Alexander J Antoniou1, Charles Marcus1, Abdel K Tahari1, Richard L Wahl2, Rathan M Subramaniam3. 1. Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland. 2. Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland. 3. Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland; and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland rsubram4@jhmi.edu.
Abstract
UNLABELLED: The value of performing follow-up PET/CT imaging more than 6 mo after the conclusion of therapy-either as a routine practice or because of clinically suspected recurrence-is not well established. The purpose of this study was to evaluate the added value of follow-up PET/CT to the clinical assessment and survival outcome of lung cancer patients. METHODS: This was a retrospective study of 261 biopsy-proven lung cancer patients at a single tertiary center. In total, 488 follow-up PET/CT scans done 6 or more months after the completion of initial treatment were included in this study. Median follow-up from the completion of primary treatment was 29.3 mo (range, 6.1-295.1 mo). Overall survival (OS) benefit was measured using Kaplan-Meier plots with a Mantel-Cox log-rank test. A multivariate Cox regression model was provided with clinical covariates. RESULTS: Of the 488 PET/CT scans, 281 were positive and 207 negative for recurrence. Overall median survival from the time of the PET/CT study was 48.5 mo. The median survival of PET-positive and PET-negative groups was 32.9 and 81.6 mo, respectively (P < 0.0001). A subgroup analysis demonstrated a similar difference in OS for 212 scans completed between 6 and 24 mo after treatment (P = 0.0004) and 276 scans completed after 24 mo (P = 0.0006). In the context of clinical assessment, PET/CT identified recurrence in 43.7% (107/245) of scans without prior clinical suspicion and ruled out recurrence in 15.2% (37/243) of scans with prior clinical suspicion. There was a significant difference in OS when grouped by clinical suspicion (P = 0.0112) or routine follow-up (P < 0.0001). In a multivariate Cox regression model, factors associated with OS were age (P < 0.0001) and PET/CT result (P = 0.0003). An age-stratified subgroup analysis demonstrated a significant difference in OS by PET scan result among patients younger than 60 y and between 60 and 70 y but not in those older than 70 y (P < 0.0001, P = 0.0004, and P = 0.8193, respectively). CONCLUSION: (18)F-FDG PET/CT performed for follow-up more than 6 mo after the completion of primary treatment adds value to clinical judgment and is a prognostic marker of OS in lung cancer patients, regardless of the timing of the follow-up scan, and especially in patients younger than 70 y.
UNLABELLED: The value of performing follow-up PET/CT imaging more than 6 mo after the conclusion of therapy-either as a routine practice or because of clinically suspected recurrence-is not well established. The purpose of this study was to evaluate the added value of follow-up PET/CT to the clinical assessment and survival outcome of lung cancerpatients. METHODS: This was a retrospective study of 261 biopsy-proven lung cancerpatients at a single tertiary center. In total, 488 follow-up PET/CT scans done 6 or more months after the completion of initial treatment were included in this study. Median follow-up from the completion of primary treatment was 29.3 mo (range, 6.1-295.1 mo). Overall survival (OS) benefit was measured using Kaplan-Meier plots with a Mantel-Cox log-rank test. A multivariate Cox regression model was provided with clinical covariates. RESULTS: Of the 488 PET/CT scans, 281 were positive and 207 negative for recurrence. Overall median survival from the time of the PET/CT study was 48.5 mo. The median survival of PET-positive and PET-negative groups was 32.9 and 81.6 mo, respectively (P < 0.0001). A subgroup analysis demonstrated a similar difference in OS for 212 scans completed between 6 and 24 mo after treatment (P = 0.0004) and 276 scans completed after 24 mo (P = 0.0006). In the context of clinical assessment, PET/CT identified recurrence in 43.7% (107/245) of scans without prior clinical suspicion and ruled out recurrence in 15.2% (37/243) of scans with prior clinical suspicion. There was a significant difference in OS when grouped by clinical suspicion (P = 0.0112) or routine follow-up (P < 0.0001). In a multivariate Cox regression model, factors associated with OS were age (P < 0.0001) and PET/CT result (P = 0.0003). An age-stratified subgroup analysis demonstrated a significant difference in OS by PET scan result among patients younger than 60 y and between 60 and 70 y but not in those older than 70 y (P < 0.0001, P = 0.0004, and P = 0.8193, respectively). CONCLUSION: (18)F-FDG PET/CT performed for follow-up more than 6 mo after the completion of primary treatment adds value to clinical judgment and is a prognostic marker of OS in lung cancerpatients, regardless of the timing of the follow-up scan, and especially in patients younger than 70 y.
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