Positron emission tomography and stage migration in head and neck cancer

Noam Vanderwalde, Ramzi G. Salloum, Tsai Ling Liu, Mark C. Hornbrook, Maureen C. O'Keeffe Rosetti, Debra P. Ritzwoller, Paul A. Fishman, Jennifer Elston Lafata, Amir H. Khandani, Bhishamjit S. Chera

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

IMPORTANCE: Since 2001, there has been a rapid adoption of positron emission tomography (PET) for diagnosis and American Joint Committee on Cancer (AJCC) staging of head and neck cancer (HNC) without data describing improved clinical outcomes. OBJECTIVE: To determine the association between increased use of PET and stage and/or survival for patients with HNC in the managed care environment. DESIGN, SETTING, AND PARTICIPANTS: Adult patients diagnosed as having HNC (n = 958) from 2000 to 2008 at 4 integrated health systems were identified via tumor registries linked to administrative data. The AJCC stage distribution, patient and treatment characteristics, and survival between pre-PET era (2000-2004) vs PET era (2005-2008) and use of PET vs no use of PET during the PET era were compared. The AJCC stages were categorized to represent localized (stage I or II), locally advanced (stage III, IVA, or IVB), and metastatic (stage IVC) disease. INTERVENTIONS: Treatments were determined by billing codes for surgery, radiation treatment, and chemotherapy. MAIN OUTCOMES AND MEASURES: The primary outcome for this studywas the use of PET. Secondary outcomes included treatment received and 2-year survival. A logit model estimated the effects of PET on diagnosis of locally advanced disease. Kaplan-Meier estimates described overall survival differences between PET and non-PET. Cox regression evaluated the association of PET on survival in patients with locally advanced disease. RESULTS: An association between PET and locally advanced disease was found (odds ratio, 2.86 [95% CI, 1.90-4.29) (P < .001). Two-year overall survival for patients with locally advanced disease with and without PET was 52% and 32%, respectively (P = .004), but there was no difference for all stages (P = .69). On Cox proportional hazard regression, PET had no association with survival in patients with locally advanced disease (hazard ratio, 1.208 [95% CI, 0.778-1.877]) (P = .40). CONCLUSIONS AND RELEVANCE: The increasing use of PET among patients with HNC is associated with a greater number of patients with higher-stage disease and a dilution of the population with higher-stage disease with patients who have a better prognosis. Thus, the improved survival in patients with locally advanced disease likely reflects selection bias and stage migration. Further research on PET use among patients with HNC is necessary to determine if it results in improved treatment for individual patients.

Original languageEnglish (US)
Pages (from-to)654-661
Number of pages8
JournalJAMA Otolaryngology - Head and Neck Surgery
Volume140
Issue number7
DOIs
StatePublished - Jan 1 2014

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Head and Neck Neoplasms
Positron-Emission Tomography
Survival
Neoplasms
Selection Bias
Neoplasm Staging
Kaplan-Meier Estimate
Managed Care Programs
Therapeutics
Registries

All Science Journal Classification (ASJC) codes

  • Surgery
  • Otorhinolaryngology

Cite this

Vanderwalde, N., Salloum, R. G., Liu, T. L., Hornbrook, M. C., O'Keeffe Rosetti, M. C., Ritzwoller, D. P., ... Chera, B. S. (2014). Positron emission tomography and stage migration in head and neck cancer. JAMA Otolaryngology - Head and Neck Surgery, 140(7), 654-661. https://doi.org/10.1001/jamaoto.2014.812

Positron emission tomography and stage migration in head and neck cancer. / Vanderwalde, Noam; Salloum, Ramzi G.; Liu, Tsai Ling; Hornbrook, Mark C.; O'Keeffe Rosetti, Maureen C.; Ritzwoller, Debra P.; Fishman, Paul A.; Elston Lafata, Jennifer; Khandani, Amir H.; Chera, Bhishamjit S.

In: JAMA Otolaryngology - Head and Neck Surgery, Vol. 140, No. 7, 01.01.2014, p. 654-661.

Research output: Contribution to journalArticle

Vanderwalde, N, Salloum, RG, Liu, TL, Hornbrook, MC, O'Keeffe Rosetti, MC, Ritzwoller, DP, Fishman, PA, Elston Lafata, J, Khandani, AH & Chera, BS 2014, 'Positron emission tomography and stage migration in head and neck cancer', JAMA Otolaryngology - Head and Neck Surgery, vol. 140, no. 7, pp. 654-661. https://doi.org/10.1001/jamaoto.2014.812
Vanderwalde, Noam ; Salloum, Ramzi G. ; Liu, Tsai Ling ; Hornbrook, Mark C. ; O'Keeffe Rosetti, Maureen C. ; Ritzwoller, Debra P. ; Fishman, Paul A. ; Elston Lafata, Jennifer ; Khandani, Amir H. ; Chera, Bhishamjit S. / Positron emission tomography and stage migration in head and neck cancer. In: JAMA Otolaryngology - Head and Neck Surgery. 2014 ; Vol. 140, No. 7. pp. 654-661.
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AU - O'Keeffe Rosetti, Maureen C.

AU - Ritzwoller, Debra P.

AU - Fishman, Paul A.

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N2 - IMPORTANCE: Since 2001, there has been a rapid adoption of positron emission tomography (PET) for diagnosis and American Joint Committee on Cancer (AJCC) staging of head and neck cancer (HNC) without data describing improved clinical outcomes. OBJECTIVE: To determine the association between increased use of PET and stage and/or survival for patients with HNC in the managed care environment. DESIGN, SETTING, AND PARTICIPANTS: Adult patients diagnosed as having HNC (n = 958) from 2000 to 2008 at 4 integrated health systems were identified via tumor registries linked to administrative data. The AJCC stage distribution, patient and treatment characteristics, and survival between pre-PET era (2000-2004) vs PET era (2005-2008) and use of PET vs no use of PET during the PET era were compared. The AJCC stages were categorized to represent localized (stage I or II), locally advanced (stage III, IVA, or IVB), and metastatic (stage IVC) disease. INTERVENTIONS: Treatments were determined by billing codes for surgery, radiation treatment, and chemotherapy. MAIN OUTCOMES AND MEASURES: The primary outcome for this studywas the use of PET. Secondary outcomes included treatment received and 2-year survival. A logit model estimated the effects of PET on diagnosis of locally advanced disease. Kaplan-Meier estimates described overall survival differences between PET and non-PET. Cox regression evaluated the association of PET on survival in patients with locally advanced disease. RESULTS: An association between PET and locally advanced disease was found (odds ratio, 2.86 [95% CI, 1.90-4.29) (P < .001). Two-year overall survival for patients with locally advanced disease with and without PET was 52% and 32%, respectively (P = .004), but there was no difference for all stages (P = .69). On Cox proportional hazard regression, PET had no association with survival in patients with locally advanced disease (hazard ratio, 1.208 [95% CI, 0.778-1.877]) (P = .40). CONCLUSIONS AND RELEVANCE: The increasing use of PET among patients with HNC is associated with a greater number of patients with higher-stage disease and a dilution of the population with higher-stage disease with patients who have a better prognosis. Thus, the improved survival in patients with locally advanced disease likely reflects selection bias and stage migration. Further research on PET use among patients with HNC is necessary to determine if it results in improved treatment for individual patients.

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