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

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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)
JAMA Surgery ( IF 15.7 ) Pub Date : 2021-12-01 , DOI: 10.1001/jamasurg.2021.5340
Emma C Gertsen ₁ , Hylke J F Brenkman ₁ , Richard van Hillegersberg ₁ , Johanna W van Sandick ₂ , Mark I van Berge Henegouwen ₃ , Suzanne S Gisbertz ₃ , Misha D P Luyer ₄ , Grard A P Nieuwenhuijzen ₄ , Jan J B van Lanschot ₅ , Sjoerd M Lagarde ₅ , Bas P L Wijnhoven ₅ , Wobbe O de Steur ₆ , Henk H Hartgrink ₆ , Jan H M B Stoot ₇ , Karel W E Hulsewe ₇ , Ernst J Spillenaar Bilgen ₈ , Marc J van Det ₉ , Ewout A Kouwenhoven ₉ , Donald L van der Peet ₁₀ , Freek Daams ₁₀ , Nicole C T van Grieken ₁₁ , Joos Heisterkamp ₁₂ , Boudewijn van Etten ₁₃ , Jan Willem van den Berg ₁₃ , Jean Pierre Pierie ₁₄ , Hasan H Eker ₁₄ , Annemieke Y Thijssen ₁₅ , Eric J T Belt ₁₆ , Peter van Duijvendijk ₁₇ , Eelco Wassenaar ₁₇ , Hanneke W M van Laarhoven _{18,

19} , Kevin P Wevers ₂₀ , Lieke Hol ₂₁ , Frank J Wessels ₂₂ , Nadia Haj Mohammad ₂₃ , Miriam P van der Meulen ₂₄ , Geert W J Frederix ₂₄ , Erik Vegt ₂₅ , Peter D Siersema ₂₆ , Jelle P Ruurda ₁ ,

Affiliation

Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Department of Surgery, the Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
Department of Surgery, Amsterdam University Medical Center, location AMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands.
Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands.
Department of Surgery, Erasmus MC University Medical Center Rotterdam, the Netherlands.
Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
Department of Surgery, Zuyderland MC, Sittard-Geleen, the Netherlands.
Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands.
Department of Surgery, ZGT hospital, Almelo, the Netherlands.
Department of Surgery, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, Amsterdam, the Netherlands.
Department of Pathology, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, Amsterdam, the Netherlands.
Department of Surgery, Elisabeth Twee-Steden Hospital, Tilburg, the Netherlands.
Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Department of Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands.
Department of Gastroenterology, Albert Schweitzer Hospital, Dordrecht, the Netherlands.
Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands.
Department of Surgery, Gelre Ziekenhuizen, Apeldoorn, the Netherlands.
Prospective Observational Cohort Study of Oesophageal-Gastric Cancer Patients (POCOP) of the Dutch Upper GI Cancer Group, Amsterdam, the Netherlands.
Department of Medical Oncology, Amsterdam University Medical Center, location AMC, Cancer Center Amsterdam, Amsterdam, the Netherlands.
Department of Surgery, Isala Ziekenhuis, Zwolle, the Netherlands.
Department of Gastroenterology, Maasstad Ziekenhuis, Rotterdam, the Netherlands.
Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, the Netherlands.
Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.
Department of Gastroenterology, Radboud University Medical Center, Nijmegen, the Netherlands.

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.

中文翻译：

18F-氟脱氧葡萄糖-正电子发射断层扫描/计算机断层扫描和腹腔镜用于局部晚期胃癌分期：一项多中心前瞻性荷兰队列研究 (PLASTIC)

重要性 胃癌的最佳分期仍然存在争议。

目的评价¹⁸ F-氟脱氧葡萄糖-正电子发射断层扫描联合计算机断层扫描（FDG-PET/CT）和腹腔镜分期（SL）联合胃镜和CT初步分期对局部晚期胃癌患者的价值。

设计、地点和参与者 这项多中心前瞻性观察性队列研究纳入了 2017 年 8 月 1 日至 2020 年 2 月 1 日期间的 394 名局部晚期、临床可治愈的胃腺癌（≥cT3 和/或 N+、M0 类别，基于 CT）的患者。

暴露除了初始分期外，所有患者都接受了 FDG-PET/CT 和/或 SL。

主要结果和措施 主要结果是根据这两项调查的结果改变治疗意图的患者数量。次要结果包括诊断性能、FDG-PET/CT 偶然发现的数量、SL 后的发病率和死亡率以及诊断延迟。

结果在纳入的 394 名患者中，256 名 (65%) 为男性，平均 (SD) 年龄为 67.6 (10.7) 岁。共有 382 名患者接受了 FDG-PET/CT，357 名患者接受了 SL。根据额外的 FDG-PET/CT 和 SL 发现，65 名患者 (16%) 的治疗意图从治愈性转变为姑息性治疗。FDG-PET/CT 在 12 名患者 (3%) 中检测到远处转移，SL 在 73 名患者 (19%) 中检测到腹膜或局部不可切除的疾病，重叠 7 名患者 (2%)。FDG-PET/CT 检测远处转移的敏感性为 33%（95% CI，17%-53%），特异性为 97%（95% CI，94%-99%）。在 382 名患者中的 83 名 (22%) 中发现了 FDG/PET 的二次发现，这导致对 394 名患者中的 65 名 (16%) 进行了额外检查。分期腹腔镜检查导致 3 名患者 (0.8%) 出现需要再次干预的并发症，但没有术后死亡。

结论和相关性 本研究的结果表明 FDG-PET/CT 的附加价值明显有限。然而，SL 通过检测腹膜和不可切除的疾病大大增加了局部晚期胃癌的分期过程。因此，将 SL 纳入晚期胃癌分期指南可能是有用的，但不包括 FDG-PET/CT。

更新日期：2021-12-08

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