Impact of positron emission tomography/computed tomography and positron emission tomography (PET) alone on expected management of patients with cancer: Initial results from the national oncologic PET registry
Impact of positron emission tomography/computed tomography and positron emission tomography (PET) alone on expected management of patients with cancer: Initial results from the national oncologic PET registry
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DOI：
10.1200/jco.2007.14.5631
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发表时间：
2008-05-01
影响因子：
45.3
通讯作者：
Coleman, R. Edward
中科院分区：
文献类型：
--
作者：
Hillner, Bruce E.;Siegel, Barry A.;Coleman, R. Edward
目的根据 Medicare 的证据开发政策承保范围，如果收集了前瞻性登记数据，正电子发射断层扫描 (PET)/计算机断层扫描 (CT) 和 PET 将成为以前未承保的癌症适应症的承保服务。国家肿瘤 PET 登记处 (NOPR) 的开发是为了满足这些覆盖范围要求并评估 PET 如何影响护理决策。方法 NOPR 从转诊医生处收集了有关 PET 前后预期患者管理的问卷数据。一年后，该队列包含来自 1,178 个中心的 22,975 项研究（83.7% PET/CT）的数据。用于诊断疑似癌症（或未知原发性癌症）、初始癌症分期、重新分期和疑似癌症复发的扫描数量大致相等。前列腺癌、胰腺癌和卵巢癌约占病例的 30%。结果如果没有 PET 数据，最常见的 PET 前计划将是其他成像。在这些患者中，37% 的 PET 后策略改为观察，48% 改为治疗。在 PET 之前计划进行活检的患者中，大约 70% 的患者避免了活检。如果 PET 前策略是治疗，则 PET 后策略涉及类型的重大改变（8.7%）和目标（5.6%）。当预期管理分为治疗或不治疗时，PET 后计划进行治疗的可能性是不治疗的三倍（28.3% vs 8.2%；比值比 = 3.4；95% CI，3.2 至 3.6）。总体而言，在 PET 后，医生在 36.5%（95% CI，35.9 至 37.2）的病例中改变了他们的预期治疗方案。结论 这个大型、前瞻性、具有全国代表性的老年癌症患者登记发现，医生经常根据 PET 扫描结果在其所有潜在用途中改变他们的预期治疗方案。
PurposeUnder Medicare's Coverage with Evidence Development policy, positron emission tomography (PET)/computed tomography (CT) and PET became covered services for previously noncovered cancer indications if prospective registry data were collected. The National Oncologic PET Registry (NOPR) was developed to meet these coverage requirements and to assess how PET affects care decisions.MethodsThe NOPR collected questionnaire data from referring physicians on intended patient management before and after PET. After 1 year, the cohort included data from 22,975 studies (83.7% PET/CT) from 1,178 centers. The numbers of scans performed for diagnosis of suspected cancer ( or unknown primary cancer), initial cancer staging, restaging, and suspected cancer recurrence were approximately equal. Prostatic, pancreatic and ovarian cancers represented approximately 30% of cases.ResultsIf PET data were not available, the most common pre-PET plan would have been other imaging. In these patients, the post-PET strategies changed to watching in 37% and treatment in 48%. In patients with planned biopsy before PET, biopsy was avoided in approximately 70%. If the pre-PET strategy was treatment, the post-PET strategy involved a major change in type in 8.7% and goal in 5.6%. When intended management was classified as either treatment or nontreatment, the post-PET plan was three-fold more likely to lead to treatment than nontreatment (28.3% v 8.2%; odds ratio = 3.4; 95% CI, 3.2 to 3.6). Overall, physicians changed their intended management in 36.5% ( 95% CI, 35.9 to 37.2) of cases after PET.ConclusionThis large, prospective, nationally representative registry of elderly cancer patients found that physicians often change their intended management on the basis of PET scan results across the full spectrum of its potential uses.