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Feng FW, Jiang FY, Liu YQ, Sun Q, Hong R, Hu CH, Hu S. Radiomics analysis of dual-layer spectral-detector CT-derived iodine maps for predicting tumor deposits in colorectal cancer. Eur Radiol 2024:10.1007/s00330-024-10918-x. [PMID: 38987399 DOI: 10.1007/s00330-024-10918-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 04/24/2024] [Accepted: 05/25/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVE To investigate the value of radiomics analysis of dual-layer spectral-detector computed tomography (DLSCT)-derived iodine maps for predicting tumor deposits (TDs) preoperatively in patients with colorectal cancer (CRC). MATERIALS AND METHODS A total of 264 pathologically confirmed CRC patients (TDs + (n = 80); TDs - (n = 184)) who underwent preoperative DLSCT from two hospitals were retrospectively enrolled, and divided into training (n = 124), testing (n = 54), and external validation cohort (n = 86). Conventional CT features and iodine concentration (IC) were analyzed and measured. Radiomics features were derived from venous phase iodine maps from DLSCT. The least absolute shrinkage and selection operator (LASSO) was performed for feature selection. Finally, a support vector machine (SVM) algorithm was employed to develop clinical, radiomics, and combined models based on the most valuable clinical parameters and radiomics features. Area under receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis were used to evaluate the model's efficacy. RESULTS The combined model incorporating the valuable clinical parameters and radiomics features demonstrated excellent performance in predicting TDs in CRC (AUCs of 0.926, 0.881, and 0.887 in the training, testing, and external validation cohorts, respectively), which outperformed the clinical model in the training cohort and external validation cohorts (AUC: 0.839 and 0.695; p: 0.003 and 0.014) and the radiomics model in two cohorts (AUC: 0.922 and 0.792; p: 0.014 and 0.035). CONCLUSION Radiomics analysis of DLSCT-derived iodine maps showed excellent predictive efficiency for preoperatively diagnosing TDs in CRC, and could guide clinicians in making individualized treatment strategies. CLINICAL RELEVANCE STATEMENT The radiomics model based on DLSCT iodine maps has the potential to aid in the accurate preoperative prediction of TDs in CRC patients, offering valuable guidance for clinical decision-making. KEY POINTS Accurately predicting TDs in CRC patients preoperatively based on conventional CT features poses a challenge. The Radiomics model based on DLSCT iodine maps outperformed conventional CT in predicting TDs. The model combing DLSCT iodine maps radiomics features and conventional CT features performed excellently in predicting TDs.
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Affiliation(s)
- Fei-Wen Feng
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Fei-Yu Jiang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuan-Qing Liu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Medical Imaging, Soochow University, Suzhou, China
| | - Qi Sun
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Rong Hong
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chun-Hong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China.
- Institute of Medical Imaging, Soochow University, Suzhou, China.
| | - Su Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China.
- Institute of Medical Imaging, Soochow University, Suzhou, China.
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Guan Z, Li ZW, Yang D, Yu T, Jiang HJ, Zhang XY, Yan S, Hou W, Sun YS. Small arteriole sign: an imaging feature for staging T4a colon cancer. Eur Radiol 2024; 34:444-454. [PMID: 37505247 DOI: 10.1007/s00330-023-09968-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES By analyzing the distribution of existing and newly proposed staging imaging features in pT1-3 and pT4a tumors, we searched for a salient feature and validated its diagnostic performance. METHODS Preoperative multiphase contrast-enhanced CT images of the training cohort were retrospectively collected at three centers from January 2016 to December 2017. We used the chi-square test to analyze the distribution of several stage-related imaging features in pT1-3 and pT4a tumors, including small arteriole sign (SAS), outer edge of the intestine, tumor invasion range, and peritumoral adipose tissue. Preoperative multiphase contrast-enhanced CT images of the validation cohort were retrospectively collected at Beijing Cancer Hospital from January 2018 to December 2018. The diagnostic performance of the selected imaging feature, including accuracy, sensitivity, and specificity, was validated and compared with the conventional clinical tumor stage (cT) by the McNemar test. RESULTS In the training cohort, a total of 268 patients were enrolled, and only SAS was significantly different between pT1-3 and pT4a tumors. The accuracy, sensitivity, and specificity of the SAS and conventional cT in differentiating T1-3 and T4a tumors were 94.4%, 81.6%, and 97.3% and 53.7%, 32.7%, and 58.4%, respectively (all p < 0.001). In the validation cohort, a total of 135 patients were collected. The accuracy, sensitivity, and specificity of the SAS and the conventional cT were 93.3%, 76.2%, and 96.5% and 62.2%, 38.1%, and 66.7%, respectively (p < 0.001, p = 0.021, p < 0.001). CONCLUSION Small arteriole sign positivity, an indirect imaging feature of serosa invasion, may improve the accuracy of identifying T4a colon cancer. CLINICAL RELEVANCE STATEMENT Small arteriole sign helps to distinguish T1-3 and T4a colon cancer and further improves the accuracy of preoperative CT staging of colon cancer. KEY POINTS • The accuracy of preoperative CT staging of colon cancer is not ideal, especially for T4a tumors. • Small arteriole sign (SAS) is a newly defined imaging feature that shows the appearance of tumor-supplying arterioles at the site where they penetrate the intestine wall. • SAS is an indirect imaging marker of tumor invasion into the serosa with a great value in distinguishing between T1-3 and T4a colon cancer.
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Affiliation(s)
- Zhen Guan
- Departments of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Zhong-Wu Li
- Departments of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Ding Yang
- Departments of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Tao Yu
- Department of Medical Imaging, Liaoning Cancer Hospital & Institute, Shenyang, 110042, China
| | - Hui-Jie Jiang
- Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China
| | - Xiao-Yan Zhang
- Departments of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China.
| | - Shuo Yan
- Departments of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Wei Hou
- Departments of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Ying-Shi Sun
- Departments of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China.
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Xie M, Liu G, Dong Y, Yu L, Song R, Zhang W, Zhang Y, Huang S, He J, Xiao Y, Long L. Effect of visceral fat area on the accuracy of preoperative CT-N staging of colorectal cancer. Eur J Radiol 2023; 168:111131. [PMID: 37804651 DOI: 10.1016/j.ejrad.2023.111131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 09/27/2023] [Accepted: 09/30/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE To investigate the effect of visceral fat area (VFA) on the accuracy of preoperative CT-N staging of colorectal cancer. METHODS We retrospectively reviewed the clinical and imaging data of 385 CRC patients who underwent surgical resection for colorectal cancer between January 2018 and July 2021. Preoperative CT-N staging and imaging features were determined independently by two radiologists. Using postoperative pathology as the gold standard, patients were divided into accurately and incorrectly staged groups, and clinical and imaging characteristics were compared between the two groups. VFA and subcutaneous fat area (SFA) at the L3 vertebral level, sex, age, BMI, tumor location, size, and tumor circumference ratio (TCR) were included. Logistic regression analysis was used to evaluate the independent factors influencing the accuracy of preoperative N staging of colorectal cancer. RESULTS Of the 385 patients enrolled, 259 (67.27%) were in the preoperative N-stage accurate staging group, and 126 (32.73%) were in the incorrectly staged group. Univariate analysis showed that there were significant differences in BMI, tumor location, VFA, SFA, size and TCR between the two groups (P<0.05). Logistic regression analysis showed that VFA (95% CI: 1.277, 3.813; P=0.005) and TCR (95% CI: 1.649, 17.545; P=0.005) were independent factors affecting the accuracy of N staging. The optimal cutoff points for VFA and TCR in predicting incorrect staging were 110 cm2 and 0.675, respectively. CONCLUSIONS Colorectal cancer patients with lower VFA and higher TCR and preoperative CT-N staging had an increased risk for diagnostic errors.
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Affiliation(s)
- Meizhen Xie
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China; Department of Radiology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi 545006, China; Liuzhou Key Laboratory of Molecular Imaging, Liuzhou, Guangxi 545006, China
| | - Gangyi Liu
- Department of Laboratory, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi 545006, China
| | - Yan Dong
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Lan Yu
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Rui Song
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Wei Zhang
- Department of Radiology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi 545006, China; Liuzhou Key Laboratory of Molecular Imaging, Liuzhou, Guangxi 545006, China
| | - Ying Zhang
- Department of Pathology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi 545006, China
| | - Shafei Huang
- Department of Scientific Research, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi 545006, China
| | - Jiaqian He
- Department of Radiology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi 545006, China
| | - Yunping Xiao
- Department of Radiology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi 545006, China; Liuzhou Key Laboratory of Molecular Imaging, Liuzhou, Guangxi 545006, China
| | - Liling Long
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China.
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Wang J, Yang C, Liu L, Rao S, Zeng M. Preoperative Local Staging of Colon Cancer by CT: Radiological Staging Criteria Based on Membrane Anatomy and Visceral Adipose Tissue. Dis Colon Rectum 2023; 66:e1006-e1013. [PMID: 35834554 DOI: 10.1097/dcr.0000000000002432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Accuracy of preoperative T staging for colon cancer remains disappointing. OBJECTIVE This study aimed to propose specially designed radiological staging criteria based on membrane anatomy and visceral adipose tissue and compare the staging performance with the routinely used method. DESIGN This is a prospective observational study. SETTING This study was conducted at a high-volume colorectal center. PARTICIPANTS Consecutive patients with colonoscopy-proven colon carcinoma referred for clinical staging and elective resection were enrolled. INTERVENTION The preoperative CT data were separately reviewed by 2 teams of radiologists for assigning T-stage categories (T1-2, T3, or T4) using the routine staging method or the newly proposed radiological criteria. MEASURES Diagnostic performance for T staging was compared between the 2 criteria. RESULTS Between October 2019 and August 2020, 190 patients were included. Compared with pathological results, T stage was correctly determined in 113 of 190 patients (59.5%) with the conventional CT criteria. With the newly developed criteria, 160 patients (84.2%) were found to be correctly staged. Accuracies between the 2 criteria significantly differed ( p < 0.001). For T1-2 staging, there were no significant differences between the sensitivities of conventional and new criteria (57.1% vs 61.9%; p = 0.990) or between their specificities (95.3% vs 98.2%; p = 0.131). However, for T3 and T4 staging, the newly developed CT criteria exhibited significantly higher sensitivity (T3: 85.2% vs 57.4%; p < 0.001; T4: 90.7% vs 64.8%; p < 0.001) and specificity (T3: 82.7% vs 64%; p = 0.006; T4: 89.7% vs 69.1%; p < 0.001) than the conventional criteria. Moreover, the new criteria (area under the curve = 0.902) performed significantly better than the conventional criteria (area under the curve = 0.670; p < 0.001), for identifying the T4-stage tumor. LIMITATIONS The limitations are that it is a single-center study and there was no external validation. CONCLUSIONS The specially designed radiological criteria can offer more accurate T staging than the routine method in colon cancer. See Video Abstract at http://links.lww.com/DCR/B992 . PREDICCIN DE LA MORTALIDAD A DAS POSTERIORES A LA PRIMERA CIRUGA EN PACIENTES CON CNCER DE COLON OBSTRUCTIVO DEL LADO IZQUIERDO ANTECEDENTES:Se cree que la resección aguda para el carcinoma de colon obstructivo del lado izquierdo está asociada con un mayor riesgo de mortalidad que un enfoque puente a la cirugía que utiliza un estoma de descompresión o un stent metálico autoexpandible, pero faltan modelos de predicción.OBJETIVO:Determinar la influencia de la estrategia de tratamiento sobre la mortalidad dentro de los 90 días desde la primera intervención utilizando un modelo de predicción en pacientes que presentan carcinoma de colon obstructivo del lado izquierdo.DISEÑO:Un estudio de cohorte multicéntrico nacional, utilizando datos de una auditoría nacional prospectiva.ENTORNO CLINICO:El estudio se realizó en 75 hospitales holandeses.PACIENTES:Se incluyeron los pacientes que se sometieron a una resección con intención curativa de un carcinoma de colon obstructivo del lado izquierdo entre 2009 y 2016.INTERVENCIONES:La primera intervención fue resección aguda, puente a cirugía con stent metálico autoexpandible o puente a cirugía con estoma descompresor.PRINCIPALES MEDIDAS DE VALORACIÓN:La principal medida de resultado fue la mortalidad a los 90 días después de la primera intervención. Los factores de riesgo se identificaron mediante análisis logístico multivariable. Posteriormente se desarrolló un modelo de riesgo.RESULTADOS:En total se incluyeron 2395 pacientes, siendo la primera intervención resección aguda en 1848 (77%) pacientes, estoma como puente a la cirugía en 332 (14%) pacientes y stent como puente a la cirugía en 215 (9%) pacientes. En general, 152 pacientes (6,3%) fallecieron dentro de los 90 días posteriores a la primera intervención. Un estoma de descompresión se asoció de forma independiente con un menor riesgo de mortalidad a los 90 días (HR: 0,27, IC: 0,094-0,62). Otros predictores independientes de mortalidad fueron la edad, la clasificación ASA, la ubicación del tumor y los niveles índice de creatinina sérica y proteína C reactiva. El modelo de riesgo construido tuvo un área bajo la curva de 0,84 (IC: 0,81-0,87).LIMITACIONES:Solo se incluyeron pacientes que se sometieron a resección quirúrgica.CONCLUSIONES:La estrategia de tratamiento tuvo un impacto significativo en la mortalidad a los 90 días. Un estoma descompresor reduce considerablemente el riesgo de mortalidad, especialmente en pacientes mayores y frágiles. Se desarrolló un modelo de riesgo, que necesita una mayor validación externa. Consulte Video Resumen en http://links.lww.com/DCR/B992 . (Traducción-Dr. Ingrid Melo ).
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Affiliation(s)
- Jian Wang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
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Li M, Xu G, Chen Q, Xue T, Peng H, Wang Y, Shi H, Duan S, Feng F. Computed Tomography-based Radiomics Nomogram for the Preoperative Prediction of Tumor Deposits and Clinical Outcomes in Colon Cancer: a Multicenter Study. Acad Radiol 2023; 30:1572-1583. [PMID: 36566155 DOI: 10.1016/j.acra.2022.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/16/2022] [Accepted: 11/07/2022] [Indexed: 12/24/2022]
Abstract
RATIONALE AND OBJECTIVES To develop and validate a computed tomography (CT)-based radiomics nomogram for the preoperative prediction of tumor deposits (TDs) and clinical outcomes in patients with colon cancer. MATERIALS AND METHODS This retrospective study included 383 consecutive patients with colon cancer from two centers. Radiomics features were extracted from portal venous phase CT images. Least absolute shrinkage and selection operator regression was applied for feature selection and radiomics signature construction. The multivariate logistic regression model was used to establish a radiomics nomogram. The performance of the nomogram was assessed by using receiver operating characteristic curves, calibration curves and decision curve analysis. Kaplan‒Meier survival analysis was used to assess the difference of the overall survival (OS) in the TDs-positive and TDs-negative groups. RESULTS The radiomics signature was composed of 11 TDs status related features. The AUCs of the radiomics model in the training cohort, internal validation and external validation cohorts were 0.82, 0.78 and 0.78, respectively. The radiomics nomogram that incorporated the radiomics signature and clinical independent predictors (CT-N, CEA and CA199) showed good calibration and discrimination with AUCs of 0.88, 0.80 and 0.81 in the training cohort, internal validation and external validation cohorts, respectively. The radiomics nomogram-predicted high-risk groups had a worse OS than the low-risk groups (p < 0.001). The radiomics nomogram-predicted TDs was an independent preoperative predictor of OS. CONCLUSION The radiomics nomogram based on CT radiomics features and clinical independent predictors could effectively predict the preoperative TDs status and OS of colon cancer. IMPORTANT FINDINGS CT-based radiomics nomogram may be applied in the individual preoperative prediction of TDs status in colon cancer. Additionally, there was a significant difference in OS between the high-risk and low-risk groups defined by the radiomics nomogram, in which patients with high-risk TDs had a significantly worse OS, compared with those with low-risk TDs.
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Affiliation(s)
- Manman Li
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu, PR China, 226361
| | - Guodong Xu
- Department of Radiology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, PR China
| | - Qiaoling Chen
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu, PR China, 226361
| | - Ting Xue
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu, PR China, 226361
| | - Hui Peng
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu, PR China, 226361
| | - Yuwei Wang
- Department of Record room, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu, PR China
| | - Hui Shi
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu, PR China, 226361
| | | | - Feng Feng
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu, PR China, 226361.
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Chen W, Ye Y, Zhang D, Mao L, Guo L, Zhang H, Du X, Deng W, Liu B, Liu X. Utility of dual-layer spectral-detector CT imaging for predicting pathological tumor stages and histologic grades of colorectal adenocarcinoma. Front Oncol 2022; 12:1002592. [PMID: 36248968 PMCID: PMC9564703 DOI: 10.3389/fonc.2022.1002592] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To assess the utility of Dual-layer spectral-detector CT (DLCT) in predicting the pT stage and histologic grade for colorectal adenocarcinoma (CRAC). Methods A total of 131 patients (mean 62.7 ± 12.9 years; 72 female, 59 male) with pathologically confirmed CRAC (35 pT1-2, 61 pT3, and 35 pT4; 32 high grade and 99 low grade), who received dual-phase DLCT were enrolled in this retrospective study. Normalized iodine concentration (NIC), slope of the spectral HU curve (λHU), and effective atomic number (Eff-Z) were measured for each lesion by two radiologists independently. Intraobserver reliability and interobserver agreement were assessed. The above values were compared between three pT-stage and two histologic-grade groups. The correlation between the pT stages and above values were assessed. Receiver operating characteristic (ROC) curves were calculated to evaluate the diagnostic efficacy. Results Intra-class correlation coefficients were ranged from 0.856 to 0.983 for all measurements. Eff-Z [7.21(0.09) vs 7.31 (0.10) vs 7.35 (0.19)], NICAP [0.11 (0.05) vs 0.15 (0.08) vs 0.15 (0.08)], NICVP [0.27 (0.06) vs 0.34 (0.11) vs 0.35 (0.12)], λHUAP [1.20 (0.45) vs 1.93 (1.18) vs 2.37 (0.91)], and λHUVP [2.07 (0.68) vs 2.35 (0.62) vs 3.09 (1.07)] were significantly different among pT stage groups (all P<0.001) and exhibited a positive correlation with pT stages (r= 0.503, 0.455, 0.394, 0.512, 0.376, respectively, all P<0.001). Eff-Z [7.37 (0.10) vs 7.28 (0.08)], NICAP[0.20 (0.10) vs 0.13 (0.08)], NICVP[0.35 (0.07) vs 0.31 (0.11)], and λHUAP [2.59 (1.11) vs 1.63 (0.75)] in the high-grade group were markedly higher than those in the low-grade group (all P<0.05). For discriminating the advanced- from early-stage CARC, the AUCs of Eff-Z, NICAP, NICVP, λHUAP, and λHUVP were 0.83, 0.80, 0.79, 0.86, and 0.68, respectively (all P<0.001). For discriminating the high- from low-grade CARC, the AUCs of Eff-Z, NICAP, NICVP, and λHUAP were 0.81, 0.81, 0.64, and 0.81, respectively (all P<0.05). Conclusions The quantitative parameters derived from DLCT may provide new markers for assessing pT stages and histologic differentiation in patients with CRAC.
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Affiliation(s)
- Weicui Chen
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yongsong Ye
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Daochun Zhang
- Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, China
| | - Liting Mao
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lei Guo
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hanliang Zhang
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaohua Du
- Department of Pathology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Weiwei Deng
- Clinical and Technical Support, Philips Healthcare, Shanghai, China
| | - Bo Liu
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xian Liu
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondence: Xian Liu,
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Ma T, Li X, Zhang T, Duan M, Ma Q, Cong L, Huang Z, Wang X, Chen Y. Effect of visceral adipose tissue on the accuracy of preoperative T-staging of gastric cancer. Eur J Radiol 2022; 155:110488. [PMID: 35988392 DOI: 10.1016/j.ejrad.2022.110488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Due to the anatomical characteristics of the tumor and the specific variables of the patients, the accuracy of preoperative T-staging of gastric cancer needs to be further improved. This study investigated the effect of visceral adipose tissue (VAT) on the accuracy of clinical T-staging of gastric cancer. METHODS The clinical data of 455 patients who underwent gastrectomy from January 2013 to December 2018 were analyzed retrospectively. Taking the postoperative pathological results as the reference standard, the patients were divided into accurate staging group and mistaken staging group according to the comparison of clinical T stage (cT) and pathological T stage (pT). The individual characteristics of the two groups were compared, including visceral fat content at L2/L3 level calculated on computed tomography, age, sex, tumor size, tumor location (cardia, stomach body, stomach antrum), and degree of differentiation. Multivariate logistic regression was used to determine the independent factors affecting the accuracy of cT staging. RESULTS Among the 455 patients, 355 patients (78.0 %) had accurate preoperative cT staging and 100 patients (22.0 %) had inaccurate preoperative cT staging. The average area of VAT in the accurate staging group was (129.8 ± 72.6) cm2 and that in the mistaken staging group was (74.6 ± 61.6) cm2 (P < 0.001). The optimal cut-off value of VAT was 97.8 cm2 calculated according to the Yoden index. Multivariate logistic regression analysis showed that VAT, tumor location and tumor size were independent predictors of cT accuracy. CONCLUSIONS Patients with lower visceral fat content (<97.8 cm2) based on L2/L3 level had a higher risk of false staging in preoperative clinical T staging.
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Affiliation(s)
- Teng Ma
- Department of Radiology, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Xiaojiao Li
- Department of Radiology, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Tong Zhang
- Department of Radiology, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Mingguang Duan
- Department of Radiology, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Qianli Ma
- Department of Radiology, Taian City Central Hospital, Taian, Shandong 271000, China
| | - Lin Cong
- Department of Medical Imaging Interventional Therapy, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Zhaoqin Huang
- Department of Radiology, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Ximing Wang
- Department of Radiology, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Yunchao Chen
- Department of Radiology, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China.
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Bardou M, Rouland A, Martel M, Loffroy R, Barkun AN, Chapelle N. Review article: obesity and colorectal cancer. Aliment Pharmacol Ther 2022; 56:407-418. [PMID: 35707910 DOI: 10.1111/apt.17045] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/01/2021] [Accepted: 05/11/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Obesity is a growing global public health problem. More than half the European and North American population is overweight or obese. Colon and rectum cancers are still the second leading cause of cancer death worldwide, and epidemiological data support an association between obesity and colorectal cancers (CRCs). AIM To review the literature on CRC epidemiology in obese subjects, assessing the effects of obesity, including childhood or maternal obesity, on CRC, diagnosis, management, and prognosis, and discussing targeted prophylactic measures. METHOD We searched PubMed for obesity/overweight/metabolic syndrome and CRC. Other key words included 'staging', 'screening', 'treatment', 'weight loss', 'bariatric surgery' and 'chemotherapy'. RESULTS In Europe, about 11% of CRCs are attributed to overweight and obesity. Epidemiological data suggest that obesity is associated with a 30%-70% increased risk of colon cancer in men, the association being less consistent in women. Visceral fat or abdominal obesity seems to be of greater concern than subcutaneous fat obesity, and any 1 kg/m2 increase in body mass index confers more risk (hazard ratio 1.03). Obesity might increase the likelihood of recurrence or mortality of the primary cancer and may affect initial management, including accurate staging. The risk maybe confounded by different factors, including lower adherence to organised CRC screening programmes. It is unclear whether bariatric surgery helps reduce rectal cancer risk. CONCLUSIONS Despite a growing body of evidence linking obesity to CRC, many questions remain unanswered, including whether we should screen patients with obesity earlier or propose prophylactic bariatric surgery for certain patients with obesity.
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Affiliation(s)
- Marc Bardou
- INSERM-Centre d'Investigations Cliniques 1432 (CIC 1432), CHU Dijon-Bourgogne, Dijon, France.,UFR Sciences Santé, Université de Bourgogne-Franche Comté, Dijon, France
| | - Alexia Rouland
- Endocrinology Department, CHU Dijon-Bourgogne, Dijon, France
| | - Myriam Martel
- Department of Clinical Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | | | - Alan N Barkun
- Division of Gastroenterology, McGill University Health Centre, Montréal, Québec, Canada
| | - Nicolas Chapelle
- Department of Gastroenterology, Digestive Diseases Institute, CHU de Nantes, Nantes, France.,INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN5, Nantes, France
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Komono A, Kajitani R, Matsumoto Y, Nagano H, Yoshimatsu G, Aisu N, Urakawa H, Hasegawa S. Preoperative T staging of advanced colorectal cancer by computed tomography colonography. Int J Colorectal Dis 2021; 36:2489-2496. [PMID: 34145484 DOI: 10.1007/s00384-021-03971-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Accurate preoperative T staging is important when determining the treatment strategy for advanced colorectal cancer. We have previously reported the usefulness of preoperative T staging based on the spatial relationship of tumors and "bordering vessels" by computed tomography colonography (CTC) with multiplanar reconstruction (MPR). The aims of this study were to evaluate the external validity of this method and to determine whether there is a difference in the accuracy of T staging between the mesenteric and antimesenteric sides. METHODS The study subjects were 110 patients with colorectal cancer who underwent preoperative CTC and surgical resection from June 2016 to March 2018. Preoperative T stage was determined by CTC based on the relationship between the tumor and the bordering vessels and compared with the pathological T stage. The influence of tumor location, namely, whether the tumor was on the antimesenteric or mesenteric side, on preoperative T staging was assessed in 78 patients with colorectal cancer. RESULTS Sensitivity, specificity, accuracy, positive, and negative predictive values were respectively, 65%, 91%, 83%, 76%, and 85% for T2 (n = 34); 76%, 82%, 81%, 50%, and 94% for T3 (n = 23); and 77%, 93%, 87%, 86%, and 88% for T4a disease (n = 39). Overall right answer rate was 83.3% (15/18) for the mesenteric side and 65% (39/60) for the antimesenteric side (n = 0.14). CONCLUSION Diagnostic criteria based on the bordering vessels seen on CTC images with MPR are useful for T staging of colorectal cancer. However, the accuracy differs between the antimesenteric and mesenteric sides.
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Affiliation(s)
- Akira Komono
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Ryuji Kajitani
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Yoshiko Matsumoto
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Hideki Nagano
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Gumpei Yoshimatsu
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.,Department of Regenerative Medicine and Transplantation, Fukuoka University Hospital, Fukuoka, Japan
| | - Naoya Aisu
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Hiroshi Urakawa
- Department of Diagnostic Radiology, Fukuoka University Hospital, Fukuoka, Japan
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
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10
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Lin M, Chen QY, Zheng CH, Li P, Xie JW, Wang JB, Lin JX, Huang CM. Effect of Preoperative Tumour Under-Staging on the Long-Term Survival of Patients Undergoing Radical Gastrectomy for Gastric Cancer. Cancer Res Treat 2021; 53:1123-1133. [PMID: 33677846 PMCID: PMC8524019 DOI: 10.4143/crt.2020.651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 03/04/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose This study aimed to evaluate the effect of preoperative tumor staging deviation (PTSD) on the long-term survival of patients undergoing radical gastrectomy for gastric cancer (RGGC). Materials and Methods Clinicopathological data of 2,346 patients who underwent RGGC were retrospectively analyzed. The preoperative tumor-lymph node-metastasis (TNM) under-staging group (uTNM) comprised patients who had earlier preoperative TNM than postoperative TNM, and the no preoperative under-staging group (nTNM) comprised the remaining patients. Results There were 1,031 uTNM (44.0%) and 1,315 nTNM cases (56.0%). Cox prognostic analysis revealed that PTSD independently affected the overall survival (OS) after surgery. The 5-year OS was lower in the uTNM group (41.8%) than in the nTNM group (71.6%). The patients less than 65 years old, with lower American Society of Anaesthesiologists score, 2–5 cm tumor located at the lower stomach, and cT1 or cN0 preoperative staging would more likely undergo D1+ lymph node dissection (LND) in uTNM (p < 0.05). Logistic analyses revealed that tumor size > 2 cm and body mass index ≤ 22.72 kg/m2 were independent risk factors of preoperative TNM tumor under-staging in patients with cT1N0M0 staging (p < 0.05). Conclusion Underestimated tumor staging is not rare, which possibly results in inadequate LND and affects the long-term survival for patients undergoing RGGC. D2 LND should be carefully performed in patients who are predisposed to this underestimation.
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Affiliation(s)
- Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
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