Effect of PET‐CT on disease recurrence and management in patients with potentially resectable colorectal cancer liver metastases. Long‐term results of a randomized controlled trial
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AbstractBackgroundPreoperative evaluation of resectable colorectal cancer liver metastases with positron emission tomography (PET) combined with computed tomography (PET‐CT) is used extensively. The PETCAM trial evaluated the effect of PET‐CT (intervention) vs no PET‐CT (control) on surgical management. PET‐CT resulted in 8% change in surgical management, therefore, we aimed to compare long‐term outcomes (disease‐free [DFS], overall survival [OS]).MethodsTrial recruitment (2005‐2010) had prospective follow‐up until 2013. Events from 2013 to 2017 were collected retrospectively. Survival was described by the Kaplan‐Meier method and compared with log‐rank test. Oncologic risk factors were calculated using Cox proportional hazard models.ResultsAmong 404 patients randomized, there were no differences in DFS (hazard ratio [HR] = 1.13; 95% confidence interval [CI], 0.89 to 1.43) or OS (HR, 1.02; 95% CI, 0.78‐1.32) between groups. For all patients randomized, median DFS (PET‐CT vs no PET‐CT) was 16 months (95% CI, 13‐18) and 15 months (95% CI, 11‐22), P = .33. For patients who underwent liver resection (n = 368), DFS (17 vs 16 months, P = .51) and OS (58 months vs 52 months, P = .90) were similar between groups, respectively. Risk factors for DFS and OS were age, tumor size, node‐positive disease, extrahepatic metastases and disease‐free duration.ConclusionPreoperative PET‐CT changes surgical management in a small percentage of cases, without effect on recurrence rates or long‐term survival.
