Department of Surgery, University Medical Center Groningen, Hanzeplein 1, Groningen 9713 GZ, the Netherlands.
BMC Cancer. 2011 Oct 7;11:433. doi: 10.1186/1471-2407-11-433.
Advanced colorectal cancer (CRC), either locally advanced, metastasized (mCRC) or both, is present in a relevant proportion of patients. The chances on curation of advanced CRC are continuously improving with modern multi-modality treatment options. For incurable CRC the focus lies on palliation of symptoms, which is not necessarily a resection of the primary tumor. Both situations motivate adequate staging before treatment in CRC. This prospective observational study evaluates the outcomes after the introduction of routine staging with abdominal CT before treatment.
In a prospective observational study of 612 consecutive patients (2007-2009), the ability of abdominal CT to find liver metastases (LM), peritoneal carcinomatosis (PC) and T4 stage in colon cancer (CC) was analysed.
Advanced CRC was present in 58% of patients, mCRC in 31%. The ability to find LM was excellent (99%), cT4 stage CC good (86%) and PC poor (33%). In the group of surgical patients with emergency presentations, the incidences of both mCRC (51%) and locally advanced colon cancer (LACC) (69%) were higher than in the elective group (20% and 26% respectively). Staging tended to be omitted more often in the emergency group (35% versus 12% in elective surgery).
The strengths of staging with abdominal CT are to find LM and LACC, however it fails in diagnosing PC. On grounds of the incidence of advanced CRC, staging is warranted in patients with emergency presentations as well.
在相当一部分患者中，存在局部晚期、转移性（mCRC）或两者均有的晚期结直肠癌（CRC）。随着现代多模式治疗方案的出现，晚期 CRC 的治疗机会不断增加。对于无法治愈的 CRC，重点在于缓解症状，而不一定是切除原发肿瘤。这两种情况都需要在 CRC 治疗前进行充分的分期。本前瞻性观察研究评估了常规腹部 CT 分期在治疗前引入后的结果。
在一项对 612 例连续患者（2007-2009 年）的前瞻性观察性研究中，分析了腹部 CT 发现肝转移（LM）、腹膜癌病（PC）和结肠癌（CC）T4 期的能力。
58%的患者存在晚期 CRC，31%的患者存在 mCRC。发现 LM 的能力非常好（99%），CC 的 cT4 期较好（86%），PC 较差（33%）。在急诊手术患者组中，mCRC（51%）和局部晚期结肠癌（LACC）（69%）的发生率均高于择期手术组（分别为 20%和 26%）。在急诊组中，分期往往更常被省略（35%比择期手术的 12%）。
腹部 CT 分期的优势在于发现 LM 和 LACC，但在诊断 PC 方面失败。鉴于晚期 CRC 的发生率，急诊患者也需要进行分期。
