Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, Korea.
Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Abdom Radiol (NY). 2022 Nov;47(11):3679-3687. doi: 10.1007/s00261-022-03657-4. Epub 2022 Sep 6.
This study evaluates the prognostic significance of EMVI and DEMI on preoperative CT in patients with ascending colon cancer.
This retrospective study included consecutive patients with T3 ascending colon cancer from January 2012 to December 2016 in a tertiary center. Two radiologists independently reviewed EMVI, DEMI, and nodal status on preoperative CT. We assessed the association of age, sex, mucinous adenocarcinoma, EMVI, and DEMI with metastasis on preoperative CT using univariable and multivariable analysis. We also compared disease-free survival (DFS) with and without variables (age, sex, mucinous adenocarcinoma, EMVI, DEMI and adjuvant chemotherapy) using Cox's proportional hazards models. We assessed interobserver agreements on imaging features using the Cohen's weighted kappa.
Of 237 patients [107 men; mean (standard deviation) age, 66 (13) years], 24 had metastases on preoperative CT. Positive EMVI was associated with metastasis (odds ratio 16.9; P < 0.001) on multivariable analysis. Of 194 patients [83 men; 65 (13) years] included for DFS analysis, recurrence was observed in 31 (16%) with median follow-up of 53 months. Positive EMVI [hazard ratio (HR) 4.8; P < 0.001] and DEMI > 5 mm (HR 5.5; P < 0.001) were associated with worse DFS. Interobserver agreements were good (kappa = 0.64-0.67).
Positive EMVI and DEMI > 5 mm on preoperative CT were associated with a worse T3 ascending colon cancer prognosis. Thus, these CT findings could be used as imaging biomarkers for T3 ascending colon cancer risk stratification.
本研究评估升结肠癌患者术前 CT 中 EMVI 和 DEMI 的预后意义。
本回顾性研究纳入了 2012 年 1 月至 2016 年 12 月在一家三级中心接受治疗的 T3 升结肠癌连续患者。两名放射科医生独立评估术前 CT 上的 EMVI、DEMI 和淋巴结状态。我们使用单变量和多变量分析评估年龄、性别、黏液腺癌、EMVI 和 DEMI 与术前 CT 转移的关系。我们还使用 Cox 比例风险模型比较了有无变量（年龄、性别、黏液腺癌、EMVI、DEMI 和辅助化疗）的无病生存率（DFS）。我们使用 Cohen 的加权 kappa 评估了影像学特征的观察者间一致性。
在 237 例患者中（107 例男性；平均[标准差]年龄 66[13]岁），24 例患者在术前 CT 上有转移。多变量分析显示，阳性 EMVI 与转移相关（优势比 16.9；P<0.001）。在纳入 DFS 分析的 194 例患者中（83 例男性；65[13]岁），中位随访 53 个月后有 31 例（16%）复发。阳性 EMVI[风险比（HR）4.8；P<0.001]和 DEMI>5mm（HR 5.5；P<0.001）与较差的 DFS 相关。观察者间一致性良好（kappa=0.64-0.67）。
术前 CT 上的阳性 EMVI 和 DEMI>5mm 与 T3 升结肠癌预后不良相关。因此，这些 CT 表现可作为 T3 升结肠癌风险分层的影像学生物标志物。
