Lee Rachel M, Zaidi Mohammad Y, Gamboa Adriana C, Speegle Shelby, Kimbrough Charles W, Cloyd Jordan M, Leiting Jennifer L, Grotz Travis E, Lee Andrew J, Fournier Keith F, Powers Benjamin D, Dineen Sean P, Baumgartner Joel, Veerapong Jula, Clarke Callisia N, Sussman Jeffrey J, Patel Sameer, Hendrix Ryan J, Lambert Laura A, Vande Walle Kara A, Abbott Daniel E, LaRocca Christopher J, Raoof Mustafa, Fackche Nadege, Johnston Fabian M, Staley Charles A, Maithel Shishir K, Russell Maria C
Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA.
Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
Clin Colorectal Cancer. 2020 Mar;19(1):e1-e7. doi: 10.1016/j.clcc.2019.12.002. Epub 2019 Dec 12.
Radiographic prediction of peritoneal carcinomatosis index (PCI) can improve patient selection for cytoreductive surgery. We aimed to determine the correlation of computed tomography (CT)-predicted PCI (CT-PCI) and magnetic resonance imaging (MRI)-predicted PCI (MRI-PCI) with intraoperative-PCI, and if a preoperative-PCI cutoff is associated with incomplete cytoreduction.
Patients from the US HIPEC Collaborative (2000-2017) with appendiceal, colorectal, or peritoneal mesothelioma (PM) histology who underwent cytoreductive surgery were included. Pearson correlation coefficients were used to determine correlation between preoperative and intraoperative-PCI values. Fisher r-to-z transformation was used to compare correlations.
A total of 488 patients were included. Of these, 34% had noninvasive appendiceal, 30% invasive appendiceal, 28% colorectal, and 8% PM histology. CT-PCI was correlated with intraoperative-PCI for patients with noninvasive and invasive appendiceal and colorectal histologies (r = 0.689, 0.554, and 0.571; all P < .001), but not PM (r = 0.188; P = .295). MRI-PCI was correlated with intraoperative-PCI for all histologies (non-invasive appendiceal: r = 0.591; P = .002; invasive appendiceal: r = 0.848; P < .001; colorectal: r = 0.729; P < .001; PM: r = 0.890; P = .007). Comparing CT and MRI, correlations were similar in noninvasive appendiceal and colorectal histologies; MRI was better for invasive appendiceal and PM (P = .005 and P = .021, respectively). Twenty-eight (6%) patients underwent an incomplete cytoreduction (cytoreduction score, 2-3). PCI greater than 15 was associated with cytoreduction score of 2 to 3 for both CT and MRI (CT-PCI: odds ratio, 3.0; P = .033; MRI-PCI: odds ratio, 7.6; P = .071).
In this multi-institutional cohort, CT and MRI-PCI correlate well with intraoperative-PCI. MRI appears to be superior for invasive appendiceal and peritoneal mesothelioma. External validation in a larger population is needed.
腹膜癌指数（PCI）的影像学预测可改善细胞减灭术患者的选择。我们旨在确定计算机断层扫描（CT）预测的PCI（CT-PCI）和磁共振成像（MRI）预测的PCI（MRI-PCI）与术中PCI的相关性，以及术前PCI临界值是否与不完全细胞减灭相关。
纳入美国高温腹腔内热灌注化疗协作组（2000 - 2017年）中接受细胞减灭术且组织学类型为阑尾、结直肠或腹膜间皮瘤（PM）的患者。采用Pearson相关系数确定术前与术中PCI值之间的相关性。使用Fisher r到z变换比较相关性。
共纳入488例患者。其中，34%为非侵袭性阑尾组织学类型，30%为侵袭性阑尾组织学类型，28%为结直肠组织学类型，8%为PM组织学类型。对于非侵袭性和侵袭性阑尾及结直肠组织学类型的患者，CT-PCI与术中PCI相关（r = 0.689、0.554和0.571；均P <.001），但与PM不相关（r = 0.188；P =.295）。对于所有组织学类型，MRI-PCI与术中PCI相关（非侵袭性阑尾：r = 0.591；P =.002；侵袭性阑尾：r = 0.848；P <.001；结直肠：r = 0.729；P <.001；PM：r = 0.890；P =.007）。比较CT和MRI，在非侵袭性阑尾和结直肠组织学类型中相关性相似；MRI在侵袭性阑尾和PM方面表现更好（分别为P =.005和P =.021）。28例（6%）患者接受了不完全细胞减灭（细胞减灭评分，2 - 3分）。对于CT和MRI，PCI大于15均与细胞减灭评分为2至3分相关（CT-PCI：比值比，3.0；P =.033；MRI-PCI：比值比，7.6；P =.071）。
在这个多机构队列中，CT和MRI-PCI与术中PCI相关性良好。MRI在侵袭性阑尾和腹膜间皮瘤方面似乎更具优势。需要在更大规模人群中进行外部验证。
