Angliviel Benjamin, Benoist Stéphane, Penna Christophe, El Hajjam Mostafa, Chagnon Sophie, Julié Catherine, Beauchet Alain, Rougier Philippe, Nordlinger Bernard
Department of Surgery, AP-HP, Hôpital Ambroise Paré, Boulogne, France.
Ann Surg Oncol. 2009 May;16(5):1247-53. doi: 10.1245/s10434-009-0385-9. Epub 2009 Feb 28.
The aim of this study was to determine the effect of chemotherapy on the accuracy of CT scan for the preoperative evaluation of colorectal liver metastases (LM).
Between 1999 and 2005, 92 patients with less than six LM at diagnosis underwent surgery within four weeks of CT scan. Of these 92 patients, 60 had received chemotherapy before surgery (chemotherapy group), whereas 32 were operated without preoperative treatment (control group). Histological and surgical findings were compared with helical CT results.
On a per lesion basis, the sensitivity of CT scan for the detection of LM was 71% in the chemotherapy group and 76% in the control group. On a per patient basis, the sensitivity of CT scan was 54% in the chemotherapy group and 69% in the control group. Discrepancies between CT scan and surgical or histological findings, including both false-negative and false-positive lesions, were found in 32 patients from the chemotherapy group and 10 patients from the control group (p=0.0471). In multivariate analysis, chemotherapy (p=0.032), number of LM > 3 (p=0.034), and steatosis > 30% (p=0.012) were risk factors for inadequate staging of LM by CT scan.
Chemotherapy reduces the accuracy of CT scan for preoperative evaluation of colorectal LM.
本研究的目的是确定化疗对CT扫描在结直肠癌肝转移（LM）术前评估准确性方面的影响。
1999年至2005年间，92例诊断时肝转移灶少于6个的患者在CT扫描后四周内接受了手术。在这92例患者中，60例在手术前接受了化疗（化疗组），而32例未接受术前治疗直接进行了手术（对照组）。将组织学和手术结果与螺旋CT结果进行比较。
以每个病灶为基础，化疗组CT扫描检测肝转移灶的敏感性为71%，对照组为76%。以每位患者为基础，化疗组CT扫描的敏感性为54%，对照组为69%。化疗组有32例患者、对照组有10例患者出现CT扫描与手术或组织学结果之间的差异，包括假阴性和假阳性病灶（p = 0.0471）。多因素分析显示，化疗（p = 0.032）、肝转移灶数量>3个（p = 0.034）以及脂肪变性>30%（p = 0.012）是CT扫描对肝转移灶分期不足的危险因素。
化疗降低了CT扫描在结直肠癌肝转移术前评估中的准确性。
