Routinely staging gastric cancer with 18F-FDG PET-CT detects additional metastases and predicts early recurrence and death after surgery

Findlay, John M., Antonowicz, Stefan, Segaran, Ashvina, el Kafsi, Jihene, Zhang, Alexa, Bradley, Kevin M. ORCID: https://orcid.org/0000-0003-1911-3382, Gillies, Richard S., Maynard, Nicholas D. and Middleton, Mark R. 2019. Routinely staging gastric cancer with 18F-FDG PET-CT detects additional metastases and predicts early recurrence and death after surgery. European Radiology 29 (5) , pp. 2490-2498. 10.1007/s00330-018-5904-2

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Abstract

Objectives Fluorodeoxyglucose (FDG) positron emission tomography–computed tomography (PET-CT) is typically considered to have minimal yield in gastric cancer, and so is not consistently recommended by international guidelines. However, its yield is considerable in esophageal and junctional cancer, identifying unsuspected metastases and risk-stratifying patients using metabolic nodal stage (mN). We aimed to determine the contemporary utility of routine 18F-FDG PET-CT in gastric cancer. Methods We routinely stage patients with non-junctional gastric cancer with PET-CT, provided initial CT does not demonstrate unequivocal metastases. We performed a retrospective study of all such patients staged in our institution from January 2007 to July 2016. Our primary endpoint was detection of incurable disease. Our secondary endpoint was disease-free survival following gastrectomy. Decision theory, economic, and predictive models were generated. Results The primary tumor was FDG-avid in 225/279 patients (80.6%). Seventy-two (25.8%) had FDG-avid nodes (resectable by D2 lymphadenectomy). This was not influenced by the Lauren classification. Unsuspected metastases were identified in 20 patients (7.2%). In 13 (4.7%), these would not have been otherwise identified. Decision theory and economic modeling supported routine PET-CT. Patients with FDG-avid nodes were more likely to have incurable disease (51.4% versus 15.5%; p < 0.001), and a worse prognosis if not: multivariate hazard ratio 2.19 (1.23–3.91; p = 0.008). Prognosis worsened with mN stage. Conclusions PET-CT appears useful when used routinely for non-junctional gastric cancer, and should be considered in international recommendations. Any extra costs appear small and offset by avoiding futile investigations and radical treatment. mN stage identifies patients at risk of early recurrence and death.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Publisher:	Springer Verlag (Germany)
ISSN:	0938-7994
Date of First Compliant Deposit:	1 June 2020
Date of Acceptance:	22 November 2018
Last Modified:	04 May 2023 18:55
URI:	https://orca.cardiff.ac.uk/id/eprint/131984

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