Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
Center for Statistical Sciences, Brown University, Providence, Rhode Island.
J Nucl Med. 2018 Mar;59(3):427-433. doi: 10.2967/jnumed.117.205120. Epub 2017 Dec 28.
We have previously reported that PET using F-fluoride (NaF PET) for assessment of osseous metastatic disease was associated with substantial changes in intended management in Medicare beneficiaries participating in the National Oncologic PET Registry (NOPR). Here, we use Medicare administrative data to examine the association between NaF PET results and hospice claims within 180 d and 1-y survival. We classified NOPR NaF PET results linked to Medicare claims by imaging indication (initial staging [IS]; detection of suspected first osseous metastasis [FOM]; suspected progression of osseous metastasis [POM]; or treatment monitoring [TM]) and type of cancer (prostate, lung, breast, or other). Results were classified as definitely positive scan findings versus probably positive scan findings versus negative scan findings for osseous metastasis for IS and FOM; more extensive disease versus no change or less extensive disease for POM; and worse prognosis versus no change or better prognosis for TM, based on the postscan assessment. Our study included 21,167 scans obtained from 2011 to 2014 of consenting NOPR participants aged 65 y or older. The relative risk of hospice claims within 180 d of a NaF PET scan was 2.0-7.5 times higher for patients with evidence of new or progressing osseous metastasis than for those without, depending on indication and cancer type (all < 0.008). The percentage difference in hospice claims for those with a finding of new or more advanced osseous disease ranged from 3.9% for IS prostate patients to 28% for FOM lung patients. Six-month survival was also associated with evidence of new or increased osseous disease; risk of death was 1.8-5.1 times as likely (all ≤ 0.0001), with percentage differences of approximately 30% comparing positive and negative scans in patients with lung cancer imaged for IS or FOM. Our analyses demonstrated that NaF PET scan results are highly associated with subsequent hospice claims and, ultimately, with patient survival. NaF PET provides important information on the presence of osseous metastasis and prognosis to assist patients and their physicians when making decisions on whether to select palliative care and transition to hospice or whether to continue treatment.
我们之前报道过，使用 F-氟化物（NaF PET）评估骨转移疾病的 PET 检查与参与国家肿瘤 PET 注册中心（NOPR）的医疗保险受益人的管理方式发生了重大变化。在这里，我们使用医疗保险管理数据来检查 NaF PET 检查结果与 180 天内和 1 年内的临终关怀索赔之间的关联。我们根据成像指征（初始分期 [IS]；疑似首次骨转移的检测 [FOM]；疑似骨转移进展 [POM]；或治疗监测 [TM]）和癌症类型（前列腺、肺、乳腺或其他）将 NOPR NaF PET 结果与医疗保险索赔相关联。对于 IS 和 FOM，骨转移的肯定阳性扫描结果、可能阳性扫描结果和阴性扫描结果进行分类；对于 POM，更广泛的疾病与无变化或更不广泛的疾病进行分类；对于 TM，基于扫描后评估，预后更差与无变化或预后更好进行分类。我们的研究包括 2011 年至 2014 年期间，21167 名同意参与 NOPR 的 65 岁或以上患者的扫描。与没有新的或进展性骨转移证据的患者相比，新的或进展性骨转移证据的患者在 NaF PET 扫描后 180 天内获得临终关怀的相对风险高 2.0-7.5 倍，具体取决于适应症和癌症类型（均 <0.008）。对于有新的或更严重的骨疾病发现的患者，临终关怀的百分比差异范围从 IS 前列腺患者的 3.9%到 FOM 肺患者的 28%。6 个月的生存率也与新的或增加的骨疾病证据相关；死亡风险高 1.8-5.1 倍（均≤0.0001），与肺癌患者的 IS 或 FOM 成像中阳性和阴性扫描相比，差异约为 30%。我们的分析表明，NaF PET 扫描结果与随后的临终关怀索赔密切相关，最终与患者的生存相关。NaF PET 提供了有关骨转移和预后的重要信息，以帮助患者及其医生在决定是否选择姑息治疗和过渡到临终关怀或是否继续治疗时做出决策。
