18F-Fludeoxyglucose-Positron Emission Tomography/Computed Tomography and Laparoscopy for Staging of Locally Advanced Gastric Cancer

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18F-Fludeoxyglucose-Positron Emission Tomography/Computed Tomography and Laparoscopy for Staging of Locally Advanced Gastric Cancer : A Multicenter Prospective Dutch Cohort Study (PLASTIC). / Gertsen, Emma C.; Brenkman, Hylke J. F.; van Hillegersberg, Richard et al.

In: JAMA surgery, Vol. 156, No. 12, 12.2021, p. E1-E9.

Research output: Contribution to journal › Article › Academic › peer-review

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Gertsen, EC, Brenkman, HJF, van Hillegersberg, R, van Sandick, JW , van Berge Henegouwen, MI , Gisbertz, SS, Luyer, MDP, Nieuwenhuijzen, GAP, van Lanschot, JJB, Lagarde, SM, Wijnhoven, BPL, de Steur, WO, Hartgrink, HH, Stoot, JHMB, Hulsewe, KWE, Spillenaar Bilgen, EJ, van Det, MJ, Kouwenhoven, EA, van der Peet, DL , Daams, F, van Grieken, NCT, Heisterkamp, J, van Etten, B, van den Berg, JW, Pierie, JP, Eker, HH, Thijssen, AY, Belt, EJT, van Duijvendijk, P, Wassenaar, E, van Laarhoven, HWM, Wevers, KP, Hol, L, Wessels, FJ, Haj Mohammad, N, van der Meulen, MP, Frederix, GWJ, Vegt, E, Siersema, PD & Ruurda, JP 2021, '18F-Fludeoxyglucose-Positron Emission Tomography/Computed Tomography and Laparoscopy for Staging of Locally Advanced Gastric Cancer: A Multicenter Prospective Dutch Cohort Study (PLASTIC)', JAMA surgery, vol. 156, no. 12, pp. E1-E9. https://doi.org/10.1001/jamasurg.2021.5340

BibTeX

@article{3c631a358cb843dd847b203cf4756e30,

title = "18F-Fludeoxyglucose-Positron Emission Tomography/Computed Tomography and Laparoscopy for Staging of Locally Advanced Gastric Cancer: A Multicenter Prospective Dutch Cohort Study (PLASTIC)",

abstract = "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.",

author = "Gertsen, {Emma C.} and Brenkman, {Hylke J. F.} and {van Hillegersberg}, Richard and {van Sandick}, {Johanna W.} and {van Berge Henegouwen}, {Mark I.} and Gisbertz, {Suzanne S.} and Luyer, {Misha D. P.} and Nieuwenhuijzen, {Grard A. P.} and {van Lanschot}, {Jan J. B.} and Lagarde, {Sjoerd M.} and Wijnhoven, {Bas P. L.} and {de Steur}, {Wobbe O.} and Hartgrink, {Henk H.} and Stoot, {Jan H. M. B.} and Hulsewe, {Karel W. E.} and {Spillenaar Bilgen}, {Ernst J.} and {van Det}, {Marc J.} and Kouwenhoven, {Ewout A.} and {van der Peet}, {Donald L.} and Freek Daams and {van Grieken}, {Nicole C. T.} and Joos Heisterkamp and {van Etten}, Boudewijn and {van den Berg}, {Jan Willem} and Pierie, {Jean Pierre} and Eker, {Hasan H.} and Thijssen, {Annemieke Y.} and Belt, {Eric J. T.} and {van Duijvendijk}, Peter and Eelco Wassenaar and {van Laarhoven}, {Hanneke W. M.} and Wevers, {Kevin P.} and Lieke Hol and Wessels, {Frank J.} and {Haj Mohammad}, Nadia and {van der Meulen}, {Miriam P.} and Frederix, {Geert W. J.} and Erik Vegt and Siersema, {Peter D.} and Ruurda, {Jelle P.}",

year = "2021",

month = dec,

doi = "10.1001/jamasurg.2021.5340",

language = "English",

volume = "156",

pages = "E1--E9",

journal = "JAMA surgery",

issn = "2168-6254",

publisher = "American Medical Association",

number = "12",

}

RIS

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.

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 - 10.1001/jamasurg.2021.5340

DO - 10.1001/jamasurg.2021.5340

M3 - Article

C2 - 34705049

VL - 156

SP - E1-E9

JO - JAMA surgery

JF - JAMA surgery

SN - 2168-6254

IS - 12

ER -

ID: 20382472

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