Acceptance and disparities of PET/CT use in patients with esophageal or gastro-esophageal junction cancer: Evaluation of mature registry data.

Vaibhav Gupta, Roshini Kulanthaivelu, Ur Metser, Claudia Ortega, Gail Darling, Natalie Coburn, Patrick Veit-Haibach
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Abstract

Background/rationale: PET/CT plays a crucial role in esophageal (EC) and gastroesophageal junction cancer (GEJ) diagnosis and management. Despite endorsement in clinical guidelines, variation in acceptance of PET/CT exists. The aim of this study was to assess the early use of PET/CT among EC and GEJ patients in a regionalized setting and identify factors contributing to disparity in access.

Materials and methods: Retrospective cohort study of adults with EC or GEJ between 2012 and 2014 from the Population Registry of Esophageal and Stomach Tumours of Ontario and Ontario Health (Cancer Care Ontario). Receipt of PET/CT and relevant demographics were collected, and statistical analysis performed. Continuous data were analysed with t-tests and Wilcoxon rank sum test. Categorical data were analysed with chi-square test. Kaplan-Meier methods were used to estimate median survival.

Results: Fifty-five percent of patients diagnosed with EC or GEJ between 2012 and 2014 received PET/CT (1321/2390). Eighty-four percent of patients underwent surgical resection (729/870), and 80% receiving radical treatment (496/622) underwent PET/CT. The use of PET/CT increased from 2012 to 2014. Male patients received more PET/CT than females (85% vs.78% p < 0.001).Median survival for the overall cohort was 11.1 months, 17.2 vs. 5.2 months among those who did and did not receive PET/CT and 35 vs. 27 months among the surgical cohort (p = 0.16).

Conclusions: We found that PET/CT use increased from 2012 to 2014 and that the majority of EC/GEJ patients being considered for curative therapy received PET/CT. There were also gender disparities identified. PET/CT appears to confer a potential survival benefit in our study, although our assessment is limited. Our findings may serve as learned lessons for other new imaging modalities, new indications for PET/CT or even for the introduction of new radiopharmaceuticals for PET/CT.

食管癌或胃食管结癌患者PET/CT应用的接受度和差异:成熟登记数据的评估
背景/基本原理PET/CT在癌症食管(EC)和胃食管交界处(GEJ)的诊断和管理中起着至关重要的作用。尽管临床指南中有认可,但PET/CT的接受度仍存在差异。本研究的目的是评估在区域化环境中EC和GEJ患者早期使用PET/CT的情况,并确定导致获取差异的因素。材料和方法2012年至2014年间,安大略省和安大略省卫生部(癌症护理安大略省)食管和胃肿瘤人口登记处对患有EC或GEJ的成年人进行的回顾性队列研究。收集PET/CT和相关人口统计数据,并进行统计分析。连续数据采用t检验和Wilcoxon秩和检验进行分析。分类数据采用卡方检验进行分析。Kaplan–Meier方法用于估计中位生存率。结果2012年至2014年间,55%的EC或GEJ患者接受了PET/CT检查(1321/2390)。84%的患者接受了外科切除术(729/870),80%接受根治性治疗的患者(496/622)接受了PET/CT。从2012年到2014年,PET/CT的使用有所增加。男性患者接受的PET/CT比女性多(85%对78%) < 0.001)。整个队列的中位生存期为11.1个月,接受和未接受PET/CT的患者的中位存活期分别为17.2个月和5.2个月,手术队列中位存活率分别为35个月和27个月(p = 0.16)。结论我们发现,从2012年到2014年,PET/CT的使用有所增加,大多数被考虑进行治疗的EC/GEJ患者都接受了PET/CT。还发现了性别差异。在我们的研究中,PET/CT似乎具有潜在的生存益处,尽管我们的评估有限。我们的发现可以为其他新的成像模式、PET/CT的新适应症,甚至为PET/CT引入新的放射性药物提供经验教训。
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