Department of Medical Oncology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Abdom Radiol (NY). 2024 Feb;49(2):365-374. doi: 10.1007/s00261-023-04094-7. Epub 2023 Nov 29.
The shift from adjuvant to neoadjuvant treatment in colon cancer demands the radiological selection of patients for systemic therapy. The aim of this study was to evaluate the accuracy of the CT-based TNM stage and high-risk features, including extramural venous invasion (EMVI) and tumour deposits, in the identification of patients with histopathological advanced disease, currently considered for neoadjuvant treatment (T3-4 disease).
All consecutive patients surgically treated for non-metastatic colon cancer between January 2018 and January 2020 in a referral centre for colorectal cancer were identified retrospectively. All tumours were staged on CT according to the TNM classification system. Additionally, the presence of EMVI and tumour deposits on CT was evaluated. The histopathological TNM classification was used as reference standard.
A total of 176 patients were included. Histopathological T3-4 colon cancer was present in 85.0% of the patients with CT-detected T3-4 disease. Histopathological T3-4 colon cancer was present in 96.4% of the patients with CT-detected T3-4 colon cancer in the presence of both CT-detected EMVI and CT-detected tumour deposits. Histopathological T0-2 colon cancer was present in 50.8% of the patients with CT-detected T0-2 disease, and in 32.4% of the patients without CT-detected EMVI and tumour deposits.
The diagnostic accuracy of CT-based staging was comparable with previous studies. The presence of high-risk features on CT increased the probability of histopathological T3-4 colon cancer. However, a substantial part of the patients without CT-detected EMVI and tumour deposits was diagnosed with histopathological T3-4 disease. Hence, more accurate selection criteria are required to correctly identify patients with locally advanced disease.
在结肠癌中，从辅助治疗转为新辅助治疗需要影像学选择适合系统治疗的患者。本研究旨在评估基于 CT 的 TNM 分期和高危特征（包括壁外静脉侵犯[EMVI]和肿瘤沉积）在识别目前考虑新辅助治疗（T3-4 疾病）的患者中的准确性，这些患者存在组织病理学上的晚期疾病。
回顾性分析 2018 年 1 月至 2020 年 1 月期间，一家结直肠癌转诊中心接受手术治疗的非转移性结肠癌连续患者。所有肿瘤均根据 TNM 分类系统在 CT 上进行分期。此外，还评估了 CT 上 EMVI 和肿瘤沉积的存在。组织病理学 TNM 分类作为参考标准。
共纳入 176 例患者。在 CT 检测到 T3-4 疾病的患者中，有 85.0%存在组织病理学 T3-4 结肠癌。在 CT 检测到同时存在 EMVI 和肿瘤沉积的 T3-4 结肠癌患者中，有 96.4%存在组织病理学 T3-4 结肠癌。在 CT 检测到 T0-2 疾病的患者中，有 50.8%存在组织病理学 T0-2 结肠癌，而在未检测到 CT 检测到 EMVI 和肿瘤沉积的患者中，有 32.4%存在组织病理学 T0-2 结肠癌。
基于 CT 的分期诊断准确性与既往研究相当。CT 上存在高危特征增加了组织病理学 T3-4 结肠癌的可能性。然而，相当一部分未检测到 CT 检测到 EMVI 和肿瘤沉积的患者被诊断为组织病理学 T3-4 疾病。因此，需要更准确的选择标准来正确识别局部晚期疾病患者。
