Peter MacCallum Cancer Centre, Division of Surgical Oncology, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia.
Peter MacCallum Cancer Centre, Division of Surgical Oncology, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia.
Eur J Surg Oncol. 2022 Jul;48(7):1606-1613. doi: 10.1016/j.ejso.2022.02.003. Epub 2022 Feb 4.
Pseudomyxoma peritonei (PMP) is a rare clinical entity, commonly derived from a mucin-producing tumour of the appendix. International consensus is unclear on the role of positron emission tomography (PET) in preoperative staging. This study aimed to assess the ability of preoperative PET in predicting the histological grade of PMP.
All patients scheduled for cytoreductive surgery (CRS) +/- hyperthermic intraperitoneal chemotherapy (HIPEC) for PMP who underwent preoperative PET at a single centre between June 2007 and June 2020 were included. A nuclear medicine physician, blinded to patient outcomes, retrospectively reviewed imaging studies to assess for maximum tumour standardised uptake value (SUV) to mean liver SUV ratio (SUV) and maximum porta hepatis SUV to mean liver SUV ratio (SUV).
Between April 2007 and December 2020, a total of 204 patients underwent surgical intervention for PMP. Of these, 124 (60.8%) met the inclusion criteria. Median peritoneal carcinomatosis index for the entire cohort was 9 and complete cytoreduction (CC0/1) was achieved in 109 (88%) patients. Patients with high-grade PMP were more likely to have diffuse peritoneal disease (p < 0.001) and higher SUV (p<0.001). The area under the ROC curve (AUC) of SUV in predicting high-grade pathology was 71% (p = 0.003). Patients with a SUV ≤ 0.78 had improved disease-free survival (p = 0.042).
Preoperative PET showed positive correlation with high-grade PMP and acceptable sensitivity and specificity as a diagnostic tool. PET should be considered a useful adjunct to standard imaging for predicting histological grade in the staging of patients with PMP.
假性黏液瘤腹膜（PMP）是一种罕见的临床实体，通常源自阑尾的黏液性肿瘤。国际共识对于正电子发射断层扫描（PET）在术前分期中的作用尚不清楚。本研究旨在评估术前 PET 预测 PMP 组织学分级的能力。
纳入 2007 年 6 月至 2020 年 6 月期间在单一中心接受术前 PET 检查并计划接受细胞减灭术（CRS）+/-腹腔内热灌注化疗（HIPEC）治疗 PMP 的所有患者。一位核医学医师在不了解患者结局的情况下对影像学研究进行回顾性评估，以评估最大肿瘤标准化摄取值（SUV）与平均肝脏 SUV 比值（SUV）以及最大门脉肝 SUV 与平均肝脏 SUV 比值（SUV）。
2007 年 4 月至 2020 年 12 月，共有 204 例患者因 PMP 接受手术干预。其中，124 例（60.8%）符合纳入标准。整个队列的腹膜癌指数中位数为 9，109 例（88%）患者实现完全细胞减灭（CC0/1）。高级别 PMP 患者更可能患有弥漫性腹膜疾病（p<0.001）和更高的 SUV（p<0.001）。SUV 预测高级别病理的 ROC 曲线下面积（AUC）为 71%（p=0.003）。SUV≤0.78 的患者无疾病生存率提高（p=0.042）。
术前 PET 与高级别 PMP 呈正相关，作为一种诊断工具具有可接受的敏感性和特异性。PET 应被视为预测 PMP 患者组织学分级的标准影像学检查的有用辅助手段。
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