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Gertsen EC, Brenkman HJF, van Hillegersberg R, et al. 18F-Fludeoxyglucose-Positron Emission Tomography/Computed Tomography and Laparoscopy for Staging of Locally Advanced Gastric Cancer: A Multicenter Prospective Dutch Cohort Study (PLASTIC). JAMA Surg. 2021;156(12):e215340doi: 10.1001/jamasurg.2021.5340.
Gertsen, E. C., Brenkman, H. J. F., van Hillegersberg, R., van Sandick, J. W., van Berge Henegouwen, M. I., Gisbertz, S. S., Luyer, M. D. P., Nieuwenhuijzen, G. A. P., van Lanschot, J. J. B., Lagarde, S. M., Wijnhoven, B. P. L., de Steur, W. O., Hartgrink, H. H., Stoot, J. H. M. B., Hulsewe, K. W. E., Spillenaar Bilgen, E. J., van Det, M. J., Kouwenhoven, E. A., van der Peet, D. L., Daams, F., van Grieken, N. C. T., Heisterkamp, J., van Etten, B., van den Berg, J. W., Pierie, J. P., Eker, H. H., Thijssen, A. Y., Belt, E. J. T., van Duijvendijk, P., Wassenaar, E., van Laarhoven, H. W. M., Wevers, K. P., Hol, L., Wessels, F. J., Haj Mohammad, N., van der Meulen, M. P., Frederix, G. W. J., Vegt, E., Siersema, P. D., Ruurda, J. P. (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, 156(12), e215340. https://doi.org/10.1001/jamasurg.2021.5340
Gertsen, Emma C, et al. "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. 156,12 (2021): e215340. doi: https://doi.org/10.1001/jamasurg.2021.5340
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. 18F-Fludeoxyglucose-Positron Emission Tomography/Computed Tomography and Laparoscopy for Staging of Locally Advanced Gastric Cancer: A Multicenter Prospective Dutch Cohort Study (PLASTIC). JAMA Surg. 2021 Dec 01;156(12):e215340. doi: 10.1001/jamasurg.2021.5340. Epub 2021 Dec 08. PMID: 34705049; PMCID: PMC8552113.
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JAMA Surg. 2021 Dec 01;156(12):e215340. doi: 10.1001/jamasurg.2021.5340. Epub 2021 Dec 08.

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

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

Affiliations

  1. Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
  2. Department of Surgery, the Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
  3. Department of Surgery, Amsterdam University Medical Center, location AMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands.
  4. Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands.
  5. Department of Surgery, Erasmus MC University Medical Center Rotterdam, the Netherlands.
  6. Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
  7. Department of Surgery, Zuyderland MC, Sittard-Geleen, the Netherlands.
  8. Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands.
  9. Department of Surgery, ZGT hospital, Almelo, the Netherlands.
  10. Department of Surgery, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, Amsterdam, the Netherlands.
  11. Department of Pathology, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, Amsterdam, the Netherlands.
  12. Department of Surgery, Elisabeth Twee-Steden Hospital, Tilburg, the Netherlands.
  13. Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
  14. Department of Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands.
  15. Department of Gastroenterology, Albert Schweitzer Hospital, Dordrecht, the Netherlands.
  16. Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands.
  17. Department of Surgery, Gelre Ziekenhuizen, Apeldoorn, the Netherlands.
  18. Prospective Observational Cohort Study of Oesophageal-Gastric Cancer Patients (POCOP) of the Dutch Upper GI Cancer Group, Amsterdam, the Netherlands.
  19. Department of Medical Oncology, Amsterdam University Medical Center, location AMC, Cancer Center Amsterdam, Amsterdam, the Netherlands.
  20. Department of Surgery, Isala Ziekenhuis, Zwolle, the Netherlands.
  21. Department of Gastroenterology, Maasstad Ziekenhuis, Rotterdam, the Netherlands.
  22. Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
  23. Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
  24. Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, the Netherlands.
  25. Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.
  26. Department of Gastroenterology, Radboud University Medical Center, Nijmegen, the Netherlands.

PMID: 34705049 PMCID: PMC8552113 DOI: 10.1001/jamasurg.2021.5340

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.

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