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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

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

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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Abbreviations

CCR:

Completeness of cytoreduction score

CRS:

Cytoreductive surgery

HIPEC:

Hyperthermic intraoperative chemotherapy

OSEM:

Ordered-subset expectation maximization

PCI:

Peritoneal cancer index

PFS:

Progression-free survival

PMP:

Pseudomyxoma peritonei

SUV:

Standardized uptake value

VOI:

Volume of interest

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Acknowledgements

We wish to thank the study participants and referring technicians for their participation in this study.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan

    Masatoshi Hotta & Ryogo Minamimoto

  2. Department of Surgery, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan

    Yoshimasa Gohda & Hideaki Yano

  3. Department of Pathology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan

    Toru Igari

Authors
  1. Masatoshi Hotta
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  2. Ryogo Minamimoto
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  5. Hideaki Yano
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Corresponding author

Correspondence to Masatoshi Hotta.

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The scientific guarantor of this publication is Ryogo Minamimoto.

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The authors declare that they have no competing interests.

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Written informed consent was waived by the institutional review board.

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• Retrospective

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• Performed at one institution

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Hotta, M., Minamimoto, R., Gohda, Y. et al. 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. Eur Radiol 29, 5709–5716 (2019). https://doi.org/10.1007/s00330-019-06102-1

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  • DOI: https://doi.org/10.1007/s00330-019-06102-1

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