Abdominal radiology (New York) · 2026
Preoperative FDG PET/CT topographic patterns and clinical parameters are associated with incomplete cytoreduction in peritoneal carcinomatosis: proposal of the Resectability Score.
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Keskin Mutlay, Kasırga Çelik Fulya
Аннотация
PURPOSE: To explore associations between preoperative FDG PET/CT-derived topographic patterns, clinical variables, and unfavorable surgical outcome (incomplete cytoreduction or intraoperative unresectability) in peritoneal carcinomatosis (PC), and to propose a simple, transparent, preoperatively applicable Resectability Score (RS) as a hypothesis-generating tool for future prospective validation.
METHODS: In this single-center retrospective cohort study (May 2018-April 2026), 39 patients with histopathologically confirmed PC who underwent surgical exploration were included. Univariable associations between PET/CT variables (PET-estimated Peritoneal Cancer Index [PCI] category, mesenteric root uptake, retroperitoneal uptake) and clinical factors and the composite endpoint were assessed. Given the limited number of outcome events, no multivariable model was fitted. The RS was proposed conceptually, with weights reflecting the strength of the observed associations, and its performance was deliberately not assessed in this dataset.
RESULTS: Eighteen of 39 patients (46.2%) had an unfavorable outcome (CC-2/3, n = 12; intraoperative unresectability, n = 6). PET-estimated PCI > 20 (OR 9.4, 95% CI 2.0-44.3; p = 0.003), mesenteric root FDG uptake (0/21 vs. 6/18; p = 0.006), and retroperitoneal FDG uptake (0/21 vs. 6/18; p = 0.006) were significantly associated with unfavorable outcome; gastric primary tumor showed a non-significant trend (OR 4.8, 95% CI 1.0-22.3; p = 0.07). Among 33 patients who underwent CRS + HIPEC, complete cytoreduction rates by PET-estimated PCI category were 85.7% (PCI ≤ 10), 63.6% (PCI 11-20), and 25.0% (PCI > 20) (p = 0.017). All six unresectable patients had shown mesenteric root or retroperitoneal FDG uptake preoperatively.
CONCLUSION: Preoperative FDG PET/CT topographic patterns in particular high disease burden and mesenteric root or retroperitoneal uptake are associated with unfavorable surgical outcomes in PC. The proposed RS is a hypothesis-generating tool only; formal derivation, internal validation, and external validation are required before any clinical application.
METHODS: In this single-center retrospective cohort study (May 2018-April 2026), 39 patients with histopathologically confirmed PC who underwent surgical exploration were included. Univariable associations between PET/CT variables (PET-estimated Peritoneal Cancer Index [PCI] category, mesenteric root uptake, retroperitoneal uptake) and clinical factors and the composite endpoint were assessed. Given the limited number of outcome events, no multivariable model was fitted. The RS was proposed conceptually, with weights reflecting the strength of the observed associations, and its performance was deliberately not assessed in this dataset.
RESULTS: Eighteen of 39 patients (46.2%) had an unfavorable outcome (CC-2/3, n = 12; intraoperative unresectability, n = 6). PET-estimated PCI > 20 (OR 9.4, 95% CI 2.0-44.3; p = 0.003), mesenteric root FDG uptake (0/21 vs. 6/18; p = 0.006), and retroperitoneal FDG uptake (0/21 vs. 6/18; p = 0.006) were significantly associated with unfavorable outcome; gastric primary tumor showed a non-significant trend (OR 4.8, 95% CI 1.0-22.3; p = 0.07). Among 33 patients who underwent CRS + HIPEC, complete cytoreduction rates by PET-estimated PCI category were 85.7% (PCI ≤ 10), 63.6% (PCI 11-20), and 25.0% (PCI > 20) (p = 0.017). All six unresectable patients had shown mesenteric root or retroperitoneal FDG uptake preoperatively.
CONCLUSION: Preoperative FDG PET/CT topographic patterns in particular high disease burden and mesenteric root or retroperitoneal uptake are associated with unfavorable surgical outcomes in PC. The proposed RS is a hypothesis-generating tool only; formal derivation, internal validation, and external validation are required before any clinical application.