Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Surg Oncol. 2022 May;41:101749. doi: 10.1016/j.suronc.2022.101749. Epub 2022 Mar 24.
The diagnostic accuracy of computed tomography (CT) for colon cancer is low, and the preoperative risk factors for locally advanced colon cancer are unknown. This study aimed to evaluate the correlation between preoperative CT scan findings and oncologic outcomes and to identify risk factors associated with locally advanced colon cancer.
Patients diagnosed with clinical stage (cT) 4 colon cancer based on preoperative CT scan findings who underwent curative surgery between January 2005 and December 2015 were retrospectively studied. Patients were divided according to pathologic stage (pT) into pT3 (n = 114) and pT4 (n = 102).
The disease-free survival rate was significantly different between the pT3 and pT4 groups (88.6% vs. 68.6%, p < 0.001). The overall survival rate of the pT3 group was significantly higher than that of the pT4 group (91.2% vs. 76.5%, p = 0.002). Perineural invasion and tumor budding were identified as preoperative risk factors predisposing to pT4 staging (p = 0.044, p = 0.001).
The survival rate of pT3 patients was significantly higher than that of pT4 patients with a preoperative cT4 diagnosis. This suggests that when planning for neoadjuvant chemotherapy in locally advanced colon cancer, preoperative CT scan findings may overestimate clinical staging and lead to inappropriate treatment. Thus, there is a need for a new modality to evaluate local advancement in colon cancer.
计算机断层扫描（CT）对结肠癌的诊断准确性较低，局部晚期结肠癌的术前危险因素尚不清楚。本研究旨在评估术前 CT 扫描结果与肿瘤学结果之间的相关性，并确定与局部晚期结肠癌相关的危险因素。
回顾性研究了 2005 年 1 月至 2015 年 12 月期间根据术前 CT 扫描结果诊断为临床分期（cT）4 期结肠癌并接受根治性手术的患者。患者根据病理分期（pT）分为 pT3 期（n=114）和 pT4 期（n=102）。
pT3 期和 pT4 期患者的无病生存率差异有统计学意义（88.6% vs. 68.6%，p<0.001）。pT3 期患者的总生存率明显高于 pT4 期患者（91.2% vs. 76.5%，p=0.002）。神经周围侵犯和肿瘤芽被确定为术前导致 pT4 分期的危险因素（p=0.044，p=0.001）。
术前 cT4 诊断为 pT3 期患者的生存率明显高于 pT4 期患者。这表明，在计划局部晚期结肠癌的新辅助化疗时，术前 CT 扫描结果可能高估了临床分期，导致治疗不当。因此，需要一种新的方法来评估结肠癌的局部进展。
