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European Radiology
Published in: European Radiology 10/2019

01-10-2019 | Peritoneal Cancer | Gastrointestinal

Impact of a modified peritoneal cancer index using FDG-PET/CT (PET-PCI) in predicting tumor grade and progression-free survival in patients with pseudomyxoma peritonei

Authors: Masatoshi Hotta, Ryogo Minamimoto, Yoshimasa Gohda, Toru Igari, Hideaki Yano

Published in: European Radiology | Issue 10/2019

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Abstract

Objectives

The peritoneal cancer index (PCI) is widely used for assessing pseudomyxoma peritonei (PMP) in surgery. The aim of this study was to evaluate the utility of a modified PCI using 18F-fluorodeoxyglucose (18F-FDG)-PET/CT (PET-PCI) for predicting pathologic grade and progression-free survival (PFS) in patients with PMP.

Methods

Thirty-five patients who underwent 18F-FDG-PET/CT before cytoreductive surgery and/or hyperthermic intraperitoneal chemotherapy were enrolled. PET-PCI was determined by summing up the visually scored 18F-FDG uptake of PMP lesions in 13 specific abdominal-pelvic regions. Uptake score was defined as 0, no lesion or lesion without uptake; 1, slight uptake less than or equivalent to mediastinal blood pool; 2, moderate uptake above mediastinal but below or equal to liver; and 3, intense uptake moderately to markedly higher than liver. SUVmax of the lesion was also evaluated.

Results

Pathologic diagnosis revealed 19 patients with low-grade PMP and 16 patients with high-grade PMP. Patients with high-grade PMP showed significantly higher PET-PCI and SUVmax than patients with low-grade PMP (PET-PCI 14.8 vs. 8.7, p = 0.007; SUVmax 3.6 vs. 2.6, p = 0.013). Using a cutoff PET-PCI of 12, Kaplan-Meier analyses showed a significant difference in PFS between patients with high and low PET-PCI (p < 0.001; hazard ratio (HR), 12.4). For SUVmax, the optimal cutoff was 2.7 and the correlation with PFS was also significant (p = 0.008; HR, 4.7). In multivariate Cox proportional-hazards regression, PET-PCI was independently and significantly correlated with PFS.

Conclusions

PET-PCI can reflect histopathologic features and appears useful for predicting recurrence in patients with PMP.

Key Points

• Peritoneal cancer index using 18F-FDG-PET/CT (PET-PCI) has great potential for predicting progression-free survival in patients with pseudomyxoma peritonei.
• PET-PCI provides higher prognostic performance than maximum standardized uptake value (SUVmax).
• PET-PCI shows high correlation with histopathologic grade of pseudomyxoma peritonei.
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Metadata
Title
Impact of a modified peritoneal cancer index using FDG-PET/CT (PET-PCI) in predicting tumor grade and progression-free survival in patients with pseudomyxoma peritonei
Authors
Masatoshi Hotta
Ryogo Minamimoto
Yoshimasa Gohda
Toru Igari
Hideaki Yano
Publication date
01-10-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 10/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06102-1

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