2-[18F]FDG-PET/CT in Cancer of Unknown Primary Tumor—A Retrospective Register-Based Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Imaging
2.3. Data
2.4. Endpoints
2.5. Definitions
2.6. Statistical Analysis
3. Results
3.1. Propensity Score
3.2. Detection Rate
3.3. Survival
4. Discussion
4.1. Main Findings
4.2. Strengths and Limitations of the Study
4.3. Significance and Other Studies
4.4. Perspectives
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable | Subgroup | CT (N = 34) | 2-[18F]FDG-PET/CT (N = 159) | p-Value |
---|---|---|---|---|
Sex | Male | 21 (61.8%) | 80 (50.3%) | 0.23 # |
Female | 13 (38.2%) | 79 (49.7%) | ||
Median age (min–max) | 70.5 (32–95) | 68 (29–91) | 0.51 $ | |
ECOG Performance status | 0 | 3 (8.8%) | 35 (22.0%) | 0.12 ^ |
1 | 5 (14.7%) | 27 (17.0%) | ||
2 | 2 (5.9%) | 17 (10.7%) | ||
3 | 7 (20.6%) | 13 (8.2%) | ||
4 | 2 (5.9%) | 4 (2.5%) | ||
Not available | 15 (44.1%) | 63 (39.6%) | ||
Median (min–max) number of comorbidities | 2 (0–7) | 1 (0–7) | 0.17 + | |
Number of previous cancer diagnoses | 0 | 27 (79.4%) | 118 (74.2%) | 0.046 ^ |
1 | 4 (11.8%) | 38 (23.9%) | ||
2 or >2 | 3 (8.8%) | 3 (1.9%) |
Variable | Subgroup | CT (N = 34) | 2-[18F]FDG-PET/CT (N = 159) | p-Value |
---|---|---|---|---|
Number of cancer patient pathways | 0 | 1 (2.9%) | 1 (0.6%) | 0.001 ^ |
1 | 29 (85.3%) | 87 (54.7%) | ||
2 | 4 (11.8%) | 60 (37.7%) | ||
3 | 0 (0%) | 11 (6.9%) | ||
Median (min-max) number of organs with metastases | 2 (1–5) | 2 (0–10) a | 0.57 + | |
Median (min-max) number of radiological procedures | 2 (1–13) | 4 (1–22) | 0.004 + | |
Median (min-max) time from first hospital visit to visit at cancer patient pathway (days) b | 2 (0–70) | 3.5 (0–130) | 0.26 $ | |
Median (min-max) time to scan (days) | 0 (0–51) | 12 (0–230) | 0.001 $ | |
Median (min-max) time to final diagnosis (days) (excluding patients without definitive diagnosis) CT (N = 19) 2-[18F]FDG-PET/CT (N = 107) | 21 (7–250) | 33 (5–484) | 0.37 $ | |
Basis for final diagnosis (excluding patients marked ‘indefinite’) CT (N = 29) 2-[18F]FDG-PET/CT (N = 152) | Clinical decision | 22 (75.9%) | 123 (80.9%) | 0.67 ^ |
Biopsy of the primary tumor | 7 (24.1%) | 26 (17.1%) | ||
Autopsy | 0 (0%) | 3 (2.0%) |
Treatment Variable | CT (N = 33) a | 2-[18F]FDG-PET/CT (N = 158) a | p-Value |
---|---|---|---|
Number of patients who received treatment | 17 (51.5%) | 109 (69.0%) | 0.054 |
Treatment purpose b,c | Curative: 3 (17.6%) Palliative: 14 (82.4%) | Curative: 35 (32.1%) Palliative: 73 (67.0%) | 0.22 |
Chemotherapy b | 13 (76.5%) | 75 (68.8%) | 0.52 |
Radiation therapy b | 3 (17.6%) | 61 (56.0%) | 0.003 |
Curative: 0 Palliative: 3 (100%) | Curative: 18 (29.5%) Palliative: 43 (70.5%) | 0.27 | |
Immune therapy b | 0 | 13 (11.9%) | 0.13 |
Surgical treatment b | 1 (5.9%) | 13 (11.9%) | 0.46 |
Other treatments b | 4 (23.5%) | 15 (13.8%) | 0.30 |
Groups | CT | 2-[18F]FDG-PET/CT | Difference | p-Value | |||
---|---|---|---|---|---|---|---|
DR | 95% CI | DR | 95% CI | DR | 95% CI | ||
Patients with either a CT (N = 34) or a 2-[18F]FDG-PET/CT (N = 159) available | 17.6% | 8.3–33.5% ¤ | 36.5% | 29.4–44.2% ¤ | 18.8% | 1.5–30.9% § | 0.012 # |
Patients with both a CT and a 2-[18F]FDG-PET/CT available (N = 107) | 14.0% | 8.7–21.8% ¤ | 32.7% | 24.6–42.1% ¤ | 18.7% | 7.4–29.5% § | <0.001 # |
Group | CT | 2-[18F]FDG-PET/CT | Total |
---|---|---|---|
Number of patients | 34 | 159 | 193 |
| 19 (55.9%) | 107 (67.3%) | 126 (65.3%) |
| 15 (44.1%) | 52 (32.7%) | 67 (34.7%) |
Total follow-up time (years) | 38.5 | 282.1 | 320.6 |
| 28.8 | 223.3 | 252.1 |
| 9.7 | 58.8 | 68.5 |
Median (min-max) survival (months) | 3.8 (0.2–98.1) | 7.4 (0.4–98.7) | 6.2 (0.2–98.7) |
| 5.1 (0.6–98.1) | 11.4 (0.4–98.7) | 9.8 (0.4–98.7) |
| 2.8 (0.2–59.3) | 4.0 (0.4–96.4) | 3.8 (0.2–96.4) |
Variable | Crude Univariable Model | Multivariable Model 1: Adjusted for Propensity Score | Multivariable Model 2: Adjusted for Age, Sex, Treatment and Propensity Score | ||||||
---|---|---|---|---|---|---|---|---|---|
HR | 95% CI | p-Value | HR | 95% CI | p-Value | HR | 95% CI | p-Value | |
PET/CT | 0.63 | 0.42–0.94 | 0.024 | 0.82 | 0.54–1.26 | 0.37 | 0.68 | 0.44–1.06 | 0.087 |
Age | 1.01 | 1.00–1.03 | 0.079 | ||||||
Sex (male) | 1.24 | 0.89–1.72 | 0.20 | ||||||
Treatment (yes) | 0.33 | 0.23–0.48 | <0.001 | ||||||
Treatment (unknown) | 0.11 | 0.01–0.78 | 0.028 | ||||||
Propensity score | 0.11 | 0.04–0.38 | <0.001 | 0.36 | 0.10–1.38 | 0.14 |
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Rimer, H.; Jensen, M.S.; Dahlsgaard-Wallenius, S.E.; Eckhoff, L.; Thye-Rønn, P.; Kristiansen, C.; Hildebrandt, M.G.; Gerke, O. 2-[18F]FDG-PET/CT in Cancer of Unknown Primary Tumor—A Retrospective Register-Based Cohort Study. J. Imaging 2023, 9, 178. https://doi.org/10.3390/jimaging9090178
Rimer H, Jensen MS, Dahlsgaard-Wallenius SE, Eckhoff L, Thye-Rønn P, Kristiansen C, Hildebrandt MG, Gerke O. 2-[18F]FDG-PET/CT in Cancer of Unknown Primary Tumor—A Retrospective Register-Based Cohort Study. Journal of Imaging. 2023; 9(9):178. https://doi.org/10.3390/jimaging9090178
Chicago/Turabian StyleRimer, Heidi, Melina Sofie Jensen, Sara Elisabeth Dahlsgaard-Wallenius, Lise Eckhoff, Peter Thye-Rønn, Charlotte Kristiansen, Malene Grubbe Hildebrandt, and Oke Gerke. 2023. "2-[18F]FDG-PET/CT in Cancer of Unknown Primary Tumor—A Retrospective Register-Based Cohort Study" Journal of Imaging 9, no. 9: 178. https://doi.org/10.3390/jimaging9090178