TY - JOUR
T1 - 18F-Fludeoxyglucose-Positron Emission Tomography/Computed Tomography and Laparoscopy for Staging of Locally Advanced Gastric Cancer
T2 - A Multicenter Prospective Dutch Cohort Study (PLASTIC)
AU - Gertsen, Emma C.
AU - Brenkman, Hylke J. F.
AU - van Hillegersberg, Richard
AU - van Sandick, Johanna W.
AU - van Berge Henegouwen, Mark I.
AU - Gisbertz, Suzanne S.
AU - Luyer, Misha D. P.
AU - Nieuwenhuijzen, Grard A. P.
AU - van Lanschot, Jan J. B.
AU - Lagarde, Sjoerd M.
AU - Wijnhoven, Bas P. L.
AU - de Steur, Wobbe O.
AU - Hartgrink, Henk H.
AU - Stoot, Jan H. M. B.
AU - Hulsewe, Karel W. E.
AU - Spillenaar Bilgen, Ernst J.
AU - van Det, Marc J.
AU - Kouwenhoven, Ewout A.
AU - van der Peet, Donald L.
AU - Daams, Freek
AU - van Grieken, Nicole C. T.
AU - Heisterkamp, Joos
AU - van Etten, Boudewijn
AU - van den Berg, Jan Willem
AU - Pierie, Jean Pierre
AU - Eker, Hasan H.
AU - Thijssen, Annemieke Y.
AU - Belt, Eric J. T.
AU - van Duijvendijk, Peter
AU - Wassenaar, Eelco
AU - van Laarhoven, Hanneke W. M.
AU - Wevers, Kevin P.
AU - Hol, Lieke
AU - Wessels, Frank J.
AU - Haj Mohammad, Nadia
AU - van der Meulen, Miriam P.
AU - Frederix, Geert W. J.
AU - Vegt, Erik
AU - Siersema, Peter D.
AU - Ruurda, Jelle P.
N1 - Funding Information: Funding/Support: This trial was supported by Publisher Copyright: © 2021 American Medical Association. All rights reserved.
PY - 2021/12
Y1 - 2021/12
N2 - Importance: The optimal staging for gastric cancer remains a matter of debate. Objective: To evaluate the value of 18F-fludeoxyglucose-positron emission tomography with computed tomography (FDG-PET/CT) and staging laparoscopy (SL) in addition to initial staging by means of gastroscopy and CT in patients with locally advanced gastric cancer. Design, Setting, and Participants: This multicenter prospective, observational cohort study included 394 patients with locally advanced, clinically curable gastric adenocarcinoma (≥cT3 and/or N+, M0 category based on CT) between August 1, 2017, and February 1, 2020. Exposures: All patients underwent an FDG-PET/CT and/or SL in addition to initial staging. Main Outcomes and Measures: The primary outcome was the number of patients in whom the intent of treatment changed based on the results of these 2 investigations. Secondary outcomes included diagnostic performance, number of incidental findings on FDG-PET/CT, morbidity and mortality after SL, and diagnostic delay. Results: Of the 394 patients included, 256 (65%) were men and mean (SD) age was 67.6 (10.7) years. A total of 382 patients underwent FDG-PET/CT and 357 underwent SL. Treatment intent changed from curative to palliative in 65 patients (16%) based on the additional FDG-PET/CT and SL findings. FDG-PET/CT detected distant metastases in 12 patients (3%), and SL detected peritoneal or locally nonresectable disease in 73 patients (19%), with an overlap of 7 patients (2%). FDG-PET/CT had a sensitivity of 33% (95% CI, 17%-53%) and specificity of 97% (95% CI, 94%-99%) in detecting distant metastases. Secondary findings on FDG/PET were found in 83 of 382 patients (22%), which led to additional examinations in 65 of 394 patients (16%). Staging laparoscopy resulted in a complication requiring reintervention in 3 patients (0.8%) without postoperative mortality. The mean (SD) diagnostic delay was 19 (14) days. Conclusions and Relevance: This study's findings suggest an apparently limited additional value of FDG-PET/CT; however, SL added considerably to the staging process of locally advanced gastric cancer by detection of peritoneal and nonresectable disease. Therefore, it may be useful to include SL in guidelines for staging advanced gastric cancer, but not FDG-PET/CT.
AB - Importance: The optimal staging for gastric cancer remains a matter of debate. Objective: To evaluate the value of 18F-fludeoxyglucose-positron emission tomography with computed tomography (FDG-PET/CT) and staging laparoscopy (SL) in addition to initial staging by means of gastroscopy and CT in patients with locally advanced gastric cancer. Design, Setting, and Participants: This multicenter prospective, observational cohort study included 394 patients with locally advanced, clinically curable gastric adenocarcinoma (≥cT3 and/or N+, M0 category based on CT) between August 1, 2017, and February 1, 2020. Exposures: All patients underwent an FDG-PET/CT and/or SL in addition to initial staging. Main Outcomes and Measures: The primary outcome was the number of patients in whom the intent of treatment changed based on the results of these 2 investigations. Secondary outcomes included diagnostic performance, number of incidental findings on FDG-PET/CT, morbidity and mortality after SL, and diagnostic delay. Results: Of the 394 patients included, 256 (65%) were men and mean (SD) age was 67.6 (10.7) years. A total of 382 patients underwent FDG-PET/CT and 357 underwent SL. Treatment intent changed from curative to palliative in 65 patients (16%) based on the additional FDG-PET/CT and SL findings. FDG-PET/CT detected distant metastases in 12 patients (3%), and SL detected peritoneal or locally nonresectable disease in 73 patients (19%), with an overlap of 7 patients (2%). FDG-PET/CT had a sensitivity of 33% (95% CI, 17%-53%) and specificity of 97% (95% CI, 94%-99%) in detecting distant metastases. Secondary findings on FDG/PET were found in 83 of 382 patients (22%), which led to additional examinations in 65 of 394 patients (16%). Staging laparoscopy resulted in a complication requiring reintervention in 3 patients (0.8%) without postoperative mortality. The mean (SD) diagnostic delay was 19 (14) days. Conclusions and Relevance: This study's findings suggest an apparently limited additional value of FDG-PET/CT; however, SL added considerably to the staging process of locally advanced gastric cancer by detection of peritoneal and nonresectable disease. Therefore, it may be useful to include SL in guidelines for staging advanced gastric cancer, but not FDG-PET/CT.
UR - http://www.scopus.com/inward/record.url?scp=85118448989&partnerID=8YFLogxK
U2 - https://doi.org/10.1001/jamasurg.2021.5340
DO - https://doi.org/10.1001/jamasurg.2021.5340
M3 - Article
C2 - 34705049
SN - 2168-6254
VL - 156
SP - E1-E9
JO - Jama surgery
JF - Jama surgery
IS - 12
ER -