Department of Radiology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
Department of Surgery, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
Eur Radiol. 2019 Oct;29(10):5709-5716. doi: 10.1007/s00330-019-06102-1. Epub 2019 Mar 14.
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.
腹膜肿瘤指数（PCI）广泛用于评估腹膜假黏液瘤（PMP）手术。本研究旨在评估使用 18F-氟脱氧葡萄糖（18F-FDG）-正电子发射断层扫描/计算机断层扫描（PET-PCI）评估 PCI 对预测 PMP 患者病理分级和无进展生存期（PFS）的效用。
35 例患者在细胞减灭术和/或腹腔内热化疗前行 18F-FDG-PET/CT 检查。通过对 13 个特定的腹部-骨盆区域中 PMP 病变的视觉评分 18F-FDG 摄取进行求和来确定 PET-PCI。摄取评分定义为 0，无病变或无摄取病变；1，摄取轻微，低于或等于纵隔血池；2，中度摄取，高于纵隔但低于或等于肝脏；3，摄取强度中等至明显高于肝脏。还评估了病变的 SUVmax。
病理诊断显示 19 例患者为低级别 PMP，16 例患者为高级别 PMP。高级别 PMP 患者的 PET-PCI 和 SUVmax 明显高于低级别 PMP 患者（PET-PCI 为 14.8 比 8.7，p=0.007；SUVmax 为 3.6 比 2.6，p=0.013）。使用截断值为 12 的 PET-PCI，Kaplan-Meier 分析显示 PFS 存在显著差异（p<0.001；风险比（HR）为 12.4）。对于 SUVmax，最佳截断值为 2.7，与 PFS 也存在显著相关性（p=0.008；HR 为 4.7）。在多变量 Cox 比例风险回归中，PET-PCI 与 PFS 独立且显著相关。
PET-PCI 可以反映组织病理学特征，并且似乎可用于预测 PMP 患者的复发。
18F-FDG-PET/CT（PET-PCI）的腹膜肿瘤指数对预测腹膜假黏液瘤患者的无进展生存期具有很大的潜力。
PET-PCI 提供了比最大标准化摄取值（SUVmax）更高的预后性能。
PET-PCI 与腹膜假黏液瘤的组织病理学分级具有高度相关性。
