Rachel M Lee1, Mohammad Y Zaidi1, Adriana C Gamboa1, Shelby Speegle1, Charles W Kimbrough2, Jordan M Cloyd2, Jennifer L Leiting3, Travis E Grotz3, Andrew J Lee4, Keith F Fournier4, Benjamin D Powers5, Sean P Dineen5, Joel Baumgartner6, Jula Veerapong6, Callisia N Clarke7, Jeffrey J Sussman8, Sameer Patel8, Ryan J Hendrix9, Laura A Lambert10, Kara A Vande Walle11, Daniel E Abbott11, Christopher J LaRocca12, Mustafa Raoof12, Nadege Fackche13, Fabian M Johnston13, Charles A Staley1, Shishir K Maithel1, Maria C Russell14. 1. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA. 2. Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH. 3. Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN. 4. Division of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX. 5. Department of Gastrointestinal Oncology, Moffitt Cancer Center, Department of Oncologic Sciences, Morsani College of Medicine, Tampa, FL. 6. Division of Surgical Oncology, Department of Surgery, University of California San Diego, San Diego, CA. 7. Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI. 8. Department of Surgery, University of Cincinnati, Cincinnati, OH. 9. Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, MA. 10. Huntsman Cancer Institute, Division of Surgical Oncology, Department of Surgery, University of Utah, Salt Lake City, UT. 11. Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI. 12. Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA. 13. Department of Surgery, Johns Hopkins University, Baltimore, MD. 14. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA. Electronic address: maria.c.russell@emory.edu.
Abstract
BACKGROUND: 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 AND METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
BACKGROUND: 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 AND METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
Authors: Rachel M Lee; Adriana C Gamboa; Michael K Turgeon; Mohammad Y Zaidi; Charles Kimbrough; Jennifer Leiting; Travis Grotz; Andrew J Lee; Keith Fournier; Benjamin Powers; Sean Dineen; Joel M Baumgartner; Jula Veerapong; Harveshp Mogal; Callisia Clarke; Gregory Wilson; Sameer Patel; Ryan Hendrix; Laura Lambert; Courtney Pokrzywa; Daniel E Abbott; Christopher J LaRocca; Mustafa Raoof; Jonathan Greer; Fabian M Johnston; Charles A Staley; Jordan M Cloyd; Shishir K Maithel; Maria C Russell Journal: J Surg Oncol Date: 2020-10-01 Impact factor: 3.454