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

被引：54

作者：

Gertsen, Emma C. ^{[1
]}

Brenkman, Hylke J. F. ^{[1
]}

van Hillegersberg, Richard ^{[1
]}

van Sandick, Johanna W. ^{[2
]}

Henegouwen, Mark I. van Berge ^{[3
]}

Gisbertz, Suzanne S. ^{[3
]}

Luyer, Misha D. P. ^{[4
]}

Nieuwenhuijzen, Grard A. P. ^{[4
]}

van Lanschot, Jan J. B. ^{[5
]}

Lagarde, Sjoerd M. ^{[5
]}

Wijnhoven, Bas P. L. ^{[5
]}

de Steur, Wobbe O. ^{[6
]}

Hartgrink, Henk H. ^{[6
]}

Stoot, Jan H. M. B. ^{[7
]}

Hulsewe, Karel W. E. ^{[7
]}

Bilgen, Ernst J. Spillenaar ^{[8
]}

van Det, Marc J. ^{[9
]}

Kouwenhoven, Ewout A. ^{[9
]}

van der Peet, Donald L. ^{[10
]}

Daams, Freek ^{[10
]}

van Grieken, Nicole C. T. ^{[11
]}

Heisterkamp, Joos ^{[12
]}

van Etten, Boudewijn ^{[13
]}

van den Berg, Jan Willem ^{[13
]}

Pierie, Jean Pierre ^{[14
]}

Eker, Hasan H. ^{[14
]}

Thijssen, Annemieke Y. ^{[15
]}

Belt, Eric J. T. ^{[16
]}

van Duijvendijk, Peter ^{[17
]}

Wassenaar, Eelco ^{[17
]}

van Laarhoven, Hanneke W. M. ^{[18
]}

Wevers, Kevin P. ^{[19
]}

Hol, Lieke ^{[20
]}

Wessels, Frank J. ^{[21
]}

Mohammad, Nadia Haj ^{[22
]}

van der Meulen, Miriam P. ^{[23
]}

Frederix, Geert W. J. ^{[23
]}

Vegt, Erik ^{[24
]}

Siersema, Peter D. ^{[25
]}

Ruurda, Jelle P. ^{[1
]}

机构：

[1] Univ Utrecht, Univ Med Ctr Utrecht, Dept Surg, Utrecht, Netherlands

[2] Netherlands Canc Inst Antoni Van Leeuwenhoek, Dept Surg, Amsterdam, Netherlands

[3] Univ Amsterdam, Canc Ctr Amsterdam, Amsterdam Univ Med Ctr, Dept Surg,Locat AMC, Amsterdam, Netherlands

[4] Catharina Hosp, Dept Surg, Eindhoven, Netherlands

[5] Erasmus MC Univ Med Ctr Rotterdam, Dept Surg, Rotterdam, Netherlands

[6] Leiden Univ Med Ctr, Dept Surg, Leiden, Netherlands

[7] Zuyderland MC, Dept Surg, Sittard Geleen, Netherlands

[8] Rijnstate Hosp, Dept Surg, Arnhem, Netherlands

[9] ZGT Hosp, Dept Surg, Almelo, Netherlands

[10] Amsterdam Univ Med Ctr, Canc Ctr Amsterdam Amsterdam, Dept Surg, Locat VUmc, Amsterdam, Netherlands

[11] Amsterdam Univ Med Ctr, Dept Pathol, Locat VUmc, Canc Ctr Amsterdam, Amsterdam, Netherlands

[12] Elisabeth Twee Steden Hosp, Dept Surg, Tilburg, Netherlands

[13] Univ Groningen, Univ Med Ctr Groningen, Dept Surg, Groningen, Netherlands

[14] Med Ctr Leeuwarden, Dept Surg, Leeuwarden, Netherlands

[15] Albert Schweitzer Hosp, Dept Gastroenterol, Dordrecht, Netherlands

[16] Albert Schweitzer Hosp, Dept Surg, Dordrecht, Netherlands

[17] Gelre Ziekenhuizen, Dept Surg, Apeldoorn, Netherlands

[18] Dutch Upper GI Canc Grp, Prospect Observat Cohort Study Oesophageal Gastr, Amsterdam, Netherlands

[19] Isala Ziekenhuis, Dept Surg, Zwolle, Netherlands

[20] Maasstad Ziekenhuis, Dept Gastroenterol, Rotterdam, Netherlands

[21] Univ Utrecht, Univ Med Ctr Utrecht, Dept Radiol, Utrecht, Netherlands

[22] Univ Utrecht, Univ Med Ctr Utrecht, Dept Med Oncol, Utrecht, Netherlands

[23] Univ Utrecht, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands

[24] Erasmus MC Univ Med Ctr Rotterdam, Dept Radiol & Nucl Med, Rotterdam, Netherlands

[25] Radboud Univ Nijmegen Med Ctr, Dept Gastroenterol, Nijmegen, Netherlands

来源：

JAMA SURGERY | 2021年 / 156卷 / 12期

关键词：

PERITONEAL-LAVAGE CYTOLOGY; F-18-FDG PET; FDG-PET; ADENOCARCINOMA; CHEMOTHERAPY; METASTASIS; SURGERY; TUMOR; NODE;

D O I：

10.1001/jamasurg.2021.5340

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

IMPORTANCE The optimal staging for gastric cancer remains a matter of debate. OBJECTIVE To evaluate the value of F-18-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 outcomewas 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.

引用

页码：E1 / E9

页数：9

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