癌症诱导的 CT 棘突：结直肠癌术前的一个重要预后因素。

Cancer-induced spiculation on computed tomography: a significant preoperative prognostic factor for colorectal cancer.

机构信息

Department of Surgery, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan.

Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, 97239, USA.

出版信息

Surg Today. 2019 Jul;49(7):629-636. doi: 10.1007/s00595-019-01780-2. Epub 2019 Feb 21.

DOI:10.1007/s00595-019-01780-2

PMID:30790053

Abstract

PURPOSE

Cancer-induced spiculation (CIS) on computed tomography, which is reticular or linear opacification of the pericolorectal fat tissues around the cancer site, is generally regarded as cancer infiltration into T3 or T4, but its clinicopathological significance is unknown. This study examines the correlation between CIS and clinicopathological findings to establish its prognostic value.

METHODS

The subjects of this retrospective study were 335 patients with colorectal cancer (CRC), who underwent curative surgery between January, 2010 and December, 2011, at the National Defense Medical College Hospital in Saitama Prefecture, Japan.

RESULTS

The level of interobserver agreement in the evaluation of CIS was substantial (83%; kappa value, 0.65). The presence of CIS was specific for T3/T4 disease (positive predictive value, 88.3%), and was significantly associated with tumor size and venous invasion. The 5-year relapse-free survival rate was significantly lower in patients with CIS than in those without CIS (68.6% and 84.0%, respectively, p = 0.001). Subgroup analysis revealed remarkable prognostic differences in patients with stage III and T3 disease. Multivariate analysis revealed that CIS was a significant independent prognostic factor.

CONCLUSIONS

CIS was a significant preoperative prognostic factor and could be useful in the selection of preoperative therapy for patients with CRC.

摘要

目的

计算机断层扫描（CT）上的癌性毛刺（CIS），即癌灶周围结直肠旁脂肪组织的网状或线状不透明，通常被认为是癌症浸润到 T3 或 T4，但其临床病理意义尚不清楚。本研究旨在探讨 CIS 与临床病理发现之间的相关性，以确定其预后价值。

方法

本回顾性研究的对象是 2010 年 1 月至 2011 年 12 月期间在日本埼玉县国防医科大学医院接受根治性手术的 335 例结直肠癌（CRC）患者。

结果

观察者评估 CIS 的一致性水平较高（83%；kappa 值为 0.65）。CIS 的存在对 T3/T4 疾病具有特异性（阳性预测值为 88.3%），且与肿瘤大小和静脉侵犯显著相关。CIS 阳性患者的 5 年无复发生存率明显低于 CIS 阴性患者（分别为 68.6%和 84.0%，p=0.001）。亚组分析显示，III 期和 T3 期患者的预后差异显著。多因素分析显示，CIS 是一个显著的独立预后因素。