Yongue Gabriella, Hotouras Alexander, Murphy Jamie, Mukhtar Hasan, Bhan Chetan, Chan Christopher L
aDepartment of Colorectal Surgery, Whittington Health NHS Trust, University College London, London bPhysiology Unit, St Marks Hospital, Harrow cAcademic Surgical Unit, The Royal London Hospital, Bart's Health NHS Trust, London, UK.
Eur J Gastroenterol Hepatol. 2015 Apr;27(4):467-70. doi: 10.1097/MEG.0000000000000315.
National UK guidelines recommend preoperative computed tomography (CT) examination of the chest for all patients with colorectal cancer (CRC) as identification of thoracic metastatic disease may influence treatment plans. The diagnostic yield of this approach for patients without radiological evidence of hepatic metastases remains unclear. The aim of this study was to establish the impact upon treatment of chest CT examination for CRC patients without metastatic liver disease.
All patients diagnosed with CRC without liver metastases disease between December 2006 and December 2013 in a single institution were identified from a prospectively recorded departmental database. Data collected included patient demographics, disease stage and chest CT findings.
There were 358 CRC patients (183 male, 175 female, median age 70 years, range 24-96 years) without liver metastases. Colon cancer accounted for 68% of cases with 32% of patients diagnosed with rectal cancer. The majority of patients (n=292, 81.6%) had no evidence of thoracic pathology during the study period. Lung metastases were identified in five (1.4%) patients, one of them subsequently diagnosed with benign pulmonary nodule. In 61 (17.0%) patients the lung nodules were classified as intermediate with only three subsequently reclassified as pulmonary metastases (n=1) or primary lung cancer (n=2).
In the absence of liver metastases, CRC rarely spreads to the lung. Consequently, preoperative chest CT examination for patients without evidence of liver metastases may not be necessary in the majority of patients. Future studies are required to identify patients at high risk for pulmonary metastases who may benefit from this preoperative investigation.
英国国家指南建议，所有结直肠癌（CRC）患者术前行胸部计算机断层扫描（CT）检查，因为发现胸段转移瘤可能会影响治疗方案。对于无肝转移影像学证据的患者，这种检查方法的诊断率尚不清楚。本研究的目的是确定胸部CT检查对无肝转移的CRC患者治疗的影响。
从一个前瞻性记录的科室数据库中识别出2006年12月至2013年12月期间在单一机构诊断为无肝转移疾病的所有CRC患者。收集的数据包括患者人口统计学资料、疾病分期和胸部CT检查结果。
共有358例无肝转移的CRC患者（男性183例，女性175例，中位年龄70岁，范围24 - 96岁）。结肠癌占病例的68%，32%的患者诊断为直肠癌。在研究期间，大多数患者（n = 292，81.6%）没有胸部病变的证据。5例（1.4%）患者发现肺转移，其中1例随后被诊断为良性肺结节。61例（17.0%）患者的肺结节被分类为可疑，其中只有3例随后重新分类为肺转移（n = 1）或原发性肺癌（n = 2）。
在无肝转移的情况下，CRC很少转移至肺部。因此，对于大多数无肝转移证据的患者，术前行胸部CT检查可能没有必要。未来需要开展研究，以确定可能从这种术前检查中获益的肺转移高危患者。
