Impact of FDG-PET-induced treatment choices on long-term outcome in non-small cell lung cancer.
BACKGROUND
The TNM staging reflects the anatomic extent of lung cancer and estimates the survival expectation. Addition of FDG-PET to conventional staging (CS) improves accuracy, but few data have described the impact of this on long-term survival in relation to treatment.


OBJECTIVE
To study the influence of FDG-PET on long-term outcome.


METHODS
Long-term outcome data of patients were retrieved out of previously published PET studies of the Leuven Lung Cancer Group. All patients had a potential for radical treatment, and at least 5-year follow-up data. Patients were dichotomized in early (I-IIIA) versus late (IIIB-IV) stages.


RESULTS
A first analysis - comparison of the 2 staging algorithms, CS alone versus CS+PET - confirmed the better staging capabilities of the latter. A second analysis, focusing on discordant findings and interaction of both staging algorithms, demonstrated that patients with early stage on PET did well, while those with late stage on PET did poorly, irrespective of findings on CS. The third analysis focused on the relation between treatment choices at the multidisciplinary board and outcome, which is especially relevant in patients with discordant finding on CS and CS+PET. From all radically treated patients, only those with early stage on CS+PET had a good outcome, but not those with early stage on CS and an unexplained late stage finding on PET.


CONCLUSIONS
This long-term follow-up analysis confirms that addition of PET to CS results in better stage designation and prognosis. Additionally, discordant findings between CS and CS+PET should be considered relevant, with need for cytological/histological examination.
Wauters
Isabelle
I
Respiratory Oncology Unit (Pulmonology) and Leuven Lung Cancer Group, University Hospital Gasthuisberg, Catholic University, BE-3000 Leuven, Belgium.
Stroobants
Sigrid
S
De Leyn
Paul
P
D'Hoore
Isabelle
I
Nackaerts
Kris
K
Dooms
Christophe
C
Vansteenkiste
Johan
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology; D002755:Choice Behavior; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012189:Retrospective Studies
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18