Seo Nieun, Lim Joon Seok, Chung Taek, Lee Jong Min, Min Byung Soh, Kim Myeong-Jin
Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea.
Eur Radiol. 2023 Apr;33(4):2757-2767. doi: 10.1007/s00330-022-09222-3. Epub 2022 Nov 10.
The aim of this retrospective study was to predict circumferential resection margin (CRM) involvement on preoperative CT, and prognostic impact of CRM assessment by CT (ctCRM) in patients with retroperitonealized colon cancer.
This study included patients who underwent resection for ascending or descending colon cancer between July 2010 and February 2013. Positive ctCRM was defined as tumor distance to the retromesenteric plane of ≤ 1 mm. The origin of positive CRM was divided into primary tumor or other tumor components including lymph nodes, tumor deposits, or extramural venous invasions. Logistic regression analysis was performed to identify preoperative factors to predict pathologic CRM (pCRM). A Cox proportional hazards model was used in multivariable analysis to determine the preoperative factors affecting disease-free survival (DFS).
A total of 274 patients (mean age, 64.0 years ± 11.0 [standard deviation]; 157 men) with retroperitonealized colon cancer were evaluated. Of 274 patients, 67 patients (24.5%) had positive CRM on surgical pathology. The accuracy of preoperative CT in predicting pCRM was 79.6% (218/274). Among preoperative factors, only CRM assessment on CT was independently associated with pCRM (p < 0.001). Positive ctCRM by primary tumor was an independent factor for DFS (HR, 3.362 [1.714-6.593]) and systemic recurrence (HR, 3.715 [1.787-7.724], but not for local recurrence on multivariable analyses.
Preoperative CT can accurately predict pCRM, and positive ctCRM by primary tumor is an independent risk factor for DFS and systemic recurrence, but not for local recurrence in retroperitonealized colon cancer.
• Preoperative CT can predict pathologic circumferential resection margin (CRM) with approximately 80% of accuracy in patients with retroperitonealized colon cancer. • Positive CRM by a primary tumor on preoperative CT is a poor prognostic factor for disease-free survival and systemic recurrence in patients with retroperitonealized colon cancer. • CRM involvement on CT was not associated with local recurrence in patients with retroperitonealized colon cancer.
本回顾性研究旨在预测术前CT对腹膜后结肠癌患者环周切缘（CRM）受累情况的评估，以及CT评估CRM（ctCRM）对患者预后的影响。
本研究纳入了2010年7月至2013年2月间接受升结肠癌或降结肠癌切除术的患者。ctCRM阳性定义为肿瘤距肠系膜后平面≤1mm。CRM阳性的来源分为原发性肿瘤或其他肿瘤成分，包括淋巴结、肿瘤结节或壁外静脉侵犯。采用逻辑回归分析确定预测病理CRM（pCRM）的术前因素。多变量分析中使用Cox比例风险模型确定影响无病生存期（DFS）的术前因素。
共评估了274例腹膜后结肠癌患者（平均年龄64.0岁±11.0[标准差]；男性157例）。274例患者中，67例（24.5%）手术病理显示CRM阳性。术前CT预测pCRM的准确率为79.6%（218/274）。在术前因素中，仅CT上的CRM评估与pCRM独立相关（p<0.001）。原发性肿瘤导致的ctCRM阳性是DFS（风险比[HR]，3.362[1.714 - 6.593]）和全身复发（HR，3.715[1.787 - 7.724]）的独立因素，但在多变量分析中不是局部复发的独立因素。
术前CT可准确预测pCRM，原发性肿瘤导致的ctCRM阳性是DFS和全身复发的独立危险因素，但不是腹膜后结肠癌局部复发的独立危险因素。
•术前CT可在约80%的准确率下预测腹膜后结肠癌患者的病理环周切缘（CRM）。•术前CT显示原发性肿瘤CRM阳性是腹膜后结肠癌患者无病生存期和全身复发的不良预后因素。•CT显示的CRM受累与腹膜后结肠癌患者的局部复发无关。
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