Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan.
Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan.
BJS Open. 2024 Jan 3;8(1). doi: 10.1093/bjsopen/zrad121.
The impact of computed tomography (CT)-detected extramural venous invasion on the recurrence of colon cancer is not fully understood. The aim of this study was to investigate the clinical significance of extramural venous invasion diagnosed before surgery by contrast-enhanced CT colonography using three-dimensional multiplanar reconstruction images.
Patients with colon cancer staged greater than or equal to T2 and/or stage I-III who underwent contrast-enhanced CT colonography between 2013 and 2018 at the National Cancer Center Hospital in Japan were retrospectively investigated for CT-detected extramural venous invasion. Inter-observer agreement for the detection of CT-detected extramural venous invasion was evaluated and Kaplan-Meier survival curves were plotted for recurrence-free survival using CT-TNM staging and CT-detected extramural venous invasion. Preoperative clinical variables were analysed using Cox regression for recurrence-free survival.
Out of 922 eligible patients, 544 cases were analysed (50 (9.2 per cent) were diagnosed as positive for CT-detected extramural venous invasion and 494 (90.8 per cent) were diagnosed as negative for CT-detected extramural venous invasion). The inter-observer agreement for CT-detected extramural venous invasion had a κ coefficient of 0.830. The group positive for CT-detected extramural venous invasion had a median follow-up of 62.1 months, whereas the group negative for CT-detected extramural venous invasion had a median follow-up of 60.7 months. When CT-TNM stage was stratified according to CT-detected extramural venous invasion status, CT-T3 N(-)extramural venous invasion(+) had a poor prognosis compared with CT-T3 N(-)extramural venous invasion(-) and CT-stage I (5-year recurrence-free survival of 50.6 versus 89.3 and 90.1 per cent respectively; P < 0.001). In CT-stage III, the group positive for CT-detected extramural venous invasion also had a poor prognosis compared with the group negative for CT-detected extramural venous invasion (5-year recurrence-free survival of 52.0 versus 78.5 per cent respectively; P = 0.003). Multivariable analysis revealed that recurrence was associated with CT-T4 (HR 3.10, 95 per cent c.i. 1.85 to 5.20; P < 0.001) and CT-detected extramural venous invasion (HR 3.08, 95 per cent c.i. 1.90 to 5.00; P < 0.001).
CT-detected extramural venous invasion was found to be an independent predictor of recurrence and could be used in combination with preoperative TNM staging to identify patients at high risk of recurrence.
计算机断层扫描（CT）检测到的外膜静脉侵犯对结肠癌复发的影响尚未完全了解。本研究旨在通过对比增强 CT 结肠成像的三维多平面重建图像，探讨术前 CT 检测到的外膜静脉侵犯的临床意义。
回顾性分析 2013 年至 2018 年在日本国家癌症中心医院接受对比增强 CT 结肠成像的 T2 期及以上和/或 I-III 期结肠癌患者，评估 CT 检测到的外膜静脉侵犯。评估观察者之间对 CT 检测到的外膜静脉侵犯的检测一致性，并使用 CT-TNM 分期和 CT 检测到的外膜静脉侵犯绘制无复发生存率的 Kaplan-Meier 生存曲线。使用 Cox 回归分析对无复发生存进行术前临床变量分析。
在 922 名合格患者中，分析了 544 例（50 例（9.2%）被诊断为 CT 检测到的外膜静脉侵犯阳性，494 例（90.8%）被诊断为 CT 检测到的外膜静脉侵犯阴性）。CT 检测到的外膜静脉侵犯的观察者之间一致性具有 κ 系数 0.830。CT 检测到外膜静脉侵犯阳性组的中位随访时间为 62.1 个月，而 CT 检测到外膜静脉侵犯阴性组的中位随访时间为 60.7 个月。当根据 CT 检测到的外膜静脉侵犯状态对 CT-TNM 分期进行分层时，与 CT-T3N（-）外膜静脉侵犯（+）相比，CT-T3N（-）外膜静脉侵犯（-）和 CT 期 I 的预后较差（5 年无复发生存率分别为 50.6%、89.3%和 90.1%；P <0.001）。在 CT 期 III 中，与 CT 检测到外膜静脉侵犯阴性组相比，CT 检测到外膜静脉侵犯阳性组的预后也较差（5 年无复发生存率分别为 52.0%和 78.5%；P = 0.003）。多变量分析显示，复发与 CT-T4（HR 3.10，95%可信区间 1.85 至 5.20；P <0.001）和 CT 检测到的外膜静脉侵犯（HR 3.08，95%可信区间 1.90 至 5.00；P <0.001）有关。
CT 检测到的外膜静脉侵犯被发现是复发的独立预测因子，可与术前 TNM 分期结合使用，以识别复发风险较高的患者。
