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
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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.
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.
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.
PET-PCI can reflect histopathologic features and appears useful for predicting recurrence in patients with PMP.
• 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.
KeywordsFluorodeoxyglucose F18 Positron-emission tomography Pseudomyxoma peritonei Prognosis
Completeness of cytoreduction score
Hyperthermic intraoperative chemotherapy
Ordered-subset expectation maximization
Peritoneal cancer index
Standardized uptake value
Volume of interest
We wish to thank the study participants and referring technicians for their participation in this study.
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Ryogo Minamimoto.
Conflict of interest
The authors declare that they have no competing interests.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was waived by the institutional review board.
Institutional review board approval was obtained.
• Diagnostic or prognostic study
• Performed at one institution
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