F-18-FDG PET provides high-impact and powerful prognostic stratification in staging newly diagnosed non-small cell lung cancer

Survival of lung cancer patients remains poor despite increasingly aggressi ve treatment. Conventional staging has well-described limitations. F-18-FDG PET has been shown to stage lung cancer more accurately than does CT scann ing, but the impact on patient treatment and outcome is poorly defined. Thi s study evaluated this impact in routine clinical practice within a tertiar y oncology facility. Methods: For 153 consecutive patients with newly diagn osed non-small cell lung cancer, the treatment plan based on conventional s taging methods was compared with the treatment plan based on incorporation of PET findings. Survival was analyzed using the Cox proportional hazards r egression model. Results: For broad groupings of stage, 10% of cases were d ownstaged and 33% upstaged by PET. When assessable, the PET stage was confi rmed in 89% of patients. PET had a high impact on 54 patients (35%), includ ing 34 whose therapy was changed from curative to palliative, 6 whose thera py was changed from palliative to curative, and 14 whose treatment modality was changed but not the treatment intent. For 39 patients (25%), a previou sly selected therapy was altered because of the PET findings. The Cox model indicated that the pre-PET stage was significantly associated with surviva l (P = 0.013) but that the post-PET stage provided much stronger prognostic stratification (P < 0.0001) and remained significant after adjustment for treatment delivered. Conclusion: Staging that incorporated PET provided a m ore accurate prognostic stratification than did staging based on convention al investigations. Further, the additional information provided by PET sign ificantly and appropriately changed management in the majority of patients.