medwireNews: Use of positron emission tomography–computed tomography (PET–CT) before diagnosis is associated with increased receipt of stage-appropriate treatment and decreased mortality among veterans with non-small-cell lung cancer (NSCLC), research suggests.
“Our data suggested that PET-CT before diagnosis was associated with improved management and outcomes for veterans with NSCLC, the leading cause of cancer-related death,” report Michael Hope (San Francisco Veteran Affairs Health Care System, California, USA) and colleagues in JAMA Network Open.
The study included 64,103 patients included in the US Veterans Affairs healthcare system who were diagnosed with incident NSCLC between 2000 and 2013; of these 80.9% underwent PET–CT in the 12 months prior to or 5 years after diagnosis. The proportion of individuals having a scan markedly increased over time, from 59.2% of patients in 2000 to 93.2% in 2013, while NSCLC-specific 5-year mortality exhibited a downward trend over the same period, from 89.9% to 82.4%.
The researchers identified a significant association between receipt of PET–CT in the 12 months before diagnosis and stage-appropriate treatment. Among those with stage 1 disease, for example, surgical resection was performed in 61.5% of those who received PET–CT versus 50.9% of those without imaging.
Similarly, PET–CT use prior to diagnosis was associated with a significant 22% reduction in the risk for NSCLC-specific mortality and an identical reduction also in the all-cause mortality risk, but no such relationship was observed for postdiagnosis PET–CT.
And a subgroup analysis of veterans undergoing stage-appropriate treatment found a significant 24% decrease in all-cause mortality among those who did versus did not receive prediagnosis PET–CT.
“This suggests an association between accurate staging by PET-CT and decreased mortality by way of appropriate therapy,” say Hope and colleagues.
The researchers note that the observational design of their study limits its ability to determine causality, while the “overwhelmingly” White male population limits its generalizability. But despite this, the high prevalence of lung cancer in the Veteran Affairs population makes the results both “important and clinically relevant,” they say.
The team concludes: “Further studies are warranted in other populations to determine if our findings are more broadly applicable.”
By Catherine Booth
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