patients underwent FDG-PET/CT and 357 underwent SL. Treatment intent changed from curative to palliative in 65 patients (16%) based on the additional FDG-PET/CT and SL findings. FDG-PET/CT detected distant metastases in 12 patients (3%), and SL detected peritoneal or locally nonresectable disease in 73 patients (19%), with an overlap of 7 patients (2%). FDG-PET/CT had a sensitivity of 33% (95% CI, 17%-53%) and specificity of 97% (95% CI, 94%-99%) in detecting distant metastases. Secondary findings on FDG/PET were found in 83 of 382 patients (22%), which led to additional examinations in 65 of 394 patients (16%). Staging laparoscopy resulted in a complication requiring reintervention in 3 patients (0.8%) without postoperative mortality. The mean (SD) diagnostic delay was 19 (14) days.

Conclusions and relevance: This study's findings suggest an apparently limited additional value of FDG-PET/CT; however, SL added considerably to the staging process of locally advanced gastric cancer by detection of peritoneal and nonresectable disease. Therefore, it may be useful to include SL in guidelines for staging advanced gastric cancer, but not FDG-PET/CT.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr van Berge Henegouwen reported receiving unrestricted grants from Olympus Pharmaceuticals and Stryker Corp, surgical fees paid to the institution from Alesi Surgical, honoraria paid to the institution for serving as an advisory consultant from B Braun Medical, Mylan, Johnson & Johnson Pharmaceuticals, and Medtronic outside the submitted work. Dr Stoot reported serving as faculty in online training course for inguinal hernia repair from Medtronic. Dr Haj Mohammad reported receiving honoraria paid to the institution for serving on the Eli Lilly advisory board, fees paid to the institution for providing lectures and serving on the advisory board from Servier Laboratories and MSD, and fees paid to the institution for serving on the advisory boards from BMS and AstraZeneca outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Flowchart of Inclusion and Exclusion Criteria
FDG-PET/CT indicates 18F-fludeoxyglucose–positron emission tomography/computed tomography; PET, positron emission tomography; and SL, staging laparoscopy. acT3 and/or N+, M0 category.
See this image and copyright information in PMC

Comment in

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