Does positron emission tomography scanning improve survival in patients undergoing potentially curative lung resections for non-small-cell lung cancer?

OBJECTIVE: To determine if positron emission tomography (PET) scanning has resulted in an improvement in the short- and long-term survival of patients undergoing potentially curative resections for non-small-cell lung cancer. No publications exist to demonstrate an increased survival of patients with lung cancer due to the use of PET scanning. If PET scanning reduces unnecessary resections, the results from surgery should be improved with its introduction.
METHODS: A prospective thoracic surgery database was retrospectively analysed. Patients (N=1999), who had undergone potentially curative resections for non-small-cell lung cancer, and those who had a PET scan pre operatively (N=934), were compared with patients who had not undergone PET scanning (N=1065), prior to surgical resection. PET scanning became routine for all patients 4 years ago in our unit. Staging was defined as pathological staging to eliminate bias by 'better' preoperative staging due multislice computed tomography (CT) and PET scanning. Propensity matching based on Cox regression analysis was performed for survival analysis at each stage.
RESULTS: Propensity matching revealed that the introduction of routine PET scanning did not result in improved survival in the short or long term, for patients undergoing resections for stage Ia (N=271 in each matched group), p=0.74, stage Ib (N=321 in each matched group), p=0.43 and stage II (N=164 in each matched group), p=0.06. PET has however resulted in a significant increased survival for patients undergoing resections for stage III primary lung cancer (N=68 in each matched group), p=0.03.
CONCLUSION: We concur with current guidelines for the use of PET scanning for stage III non-small-cell lung cancer. Our results need to be corroborated with other groups as potentially stage-Ia-, Ib-, and stage-II patients may not benefit from PET scanning.