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Impact of initial PET/CT staging in terms of clinical stage, management plan, and prognosis in 592 patients with non-small-cell lung cancer

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Our objective was to determine the impact of initial 18F-FDG PET/CT (PET/CT) staging on clinical stage and the management plan and the prognostic value of PET/CT in patients with non-small-cell lung cancer (NSCLC).


We retrospectively reviewed the records of 592 patients with NSCLC who were referred to The University of Texas MD Anderson Cancer Center during 2002/2011 and had both PET/CT and conventional CT for initial staging. Clinical stages and management plans were compared between PET/CT and CT. The impact of PET/CT on management plans was considered medium/high when PET/CT changed the planned treatment modality or treatment intent. PET/CT and CT stages were compared with all-cause mortality and survival rates. We also assessed potential prognostic factors for progression-free survival (PFS) and overall survival (OS).


PET/CT changed the stage in 170 patients (28.7 %; 16.4 % upstaged, 12.3 % downstaged). PET/CT had a medium/high impact on the management plan in 220 patients (37.2 %). PFS and OS were significantly worse in patients with upstaged disease than in patients with no change in stage (median PFS 29.0 vs. 53.8 months, P < 0.001; median OS:64.7 vs. 115.9 months, P = 0.006). PFS and OS were significantly worse in patients with medium/high impact of PET/CT than in patients with no/low impact of PET/CT (median PFS 24.7 vs. 60.6 months, P < 0.001; median OS 64.7 vs. 115.9 months, P < 0.001). In multivariate analysis, a medium/high impact of PET/CT was an independent predictor of worse PFS (hazard ratio, HR, 1.73; 95 % CI 1.30 – 2.29; P = 0.0002) and OS (HR 1.84; 95 % CI 1.26 – 2.69; P = 0.002).


Initial PET/CT staging not only impacts stage and management plan but also has prognostic value.

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We thank all the patients, their families, and the investigators. We also thank the staff at MD Anderson Cancer Center for their assistance and especially Ms. Treva Greer, CNMT, PET, for data collection. This report was edited by Stephanie Deming in the Department of Scientific Publications at The University of Texas MD Anderson Cancer Center.

This work was supported in part by the MD Anderson Cancer Center James E. Anderson Distinguished Professorship in Nuclear Medicine (to Dr. Macapinlac), and by the Society of Nuclear Medicine and Molecular Imaging 2012/2014 Wagner-Torizuka Fellowship (to Dr. Takeuchi).

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Correspondence to Satoshi Takeuchi.

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Satoshi Takeuchi and Benjapa Khiewvan contributed equally to this work.

This work was presented in part at the American Society of Clinical Oncology Annual Meeting, Chicago, Illinois, May 31 through June 4, 2013.

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Takeuchi, S., Khiewvan, B., Fox, P.S. et al. Impact of initial PET/CT staging in terms of clinical stage, management plan, and prognosis in 592 patients with non-small-cell lung cancer. Eur J Nucl Med Mol Imaging 41, 906–914 (2014).

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