多排 CT 测量可切除结肠癌的肿瘤大小：与区域淋巴结转移和 N 分期的相关性。
Tumor size measured by multidetector CT in resectable colon cancer: correlation with regional lymph node metastasis and N stage.
机构信息
Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, 32# Second Section of First Ring Rd, Qingyang District, Chengdu, 610072, China.
Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China.
出版信息
World J Surg Oncol. 2021 Jun 16;19(1):179. doi: 10.1186/s12957-021-02292-5.
BACKGROUND
Lymph node metastasis (LNM) is a risk factor for poor long-term outcomes and a prognostic factor for disease-free survival in colon cancer. Preoperative lymph node status evaluation remains a challenge. The purpose of this study is to determine whether tumor size measured by multidetector computed tomography (MDCT) could be used to predict LNM and N stage in colon cancer.
MATERIAL AND METHODS
One hundred six patients with colon cancer who underwent radical surgery within 1 week of MDCT scan were enrolled. Tumor size including tumor length (Tlen), tumor maximum diameter (Tdia), tumor maximum cross-sectional area (Tare), and tumor volume (Tvol) were measured to be correlated with pathologic LNM and N stage using univariate logistic regression analysis, multivariate logistic analysis, and receiver operating characteristic (ROC) curve analysis.
RESULTS
The inter- and intraobserver reproducibility of Tlen (intraclass correlation coefficient [ICC] = 0.94, 0.95, respectively), Tdia (ICC = 0.81, 0.93, respectively), Tare (ICC = 0.97, 0.91, respectively), and Tvol (ICC = 0.99, 0.99, respectively) parameters measurement are excellent. Univariate logistic regression analysis showed that there were significant differences in Tlen, Tdia, Tare, and Tvol between positive and negative LNM (p < 0.001, 0.001, < 0.001, < 0.001, respectively). Multivariate logistic regression analysis revealed that Tvol was independent risk factor for predicting LNM (odds ratio, 1.082; 95% confidence interval for odds ratio, 1.039, 1.127, p<0.001). Tlen, Tdia, Tare, and Tvol could distinguish N0 from N1 stage (p < 0.001, 0.041, < 0.001, < 0.001, respectively), N0 from N2 (all p < 0.001), N0 from N1-2 (p < 0.001, 0.001, < 0.001, < 0.001, respectively), and N0-1 from N2 (p < 0.001, 0.001, < 0.001, < 0.001, respectively). The area under the ROC curve (AUC) was higher for Tvol than that of Tlen, Tdia, and Tare in identifying LNM (AUC = 0.83, 0.82, 0.69, 0.79), and distinguishing N0 from N1 stage (AUC = 0.79, 0.78, 0.63, 0.74), N0 from N2 stage (AUC = 0.92, 0.89, 0.80, 0.89, respectively), and N0-1 from N2 stage (AUC = 0.84, 0.79, 0.76, 0.83, respectively).
CONCLUSION
Tumor size was correlated with regional LNM in resectable colon cancer. In particularly, Tvol showed the most potential for noninvasive preoperative prediction of regional LNM and N stage.
背景
淋巴结转移（LNM）是结肠癌患者长期预后不良的危险因素，也是无病生存的预后因素。术前淋巴结状态评估仍然是一个挑战。本研究旨在确定多排螺旋 CT（MDCT）测量的肿瘤大小是否可用于预测结肠癌的 LNM 和 N 分期。
材料与方法
纳入 106 例在 MDCT 扫描后 1 周内接受根治性手术的结肠癌患者。使用单变量逻辑回归分析、多变量逻辑回归分析和受试者工作特征（ROC）曲线分析，测量肿瘤大小，包括肿瘤长度（Tlen）、肿瘤最大直径（Tdia）、肿瘤最大横截面积（Tare）和肿瘤体积（Tvol），并与病理 LNM 和 N 分期相关。
结果
Tlen（组内相关系数 [ICC] = 0.94、0.95）、Tdia（ICC = 0.81、0.93）、Tare（ICC = 0.97、0.91）和 Tvol（ICC = 0.99、0.99）参数测量的观察者内和观察者间重复性均极好。单变量逻辑回归分析显示，Tlen、Tdia、Tare 和 Tvol 在 LNM 阳性和阴性之间存在显著差异（p < 0.001、0.001、<0.001、<0.001）。多变量逻辑回归分析显示，Tvol 是预测 LNM 的独立危险因素（比值比，1.082；比值比的 95%置信区间，1.039、1.127，p<0.001）。Tlen、Tdia、Tare 和 Tvol 可区分 N0 与 N1 期（p < 0.001、0.041、<0.001、<0.001），N0 与 N2 期（均 p < 0.001），N0 与 N1-2 期（p < 0.001、0.001、<0.001、<0.001），N0-1 与 N2 期（p < 0.001、0.001、<0.001、<0.001）。Tvol 在识别 LNM（AUC = 0.83、0.82、0.69、0.79）和区分 N0 与 N1 期（AUC = 0.79、0.78、0.63、0.74）、N0 与 N2 期（AUC = 0.92、0.89、0.80、0.89）、N0-1 与 N2 期（AUC = 0.84、0.79、0.76、0.83）时，曲线下面积（AUC）均高于 Tlen、Tdia 和 Tare。
结论
肿瘤大小与可切除结肠癌的局部 LNM 相关。特别是，Tvol 最有可能用于非侵入性术前预测局部 LNM 和 N 分期。
Zotero 插件