Extent of Peritoneal Metastases on Preoperative DW-MRI is Predictive of Disease-Free and Overall Survival for CRS/HIPEC Candidates with Colorectal Cancer

Maurits P. Engbersen, Arend G. J. Aalbers, Iris Van't Sant-Jansen, Jeroen D. R. Velsing, Doenja M. J. Lambregts, Regina G. H. Beets-Tan, Niels F. M. Kok, Max J. Lahaye*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Web of Science)

Abstract

Objective The aim of this study was to determine whether the extent of peritoneal metastases (PMs) on preoperative diffusion-weighted magnetic resonance imaging (DW-MRI) can be used as a biomarker of disease-free and overall survival in patients with colorectal cancer who are considered for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). Methods For this retrospective cohort study, patients with PMs considered for CRS/HIPEC who underwent DW-MRI for preoperative staging in 2016-2017 were included. The DW-MRI protocol consisted of diffusion-weighted, T2-weighted, and pre- and post-gadolinium T1-weighted imaging of the chest, abdomen, and pelvis. DW-MRI images were evaluated by two independent readers to determine the extent of PMs represented by the Peritoneal Cancer Index (MRI-PCI), as well as extraperitoneal metastases. Cox regression and Kaplan-Meier analysis was performed to determine the prognostic value of DW-MRI for overall and disease-free survival. Results Seventy-eight patients were included. CRS/HIPEC was planned for 53 patients and completed in 50 patients (60.5%). Median follow-up after DW-MRI was 23 months (interquartile range 13-24). The MRI-PCI of both readers showed prognostic value for overall survival, independently of whether R1 resection was achieved (hazard ratio [HR] 1.06-1.08; p <0.05). For the patients who received successful CRS/HIPEC, the MRI-PCI also showed independent prognostic value for disease-free survival for both readers (HR 1.09-1.10; p <0.05). Conclusion The extent of PMs on preoperative DW-MRI is an independent predictor of overall and disease-free survival and should therefore be considered as a non-invasive prognostic biomarker.

Original languageEnglish
Pages (from-to)3516-3524
Number of pages9
JournalAnnals of Surgical Oncology
Volume27
Issue number9
DOIs
Publication statusPublished - Sep 2020

Keywords

  • HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY
  • COMPLETE CYTOREDUCTIVE SURGERY
  • COMPUTED-TOMOGRAPHY
  • PROGNOSTIC-FACTORS
  • RISK-FACTORS
  • CARCINOMATOSIS
  • HIPEC
  • INDEX
  • LAPAROSCOPY

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