摘要:目的: 探讨64排多层螺旋CT(MSCT)和血清淀粉样蛋白A(serum amyloid A protein, SAA)联合术前评估直肠癌在肿瘤分期诊断中的作用。 方法 :纳入经根治术治疗的直肠癌患者通过MSCT扫描进行评估,同时取患者静脉血测量术前SAA水平,行MSCT分期与MSCT和SAA联合分期以比较二者的诊断价值。 结果 :本研究纳入患者121例。MSCT检测T分期的准确度为851%。在评估淋巴结转移方面,MSCT和SAA联合分期的准确度为760%,明显高于MSCT分期(595%, 〖WTBX〗P lt;0001)。MSCT正确判断所有远处转移。同单一的MSCT检测相比,MSCT和SAA联合评估能显著的提高术前TNM分期的准确率(785% vs. 636%,〖WTBX〗P =0011)。 结论 :MSCT联合SAA检测比单一的MSCT检测显著提高了直肠癌术前肿瘤分期和淋巴结转移方面的准确度。这种新的术前评估方法的为肿瘤进展评估和术前治疗决策提供了更加可靠的信息。Abstract: Objective: To determine the role of combinative assessment of 64 multislice spiral computer tomography (MSCT) and serum amyloid A protein (SAA) in preoperative rectal cancer staging. Methods : Enrolled consecutive rectal cancer patients undergoing curative surgery were evaluated by MSCT scan. Meanwhile venous blood specimens were taken to measure preoperative SAA concentration. Both MSCT staging and MSCT plus SAA staging were performed to compare with each other. Results : The study population consisted of 121 patients. The accuracy of T staging was 851% for MSCT. The accuracy in evaluating lymph nodes metastases was 760% for MSCT plus SAA compared with 595% for MSCT alone (〖WTBX〗P lt;0001). All the distant metastases were correctly detected by MSCT. The method combining MSCT with SAA led to significant improvement on preoperative TNM staging compared with MSCT alone (785% vs. 636%, 〖WTBX〗P =0011). Conclusion : MSCT plus SAA showed greater accuracy than MSCT alone in rectal cancer staging and lymph node metastases. This novel strategy of preoperative evaluation appears to provide more accurate information on tumor progression and preoperative therapy decisionmaking.
ObjectiveTo analyze the relation between preoperative staging and surgical decision-making in rectal cancer patients from the West China Colorectal Cancer Database (DACCA) and to identify key factors influencing the selection of surgical approach. MethodsBased on the updated DACCA dataset as of April 24, 2024, the patients with rectal cancer were included. Chi-square tests and logistic regression analyses were performed to evaluate the correlation between preoperative staging [(y)cTNM stage] and the selection of sphincter-preserving surgery or intersphincteric resection (ISR). Additional factors, including age, body mass index (BMI), tumor location, and nutritional score, were assessed for their impact on surgical choices. ResultsA total of 2 733 rectal cancer patients were included. Preoperative (y)cTNM staging distribution was as follows: 23 (0.8%) at stage 0, 388 (14.2%) at stage Ⅰ, 760 (27.8%) at stage Ⅱ, 873 (31.9%) at stage Ⅲ, and 689 (25.2%) at stage Ⅳ. The preoperative stage Ⅱ–Ⅳ were the independent risk factors for both the choices of sphincter-preserving surgery and ISR [stage Ⅱ: sphincter-preserving surgery: OR(95%CI)=13.634 (4.952, 37.540), P<0.001; ISR: OR (95%CI)=3.097 (2.108, 4.551), P<0.001. stage Ⅲ: sphincter-preserving surgery: OR (95%CI)=14.677 (5.339, 40.345), P<0.001; ISR: OR (95%CI)=2.985 (2.042, 4.363), P<0.001. stage Ⅳ: OR (95%CI)=25.653 (9.320, 70.610), P<0.001; ISR: OR (95%CI)=4.445 (3.015, 6.555), P<0.001]. The low/ultra-low tumor location was an independent risk factor for choice of sphincter-preserving surgery [OR (95%CI)=2.038 (1.489, 2.791), P<0.001], but which was an independent protective factor for the choice of ISR [OR (95%CI)=0.013 (0.009, 0.019), P<0.001]. ConclusionsResults of this study are consistent with clinical practice, indicating that preoperative staging is the core basis for surgical decision-making in rectal cancer. With the progression of staging, patients are more inclined to choose non-sphincter-preserving and non-ISR procedures. Although low/ultralow tumors pose great challenges for anal preservation, the proportion of ISR selection remains relatively high. The anatomical location of the tumor and nutritional status also significantly affect surgical selection, necessitating comprehensive preoperative evaluation.
Objective To summarize progress of imagings and tumor markers in preoperative TN staging of colorectal cancer. Methods The domestic and international published literatures related to application of imagings such as EUS, CT, and MRI and tumor markers such as CEA, CA19-9, and CA-242 in preoperative TN staging of colorectal cancer were collected and reviewed. Results The imagings and tumor markers have different values in the preoperative TN staging of colorectal cancer, but the value of a single application is limited. The combination of imagings and tumor markers could improve the diagnostic accuracy of the preoperative TN staging of colorectal cancer. Conclusion In clinical work, combination of imagings and tumor markers should be selected basing on actual situation of patients so as to improve accuracy of preoperative TN staging of colorectal cancer, and guide clinical treatment and improve prognosis of patients.
Objective To determine the accuracy of endorectal ultrasonography (ERUS) in preoperative staging of rectal cancer and investigate the limitations and pitfalls of ERUS. Methods Ninety-four patients with rectal cancer were examined preoperatively by ERUS between September 2008 and November 2009 in this hospital. The size, shape, echo pattern, infiltration depth, and extra-rectal invasion of lesions were observed. The results of ERUS staging were compared with histopathology findings of the resected specimens. Results The overall accuracy of ERUS in T staging was 63.8% (60/94). The accuracies of ERUS for pT1, pT2, pT3, and pT4 tumor were 87.2% (82/94), 76.6% (72/94), 76.6% (72/94), and 97.9% (92/94), respectively. The sensitivity, specificity, and accuracy of ERUS for advanced rectal cancer (pT3+pT4) were 70.8% (34/48), 78.3% (36/46), and 74.5% (70/94), respectively. The sensitivity, specificity, and accuracy of ERUS in lymph node metastasis were 75.0% (42/56), 42.1% (16/38), and 61.7% (58/94), respectively. There was no significant difference of accuracy among various tumor locations above anocutaneous line (P＝0.495). The accuracy of ERUS for T staging improved with experience, the T staging accuracy improved from 40.0% after assessment of 30 cases to 81.3% after 94 cases were examined (P＝0.026). Conclusions The ERUS provides a good accuracy rate for assessment of the depth of tumor invasion and lymph node metastasis of rectal cancer, and has become an important imaging tool for preoperative staging rectal cancer. The operator experience, peritumoral inflammation mainly influences the accuracy of ERUS.
Objective To evaluate the accuracy of preoperative 64 multidetector spiral computed tomography (MDCT) in the diagnosis of stage Ⅳ gastric cancer. Methods The data of patients with stage Ⅳ gastric cancer between July 2007 and April 2008 were collected. Twenty-nine patients underwent preoperative 64 MDCT were retrospectively analyzed. All computed tomography scans were prospectly analyzed by 2 abdominal radiologists separately. Pathological tumor stage was based on TNM stage according to the revised Japanese Classification of Gastric Carcinoma from the Japanese Gastric Cancer Association. All CT results were compared with clinical, surgical and histopathologic results. Results The 65.2% (15/23), 47.8% (11/23) and 70.8% (17/24) of the stage Ⅳ patients were accurately predicted of T, N and M stage, respectively. Moreover, 58.6% (17/29) of the stage Ⅳ patients were accurately predicted of TNM stage. But 6/9 cases with peritoneal metastases were not detected by preoperative 64 MDCT. Conclusion The 64 MDCT is a promising technique for detection and preoperative staging of stage Ⅳ gastric cancer. It was difficult to detect peritoneal metastases, but it may not increase the rate of exploratory laparotomy.
Objective To establish the optimal morphological criteria combined with fibrinogen level for evaluation of lymph node metastasis in colorectal cancer. Methods A consecutive series of 690 patients who underwent curative surgery for colorectal cancer, were examined by abdominopelvic enhanced multi-slice spiral computed tomography (MSCT) scan. If regional lymph nodes appeared, the maximal long-axis diameter (MLAD), maximal short-axis diameter (MSAD), and axial ratio (MSAD/MLAD) were recorded. At each lymph node size cut-off value, the following were calculated: accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Moreover, preoperative plasma level of fibrinogen was retrospectively examined to identify metastatic or inflammatory lymph node combined with MSCT image. Both modalities, MSCT plus fibrinogen and MSCT alone, were compared based on the pathologic findings. Results The study population consisted of 100 patients with regional lymph nodes show. No significant difference was found between metastatic and inflammatory lymph nodes in imaging characteristics (Pgt;0.05). The best cut-off value of MSAD was 6 mm for lymph node metastasis with the sensitivity of 46.8%, specificity of 68.4%, accuracy of 55.0%, PPV of 70.7% and NPV of 44.1%. The best cut-off value of MLAD was 8 mm with the sensitivity of 43.5%, specificity of 63.2%, accuracy of 51.0%, PPV of 65.9% and NPV of 40.7%. Using hyperfibrinogenemia (FIB ≥3.5 g/L) to identify small metastatic lymph node, of which MSAD lt;6 mm or MLAD lt;8 mm, showed statistical diagnostic value (Kappa=0.256, P=0.047). Compared with MSAD (6 mm) alone, MSAD (6 mm) combined with hyperfibrinogenemia had a higher sensitivity (79.0% vs. 46.8%, Plt;0.001), but a similar accuracy (66.0% vs. 55.0%, Pgt;0.05) and a lower specificity (44.7% vs. 68.4%, P=0.037). MLAD (8 mm) combined with hyperfibrinogenemia led to a greater diagnostic value in sensitivity (80.6% vs. 43.5%, Plt;0.001) and accuracy (66.0% vs. 51.0%, P=0.031) than MLAD (8 mm) alone, with a no-significantly decreasing specificity (42.1% vs. 63.2%, Pgt;0.05). Conclusions This present study recommend MSAD ≥6 mm or MLAD ≥8 mm as the optimal criteria for preoperative N staging in colorectal cancer. Moreover, the sensitivity and even accuracy could be improved by combining hyperfibrinogenemia for lymph node metastasis identification.
ObjectiveTo analyze the association between preoperative staging (cTNM) and neoadjuvant therapy regimen decision-making and efficacy in patients with rectal cancer in the current version of Database from Colorectal Cancer (DACCA). MethodsThe data analysis for this study selected the DACCA version updated on April 20, 2024. The patient information was collected and categorized into three stages (Ⅱ, Ⅲ, and Ⅳ). The differences in neoadjuvant treatment decision-making and therapeutic effects, including gross changes, imaging changes, and tumor regression grade (TRG), were analyzed. ResultsA total of 3 158 eligible cases were collected in this study, with complete preoperative staging and neoadjuvant therapy decision-making data available for 2 370 patients. There were statistically significant differences in the overall comparison among the patients with rectal cancer in terms of the selection of combined targeted therapy, radiotherapy regimens, and the intensity of neoadjuvant chemotherapy by patients at different preoperative stages (χ²=42.239, P<0.001; χ²=41.615, P<0.001; H=1.161, P=0.004). Specifically, the proportion of patients choosing combined targeted therapy and combined radiotherapy gradually increased as the stage advanced. Among patients at different stages, the proportion of those choosing medium-course chemotherapy was the highest, and the proportion of patients choosing long-course chemotherapy was the highest among those with more advanced stages. Regarding the gross changes, imaging changes, and TRG results after neoadjuvant treatment in the patients at different preoperative stages, there were statistically significant differences in the overall comparison among patients with stage Ⅱ, Ⅲ, and Ⅳ rectal cancer (H=7.860, P=0.020; H=9.845, P=0.007; H=6.680, P=0.035). The proportion of partial response was the highest across all response metrics (macroscopic, radiographic, and TRG) in each stage. Notably, stage Ⅱ patients demonstrated the highest rate of complete response. For TRG evaluation, grade 2 (TRG2) was the most common outcome across all stages. ConclusionsData analysis from DACCA reveals that patients with advanced stages are more likely to choose chemotherapy combined with targeted therapy or radiotherapy, and had a higher proportion of intermediate range chemotherapy and the intensity of neoadjuvant chemotherapy is stronger. In terms of neoadjuvant treatment effects, the earlier the staging, the better the gross and imaging changes, and the lower the TRG level.
Objective To determine the role of multi-slice spiral computed tomography (MSCT) compared with transrectal ultrasound (TRUS) in preoperative staging of rectal cancer. Methods Patients with rectal cancer from January to May 2009 in Department of Anal-Colorectal Surgery of West China Hospital were enrolled. All patients were preoperatively examined by both MSCT and TRUS for T and N staging, which were compared with postoperative pathological findings. Results The study population consisted of 81 patients. Regarding depth of tumor invasion, the accuracy of TRUS (88.89%) was not significantly higher than that of MSCT (77.78%), P=0.168. Regarding lymph node metastasis, the result of MSCT was more accurate than that of TRUS (66.67% vs. 48.15%, P=0.034). Conclusions Although TRUS remains the advantages in evaluating local invasion, the gap between MSCT and TRUS are significantly diminished. MSCT is superior to TRUS in evaluation of lymph node metastasis, however, further improvement on the diagnostic accuracies would be warranted in both modalities.
Objective To summarize the research progress of MRI in the assessment of rectal cancer before surgery. Methods Literatures about the recent studies on the research progress of MRI in the assessment of rectal cancer before surgery were reviewed according to the results searched from Pubmed, CNKI, and WanFang database. Results Preoperative staging, circumferential resection margin, and extramural vascular invasion were closely related to the prognosis of rectal cancer patients, MRI could provide a good assessment of preoperative staging, circumferential resection margin, and extramural vascular invasion for rectal cancer patients, but it still had some deficiencies which needed further studies. Conclusion Application of MRI in the assessment of preoperative staging, circumferential resection margin, and extramural vascular invasion before surgery, is conducive to the development of the most appropriate treatment options for patients with rectal cancer.
Objective To summarize recent advances on preoperative staging strategies in rectal cancer. Methods Relevant references about preoperative staging strategies were collected and reviewed. The multimodal preoperative evaluation (MPE) system recently documented was focused on. Results The comparably accurate T and M stage could be achieved preoperatively by following an appropriate available method; however, the N stage’s accuracy was still not satisfying. The MPE system， incorporating with the advantages of transrectal ultrasound， computerized tomography and serum amyloid A protein in a multi-disciplinary mode could display the most accurate preoperative staging for rectal cancer currently. Conclusion The MPE has potential prospects in preoperative staging of rectal cancer， and can provide the most accurate preoperative staging for rectal cancer at present.