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Lung Cancer Survivors Receive Too Many PET Scans

By MedImaging International staff writers
Posted on 08 Mar 2016

Lung and esophageal cancer survivors undergo excessive positron emission tomography (PET) scans during follow-up care with no impact on survival, claims a new study.

Researchers at the University of Michigan (U-M; Ann Arbor, USA), and Dartmouth-Hitchcock Medical Center (Lebanon, NH, USA) searched the US Surveillance, Epidemiology, and End Results (SEER) register to identify 97,152 primary lung and 4,446 esophageal cancer patients with follow-up data, using patient and tumor characteristics to calculate risk-adjusted two-year overall survival. Using Medicare claims, they then examined PET utilization in person-years, excluding scans for staging and for follow-up of CT findings, and stratified hospitals by quintiles of PET utilization for adjusted two-year survival analysis.

The results showed a statistically significant variation in utilization of PET scans, ranging from 0.05 to 0.70 scans per person-year for lung cancer and 0.12 to 0.97 scans per person-year for esophageal cancer. But despite the statistically significant variation in use of PET to detect tumor recurrence, there was no association with improved two-year survival, suggesting possible overuse of PET for recurrence detection, which current Medicare policy would not appear to substantially affect. The study was published on February 22, 2016, in the Journal of the National Cancer Institute.

“PET scanning is a great technology and very effective, but using it in this way doesn't seem to make any difference for these cancers that have a relatively poor prognosis,” said lead author Mark Healy, MD, of U-M. “Following evidence-based guidelines for clinical follow-up is the way to go; don't order PET in asymptomatic patients. And for patients, if you are not having symptoms and you're doing well, there's no reason to seek out this scan.”

PET scans are often used for staging, restaging, and monitoring of cancer patients for treatment response. They are also often used to detect recurrence in asymptomatic patients, despite a lack of evidence demonstrating improved survival. The US Centers for Medicare & Medicaid Services (CMS; Baltimore, MD, USA) impose a limit of three follow-up PET scans per person, even when doctors only order them following a computerized tomography (CT) or other medical imaging procedure.

Related Links:
University of Michigan
Dartmouth-Hitchcock Medical Center
The US Centers for Medicare & Medicaid Services

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66 (!!!!! 4400.0148773193): SELECT fid FROM jos_deeppockets WHERE id=294763123 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294763123 AND published='1' LIMIT 1

67 (!!!!! 3971.0998535156): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=213 ORDER BY `ordering`

68 (84.877014160156): select jos_twitters.link from jos_twitters where cat=10

69 (35.04753112793): select jos_facebook.link from jos_facebook where cat=10

70 (36.001205444336): select jos_google_plus.link from jos_google_plus where cat=10

71 (35.04753112793): select jos_linkedin.link from jos_linkedin where cat=10

72 (185.01281738281): SELECT fid FROM jos_deeppockets WHERE id=294763123 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294763123 AND published='1' LIMIT 1

73 (41.007995605469): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=213 ORDER BY `ordering`

74 (!!!!! 1930.9520721436): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294763123 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

75 (348.80638122559): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294763123 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

76 (52.928924560547): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

77 (58.889389038086): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (!!!!! 4878.044128418): SELECT show_live FROM jos_com_show_setting LIMIT 1

90 (78.201293945312): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (!!!!! 1151.0848999023): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294763123 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

92 (381.9465637207): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294763123 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

93 (50.067901611328): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

94 (447.98851013184): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (122.0703125): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (312.08992004395): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (109.91096496582): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (405.07316589355): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (783.92028808594): SELECT show_live FROM jos_com_show_setting LIMIT 1

107 (55.074691772461): SELECT show_live FROM jos_com_show_setting LIMIT 1

108 (865.93627929688): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294763123 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294763123 AND published='1' LIMIT 1

109 (87.02278137207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294763123 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294763123 AND published='1' LIMIT 1

110 (!!!!! 2176.04637146): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294763123 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (530.95817565918): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294763123 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (!!!!! 1128.9119720459): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294763123 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294763123 AND published='1' LIMIT 1

113 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294763123 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294763123 AND published='1' LIMIT 1

114 (226.02081298828): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294763123 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

115 (937.93869018555): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294763123 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

116 (!!!!! 1300.8117675781): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

117 (602.00691223145): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

118 (255.82313537598): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294763123 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294763123 AND published='1' LIMIT 1

119 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294763123 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294763123 AND published='1' LIMIT 1

120 (591.03965759277): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294763123 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294763123 AND published='1' LIMIT 1

121 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294763123 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294763123 AND published='1' LIMIT 1

122 (167.8466796875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294763123 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294763123 AND published='1' LIMIT 1

123 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294763123 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294763123 AND published='1' LIMIT 1

124 (391.00646972656): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

125 (!!!!! 59355.020523071): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

126 (87.02278137207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294763123 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294763123 AND published='1' LIMIT 1

127 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294763123 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294763123 AND published='1' LIMIT 1

128 (751.97219848633): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294763123 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294763123 AND type='deeppockets_item' AND published='1' LIMIT 1

129 (!!!!! 1613976.0017395): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

130 (126.83868408203): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

131 (793.9338684082): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

132 (213.8614654541): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

133 (!!!!! 1239.0613555908): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

134 (301.12266540527): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

135 (!!!!! 4306.7932128906): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

136 (239.13383483887): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

137 (336.88545227051): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294763123 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (283.95652770996): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294763123 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

139 (114.91775512695): SELECT name FROM jos_deeppockets WHERE id=213

140 (54.836273193359): SELECT name FROM jos_deeppockets WHERE id=213

141 (473.0224609375): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))213((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

142 (431.06079101562): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))213((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

143 (59.127807617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294763123 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294763123 AND published='1' LIMIT 1

144 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294763123 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294763123 AND published='1' LIMIT 1

145 (!!!!! 8342.981338501): TRUNCATE TABLE jos_trademed_module

146 (226.02081298828): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294763123 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (96.08268737793): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294763123 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

148 (447.98851013184): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294763123 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294763123 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

150 (122.0703125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294763123 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294763123 AND published='1' LIMIT 1

151 (98.943710327148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294763123 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294763123 AND published='1' LIMIT 1

152 (!!!!! 1063.1084442139): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

153 (132.08389282227): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294763123 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294763123 AND published='1' LIMIT 1

154 (78.916549682617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294763123 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294763123 AND published='1' LIMIT 1

155 (240.80276489258): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294763123 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294763123 AND type='deeppockets_item' AND published='1' LIMIT 1

156 (92.029571533203): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=213 or channel_id is null)

157 (49.114227294922): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=213 or channel_id is null)

158 (52.928924560547): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

159 (163.79356384277): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294763123 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294763123 AND published='1' LIMIT 1

160 (81.062316894531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294763123 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294763123 AND published='1' LIMIT 1

161 (227.92816162109): select jos_twitters.link from jos_twitters where cat=10

162 (66.041946411133): select jos_facebook.link from jos_facebook where cat=10

163 (46.968460083008): select jos_google_plus.link from jos_google_plus where cat=10

164 (46.968460083008): select jos_linkedin.link from jos_linkedin where cat=10

165 (275.1350402832): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

166 (!!!!! 2277.8511047363): insert into jos_banners_delta values (14615,'2025-05-02 01:12:19','3.145.38.251','view'),(14202,'2025-05-02 01:12:19','3.145.38.251','view'),(14203,'2025-05-02 01:12:19','3.145.38.251','view')

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