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Impact of Staging With Positron-emission Tomography (PET) and Comorbidities on Management and Survival of American Veterans With Stage I-III Non–Small Cell Lung Cancer

Raghunathan, Radhika, BS, MSPH*; Cease, Kemp, MD*; Troeschel, Sandra, BSN, MSN*; Zhao, Lili, PhD; Gross, Milton, MD; Chen, Guoan, MD, PhD§; Chopra, Vineet, MD*; Ramnath, Nithya, MBBS*

American Journal of Clinical Oncology: May 2018 - Volume 41 - Issue 5 - p 513–518
doi: 10.1097/COC.0000000000000316
Original Articles: Thoracic

Objectives: The extent of whether staging by fluorodeoxyglucose positron-emission tomography (PET) impacts outcomes in American Veterans with stage I-III non–small-cell lung cancer (NSCLC) is unknown. We investigated impact of fluorodeoxyglucose PET staging and age-adjusted comorbidities (AACs) on management and survival of NSCLC in this group.

Materials and Methods: We performed a retrospective review to identify with NSCLC who underwent initial PET scan and received care at the Ann Arbor Veterans Hospital between 2005 and 2010. Survival outcomes were estimated by Kaplan-Meier methods, quantile regressions, and Cox proportional hazards models, after accounting for age at diagnosis, sex, AAC, and initial treatment.

Results: The number of PET scans increased from 0 in 2005 to 66 in 2010. There were 170 men, 4 women, median age 64 years. Median AAC score was 4. In CS I (n=54), initial PET upstaged 5 patients. Median survival for no change in PET stage was 27.43 versus 67 months for upstaged patients (P=0.034). For CS II (n=15), initial PET scan upstaged 1 patient. Median survival for no change in PET stage was 16.53 versus 2.8 months for upstaged patient (P=0.335). For CS III (n=104), PET scan upstaged 20 patients. Median survival for no change in PET stage was 13.3 versus 3.8 months for upstaged patients (P=0.016).

Conclusions: PET scans resulted in upstaging in 15% in CS I-III NSCLC. AAC scores dictated therapy decisions and outcomes more than PET staging. Veterans had lower 5-year survival rates (26.3%, 15.8%/13.4%) compared with 53% and 27% in age/sex/time-period matched SEER data for stage I-II/III NSCLC.

Departments of *Internal Medicine, Division of Medical Oncology

Nuclear Medicine, Ann Arbor Veterans Administration Health Systems

Departments of Biostatistics

§Surgery, University of Michigan, Ann Arbor, MI

The authors declare no conflicts of interest.

Reprints: Nithya Ramnath, MBBS, Department of Internal Medicine, Division of Medical Oncology, VA Ann Arbor Health Care System, 2215 Fuller Road, Ann Arbor, MI 48105. E-mail:

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