基于错配修复状态的结肠癌 CT 分期：高危结肠癌影像学特征的比较与建议。

Colon cancer CT staging according to mismatch repair status: Comparison and suggestion of imaging features for high-risk colon cancer.

机构信息

Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Seoul National University Hospital, Seoul, South Korea; GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands.

Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.

出版信息

Eur J Cancer. 2022 Oct;174:165-175. doi: 10.1016/j.ejca.2022.06.060. Epub 2022 Aug 24.

DOI:10.1016/j.ejca.2022.06.060

PMID:36029713

Abstract

BACKGROUND

Neoadjuvant treatment with either chemotherapy or immunotherapy is gaining momentum in colon cancers (CC). To reduce over-treatment, increasing staging accuracy using computed tomography (CT) is of high importance.

PURPOSE

To assess and compare CT imaging features of CC between mismatch repair-proficient (pMMR) and MMR-deficient (dMMR) tumours and identify CT features that can distinguish high-risk (pT3-4, N+) CC according to MMR status.

METHODS

Primary staging CTs of 266 patients who underwent primary surgical resection of a colon tumour were retrospectively and independently evaluated by two radiologists. Logistic regression analysis was performed to identify significant associations between imaging features and positive lymph node status. Receiver operating characteristic (ROC) curves of significantly associated features were assessed and validated in an external cohort of 104 patients.

RESULTS

Among pT3 tumours only, dMMR CC were significantly larger than pMMR CC in both length and thickness (length 59.39 ± 26.28 mm versus 48.70 ± 23.72, respectively, p = 0.031; thickness 20.54 mm ± 11.17 versus 16.34 ± 8.73, respectively, p = 0.027). For pMMR tumours, nodal internal heterogeneity on CT was significantly associated with a positive lymph node status (odds ratio (OR) = 2.66, p = 0.027), while for dMMR tumours, the largest short diameter of the nodes was associated with lymph node status (OR = 2.01, p = 0.049). The best cut-off value of the largest short diameter of involved nodes was 10.4 mm for dMMR and 7.95 mm for pMMR. In the external validation cohort, AUCs for predicting involved nodes based on the largest short diameter was 0.764 for dMMR tumours using 10 mm size cut-off and 0.624 for pMMR tumours using 7 mm cut-off.

CONCLUSION

These data show that CT imaging features of primary CC differ between dMMR and pMMR tumours, suggesting that the assessment of CT-based CC staging should take MMR status into consideration, especially for lymph node status, and thus may help in selecting patients for neoadjuvant treatment.

摘要

背景

新辅助治疗无论是化疗还是免疫治疗在结肠癌（CC）中都越来越受到重视。为了减少过度治疗，使用计算机断层扫描（CT）提高分期准确性非常重要。

目的

评估并比较错配修复功能正常（pMMR）和错配修复缺陷（dMMR）肿瘤的 CC 的 CT 成像特征，并确定根据 MMR 状态区分高风险（pT3-4、N+）CC 的 CT 特征。

方法

回顾性分析 266 例接受结肠肿瘤初次手术切除的患者的原发分期 CT，由两名放射科医生独立评估。使用逻辑回归分析评估影像学特征与阳性淋巴结状态之间的显著关联。对显著相关特征的受试者工作特征（ROC）曲线进行评估，并在 104 例外部队列患者中进行验证。

结果

仅在 pT3 肿瘤中，dMMR CC 在长度和厚度上均明显大于 pMMR CC（长度分别为 59.39 ± 26.28mm 和 48.70 ± 23.72mm，p = 0.031；厚度分别为 20.54mm ± 11.17mm 和 16.34mm ± 8.73mm，p = 0.027）。对于 pMMR 肿瘤，CT 上的淋巴结内部异质性与阳性淋巴结状态显著相关（优势比（OR）= 2.66，p = 0.027），而对于 dMMR 肿瘤，淋巴结的最大短径与淋巴结状态相关（OR = 2.01，p = 0.049）。dMMR 中受累淋巴结最大短径的最佳截断值为 10.4mm，pMMR 中为 7.95mm。在外部验证队列中，基于最大短径预测受累淋巴结的 AUC 对于 dMMR 肿瘤为 0.764（使用 10mm 大小截断），对于 pMMR 肿瘤为 0.624（使用 7mm 截断）。