1Department of Surgery, University Hospital Limerick, Limerick, Ireland 2Graduate Entry Medical School, University of Limerick, Limerick, Ireland 3Centre for Interventions in Infection, Inflammation and Immunity, Graduate Entry Medical School, University of Limerick, Ireland.
Dis Colon Rectum. 2014 Nov;57(11):1260-6. doi: 10.1097/DCR.0000000000000210.
Recent studies suggest that there is little benefit to routine preoperative staging CT of the thorax in colorectal cancer.
The current study hypothesized that staging CT of the thorax is not mandated in all patients with colorectal cancer.
This study was a tertiary-care center retrospective observational study.
Patients with a diagnosis of colon and rectal adenocarcinoma during 2006 to 2011 were included in a hospital database. Demographic, pathological, radiological, survival, and clinical factors were recorded. Three hundred eighty-two patients were included in the analysis (234 male, 148 female).
All patients underwent preoperative staging CT of the thorax to determine the presence of pulmonary metastasis and/or indeterminate lesions.
Patients demographics were reviewed, and the factors associated with pulmonary metastasis and indeterminate lesions were evaluated.
Distant metastases were evident in 61 patients (16%). CT scans revealed pulmonary metastasis in 23 patients (6%), and indeterminate lesions in 33 (8.6%). Only one-third of pulmonary lesions were evident on chest x-ray. On logistic regression analysis, nodal positivity was associated with an increased risk for pulmonary metastasis (p = 0.03). There was no difference in overall survival between patients with pulmonary metastasis and indeterminate lesions (p = 0.35, Kaplan-Meier estimate, log rank analysis). Pulmonary metastasis developed during postoperative surveillance in 7 patients with indeterminate lesions (21.2%).
This is a retrospective, single-center study with a relatively small sample size.
Pulmonary metastasis is relatively rare in colorectal cancer, and staging CT of the thorax may not be mandated in low-risk patients.
最近的研究表明，在结直肠癌患者中，常规进行术前胸部分期 CT 检查获益甚微。
本研究假设并非所有结直肠癌患者都需要进行胸部分期 CT 检查。
这是一项三级医疗中心回顾性观察性研究。
纳入了 2006 年至 2011 年间在医院数据库中诊断为结肠和直肠腺癌的患者。记录了人口统计学、病理学、影像学、生存和临床因素。共有 382 例患者纳入分析（234 例男性，148 例女性）。
所有患者均行术前胸部分期 CT 检查，以确定是否存在肺转移和/或不确定病变。
评估患者的人口统计学特征，并评估与肺转移和不确定病变相关的因素。
61 例（16%）患者存在远处转移。CT 扫描显示 23 例（6%）患者存在肺转移，33 例（8.6%）患者存在不确定病变。仅有三分之一的肺部病变在胸部 X 线片上可见。Logistic 回归分析显示，淋巴结阳性与肺转移风险增加相关（p = 0.03）。有肺转移和不确定病变的患者之间的总生存时间无差异（p = 0.35，Kaplan-Meier 估计，对数秩分析）。在 7 例不确定病变患者中（21.2%），在术后监测期间出现了肺转移。
这是一项回顾性、单中心研究，样本量相对较小。
结直肠癌患者中肺转移相对少见，低危患者可能无需进行胸部分期 CT 检查。
