Impact of Staging With Positron-emission Tomography (PET) and Comorbidities on Management and Survival of American Veterans With Stage I-III Non-Small Cell Lung Cancer.
The extent of whether staging by fluorodeoxyglucose positron-emission tomography (PET) impacts outcomes in American Veterans with stage I-III non-small-cell lung cancer (NSCLC) is unknown. We investigated impact of fluorodeoxyglucose PET staging and age-adjusted comorbidities (AACs) on management and survival of NSCLC in this group.



We performed a retrospective review to identify with NSCLC who underwent initial PET scan and received care at the Ann Arbor Veterans Hospital between 2005 and 2010. Survival outcomes were estimated by Kaplan-Meier methods, quantile regressions, and Cox proportional hazards models, after accounting for age at diagnosis, sex, AAC, and initial treatment.



The number of PET scans increased from 0 in 2005 to 66 in 2010. There were 170 men, 4 women, median age 64 years. Median AAC score was 4. In CS I (n=54), initial PET upstaged 5 patients. Median survival for no change in PET stage was 27.43 versus 67 months for upstaged patients (P=0.034). For CS II (n=15), initial PET scan upstaged 1 patient. Median survival for no change in PET stage was 16.53 versus 2.8 months for upstaged patient (P=0.335). For CS III (n=104), PET scan upstaged 20 patients. Median survival for no change in PET stage was 13.3 versus 3.8 months for upstaged patients (P=0.016).



PET scans resulted in upstaging in 15% in CS I-III NSCLC. AAC scores dictated therapy decisions and outcomes more than PET staging. Veterans had lower 5-year survival rates (26.3%, 15.8%/13.4%) compared with 53% and 27% in age/sex/time-period matched SEER data for stage I-II/III NSCLC.
Departments of Internal Medicine, Division of Medical Oncology.
Radhika
R
Raghunathan
Departments of Internal Medicine, Division of Medical Oncology.
Kemp
K
Cease
Departments of Internal Medicine, Division of Medical Oncology.
Sandra
S
Troeschel
Departments of Biostatistics.
Lili
L
Zhao
Nuclear Medicine, Ann Arbor Veterans Administration Health Systems.
Milton
M
Gross
Surgery, University of Michigan, Ann Arbor, MI.
Guoan
G
Chen
Departments of Internal Medicine, Division of Medical Oncology.
Vineet
V
Chopra
Departments of Internal Medicine, Division of Medical Oncology.
Nithya
N
Ramnath
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy; D015897:Comorbidity; D019468:Disease Management; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D015996:Survival Rate; D014481:United States
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18