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Shimura Y, Komatsu S, Nagatani Y, Funakoshi Y, Sofue K, Kido M, Kuramitsu K, Gon H, Fukushima K, Urade T, So S, Yanagimoto H, Toyama H, Minami H, Fukumoto T. The Usefulness of Total Tumor Volume as a Prognostic Factor and in Selecting the Optimal Treatment Strategy of Chemotherapeutic Intervention in Patients with Colorectal Liver Metastases. Ann Surg Oncol 2023; 30:6603-6610. [PMID: 37386304 DOI: 10.1245/s10434-023-13746-3] [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: 02/09/2023] [Accepted: 05/31/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Few reports have discussed the association between total tumor volume (TTV) and prognosis in patients with colorectal liver metastases (CRLM). The present study aimed to evaluate the usefulness of TTV for predicting recurrence-free survival and overall survival (OS) in patients receiving initial hepatic resection or chemotherapy, and to investigate the value of TTV as an indicator for optimal treatment selection for patients with CRLM. PATIENTS AND METHODS This retrospective cohort study included patients with CRLM who underwent hepatic resection (n = 93) or chemotherapy (n = 78) at the Kobe University Hospital. TTV was measured using 3D construction software and computed tomography images. RESULTS A TTV of 100 cm3 has been previously reported as a significant cut-off value for predicting OS of CRLM patients receiving initial hepatic resection. For patients receiving hepatic resection, the OS for those with a TTV ≥ 100 cm3 was significantly reduced compared with those with a TTV < 100 cm3. For patients receiving initial chemotherapy, there were no significant differences between the groups divided according to TTV cut-offs. Regarding OS of patients with TTV ≥ 100 cm3, there was no significant difference between hepatic resection and chemotherapy (p = 0.160). CONCLUSIONS TTV can be a predictive factor of OS for hepatic resection, unlike for initial chemotherapy treatment. The lack of significant difference in OS for CRLM patients with TTV ≥ 100 cm3, regardless of initial treatment, suggests that chemotherapeutic intervention preceding hepatic resection may be indicated for such patients.
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Affiliation(s)
- Yuhi Shimura
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Shohei Komatsu
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
| | - Yoshiaki Nagatani
- Department of Medical Oncology/Hematology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yohei Funakoshi
- Department of Medical Oncology/Hematology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Keitaro Sofue
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Masahiro Kido
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kaori Kuramitsu
- Department of Medical Oncology/Hematology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hidetoshi Gon
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kenji Fukushima
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takeshi Urade
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Shinichi So
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hiroaki Yanagimoto
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hirochika Toyama
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hironobu Minami
- Department of Medical Oncology/Hematology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takumi Fukumoto
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Huerta Y, De Mello Souza CH, Selmic LE, McGrath A, Skinner OT, Dark KV, Traverson M, Snell WL, Maxwell EA, Bertran J, Hasiuk MMM. Complications associated with iliosacral lymphadenectomy in dogs with metastatic apocrine gland anal sac adenocarcinoma. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2022; 63:929-934. [PMID: 36060485 PMCID: PMC9377189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To report intraoperative and immediate postoperative complications associated with removal of metastatic iliosacral lymph nodes in dogs with apocrine gland anal sac adenocarcinoma. ANIMALS There were 136 client-owned dogs in the study. PROCEDURE Retrospective multi-institutional study. The database of collaborating institutions was searched for dogs with metastatic apocrine gland anal sac adenocarcinoma that underwent lymphadenectomy for removal of one or more iliosacral lymph nodes. Information of signalment, hematological abnormalities, abdominal computed tomography or ultrasound findings, number and size of enlarged lymph nodes, intraoperative and postoperative complications, treatment and outcome were collected. RESULTS The overall complication rate associated with metastatic iliosacral lymphadenectomy was 26.1%. The only intraoperative complication recorded was hemorrhage and was reported in 24 (17.6%) surgeries, 11 (45.8%) of which received a blood transfusion. Postoperative complications were reported in 10.4% of surgeries, and included edema formation (n = 4, 2.6%), unilateral or bilateral paraparesis (n = 4, 2.6%), hypotension (n = 3, 2.0%), surgical site infection (n = 2, 1.3%), abdominal incision dehiscence (n = 1, 0.6%), urinary incontinence (n = 1, 0.6%), and death (n = 1, 0.6%). The size of the iliosacral lymph nodes was significantly associated with a greater risk of complications, hemorrhage, and the need of transfusion during lymphadenectomy for metastatic apocrine gland anal sac adenocarcinoma. CONCLUSION Complications associated with iliosacral lymphadenectomy for metastatic apocrine gland anal sac adenocarcinoma are relatively common and mostly relate to hemorrhage. These complications are significantly associated with the size of the extirpated metastatic lymph nodes. CLINICAL RELEVANCE This retrospective study provides information for the clinician regarding the potential surgical complications for extirpation of metastatic iliosacral lymph nodes. These complications, although not common, can be severe and should be discussed with owners before surgery.
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Affiliation(s)
- Yael Huerta
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida 32611, USA (Huerta, De Mello Souza, Maxwell, Bertran, Hasiuk); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio 43210, USA (Selmic, McGrath); Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri 65211, USA (Skinner, Dark); Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina 27695, USA (Traverson); BluePearl Pet Hospital Charlestown, Boston, Massachusetts 02129, USA (Snell)
| | - Carlos H De Mello Souza
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida 32611, USA (Huerta, De Mello Souza, Maxwell, Bertran, Hasiuk); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio 43210, USA (Selmic, McGrath); Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri 65211, USA (Skinner, Dark); Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina 27695, USA (Traverson); BluePearl Pet Hospital Charlestown, Boston, Massachusetts 02129, USA (Snell)
| | - Laura E Selmic
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida 32611, USA (Huerta, De Mello Souza, Maxwell, Bertran, Hasiuk); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio 43210, USA (Selmic, McGrath); Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri 65211, USA (Skinner, Dark); Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina 27695, USA (Traverson); BluePearl Pet Hospital Charlestown, Boston, Massachusetts 02129, USA (Snell)
| | - Alysha McGrath
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida 32611, USA (Huerta, De Mello Souza, Maxwell, Bertran, Hasiuk); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio 43210, USA (Selmic, McGrath); Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri 65211, USA (Skinner, Dark); Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina 27695, USA (Traverson); BluePearl Pet Hospital Charlestown, Boston, Massachusetts 02129, USA (Snell)
| | - Owen T Skinner
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida 32611, USA (Huerta, De Mello Souza, Maxwell, Bertran, Hasiuk); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio 43210, USA (Selmic, McGrath); Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri 65211, USA (Skinner, Dark); Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina 27695, USA (Traverson); BluePearl Pet Hospital Charlestown, Boston, Massachusetts 02129, USA (Snell)
| | - Katelin V Dark
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida 32611, USA (Huerta, De Mello Souza, Maxwell, Bertran, Hasiuk); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio 43210, USA (Selmic, McGrath); Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri 65211, USA (Skinner, Dark); Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina 27695, USA (Traverson); BluePearl Pet Hospital Charlestown, Boston, Massachusetts 02129, USA (Snell)
| | - Marine Traverson
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida 32611, USA (Huerta, De Mello Souza, Maxwell, Bertran, Hasiuk); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio 43210, USA (Selmic, McGrath); Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri 65211, USA (Skinner, Dark); Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina 27695, USA (Traverson); BluePearl Pet Hospital Charlestown, Boston, Massachusetts 02129, USA (Snell)
| | - William L Snell
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida 32611, USA (Huerta, De Mello Souza, Maxwell, Bertran, Hasiuk); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio 43210, USA (Selmic, McGrath); Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri 65211, USA (Skinner, Dark); Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina 27695, USA (Traverson); BluePearl Pet Hospital Charlestown, Boston, Massachusetts 02129, USA (Snell)
| | - Elizabeth A Maxwell
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida 32611, USA (Huerta, De Mello Souza, Maxwell, Bertran, Hasiuk); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio 43210, USA (Selmic, McGrath); Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri 65211, USA (Skinner, Dark); Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina 27695, USA (Traverson); BluePearl Pet Hospital Charlestown, Boston, Massachusetts 02129, USA (Snell)
| | - Judith Bertran
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida 32611, USA (Huerta, De Mello Souza, Maxwell, Bertran, Hasiuk); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio 43210, USA (Selmic, McGrath); Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri 65211, USA (Skinner, Dark); Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina 27695, USA (Traverson); BluePearl Pet Hospital Charlestown, Boston, Massachusetts 02129, USA (Snell)
| | - Michelle M M Hasiuk
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida 32611, USA (Huerta, De Mello Souza, Maxwell, Bertran, Hasiuk); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio 43210, USA (Selmic, McGrath); Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri 65211, USA (Skinner, Dark); Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina 27695, USA (Traverson); BluePearl Pet Hospital Charlestown, Boston, Massachusetts 02129, USA (Snell)
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Shu Z, Mao D, Song Q, Xu Y, Pang P, Zhang Y. Multiparameter MRI-based radiomics for preoperative prediction of extramural venous invasion in rectal cancer. Eur Radiol 2021; 32:1002-1013. [PMID: 34482429 DOI: 10.1007/s00330-021-08242-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/21/2021] [Accepted: 08/02/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To compare multiparameter MRI-based radiomics for preoperative prediction of extramural venous invasion (EMVI) in rectal cancer using different machine learning algorithms and to develop and validate the best diagnostic model. METHODS We retrospectively analyzed 317 patients with rectal cancer. Of these, 114 were EMVI positive and 203 were EMVI negative. Radiomics features were extracted from T2-weighted imaging, T1-weighted imaging, diffusion-weighted imaging, and enhanced T1-weighted imaging of rectal cancer, followed by the dimension reduction of the features. Logistic regression, support vector machine, Bayes, K-nearest neighbor, and random forests algorithms were trained to obtain the radiomics signatures. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of each radiomics signature. The best radiomics signature was selected and combined with clinical and radiological characteristics to construct a joint model for predicting EMVI. Finally, the predictive performance of the joint model was assessed. RESULTS The Bayes-based radiomics signature performed well in both the training set and the test set, with the AUCs of 0.744 and 0.738, sensitivities of 0.754 and 0.728, and specificities of 0.887 and 0.918, respectively. The joint model performed best in both the training set and the test set, with the AUCs of 0.839 and 0.835, sensitivities of 0.633 and 0.714, and specificities of 0.901 and 0.885, respectively. CONCLUSIONS The joint model demonstrated the best diagnostic performance for the preoperative prediction of EMVI in patients with rectal cancer. Hence, it can be used as a key tool for clinical individualized EMVI prediction. KEY POINTS • Radiomics features from magnetic resonance imaging can be used to predict extramural venous invasion (EMVI) in rectal cancer. • Machine learning can improve the accuracy of predicting EMVI in rectal cancer. • Radiomics can serve as a noninvasive biomarker to monitor the status of EMVI.
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Affiliation(s)
- Zhenyu Shu
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Dewang Mao
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Qiaowei Song
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yuyun Xu
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Peipei Pang
- Department of Pharmaceuticals Diagnosis, GE Healthcare, Hangzhou, China
| | - Yang Zhang
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China.
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Tai K, Komatsu S, Sofue K, Kido M, Tanaka M, Kuramitsu K, Awazu M, Gon H, Tsugawa D, Yanagimoto H, Toyama H, Murakami S, Murakami T, Fukumoto T. Total tumour volume as a prognostic factor in patients with resectable colorectal cancer liver metastases. BJS Open 2020; 4:456-466. [PMID: 32277807 PMCID: PMC7260417 DOI: 10.1002/bjs5.50280] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 02/16/2020] [Indexed: 12/29/2022] Open
Abstract
Background Although total tumour volume (TTV) may have prognostic value for hepatic resection in certain solid cancers, its importance in colorectal liver metastases (CRLM) remains unexplored. This study investigated its prognostic value in patients with resectable
CRLM. Method This was a retrospective review of patients who underwent hepatic resection for CRLM between 2008 and 2017 in a single institution. TTV was measured from CT images using three‐dimensional construction software; cut‐off values were determined using receiver operating characteristic (ROC) curve analyses. Potential prognostic factors, overall survival (OS) and recurrence‐free survival (RFS) were determined using multivariable and Kaplan–Meier analyses. Results Some 94 patients were included. TTV cut‐off values for OS and RFS were 100 and 10 ml respectively. Right colonic primary tumours, primary lymph node metastasis and bilobar liver metastasis were included in the multivariable analysis of OS; a TTV of 100 ml or above was independently associated with poorer OS (hazard ratio (HR) 6·34, 95 per cent c.i. 2·08 to 17·90; P = 0·002). Right colonic primary tumours and primary lymph node metastasis were included in the RFS analysis; a TTV of 10 ml or more independently predicted poorer RFS (HR 1·90, 1·12 to 3·57; P = 0·017). The 5‐year OS rate for a TTV of 100 ml or more was 41 per cent, compared with 67 per cent for a TTV below 100 ml (P = 0·006). Corresponding RFS rates with TTV of 10 ml or more, or less than 10 ml, were 14 and 58 per cent respectively (P = 0·009). A TTV of at least 100 ml conferred a higher rate of unresectable initial recurrences (12 of 15, 80 per cent) after initial hepatic resection. Conclusion TTV was associated with RFS and OS after initial hepatic resection for CRLM; TTV of 100 ml or above was associated with a higher rate of unresectable recurrence.
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Affiliation(s)
- K Tai
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe, Hyogo, Japan
| | - S Komatsu
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe, Hyogo, Japan
| | - K Sofue
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - M Kido
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe, Hyogo, Japan
| | - M Tanaka
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe, Hyogo, Japan
| | - K Kuramitsu
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe, Hyogo, Japan
| | - M Awazu
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe, Hyogo, Japan
| | - H Gon
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe, Hyogo, Japan
| | - D Tsugawa
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe, Hyogo, Japan
| | - H Yanagimoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe, Hyogo, Japan
| | - H Toyama
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe, Hyogo, Japan
| | - S Murakami
- Clinical and Translational Research Centre, Kobe University Hospital, Kobe, Hyogo, Japan
| | - T Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - T Fukumoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe, Hyogo, Japan
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Cai D, Huang ZH, Yu HC, Wang XL, Bai LL, Tang GN, Peng SY, Li YJ, Huang MJ, Cao GW, Wang JP, Luo YX. Prognostic value of preoperative carcinoembryonic antigen/tumor size in rectal cancer. World J Gastroenterol 2019; 25:4945-4958. [PMID: 31543685 PMCID: PMC6737319 DOI: 10.3748/wjg.v25.i33.4945] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/04/2019] [Accepted: 05/18/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Carcinoembryonic antigen (CEA) is a commonly used biomarker in colorectal cancer. However, controversy exists regarding the insufficient prognostic value of preoperative serum CEA alone in rectal cancer. Here, we combined preoperative serum CEA and the maximum tumor diameter to correct the CEA level, which may better reflect the malignancy of rectal cancer.
AIM To assess the prognostic impact of preoperative CEA/tumor size in rectal cancer.
METHODS We retrospectively reviewed 696 stage I to III rectal cancer patients who underwent curative tumor resection from 2007 to 2012. These patients were randomly divided into two cohorts for cross-validation: training cohort and validation cohort. The training cohort was used to generate an optimal cutoff point and the validation cohort was used to further validate the model. Maximally selected rank statistics were used to identify the optimum cutoff for CEA/tumor size. The Kaplan-Meier method and log-rank test were used to plot the survival curve and to compare the survival data. Univariate and multivariate Cox regression analyses were used to determine the prognostic value of CEA/tumor size. The primary and secondary outcomes were overall survival (OS) and disease-free survival (DFS), respectively.
RESULTS In all, 556 patients who satisfied both the inclusion and exclusion criteria were included and randomly divided into the training cohort (2/3 of 556, n = 371) and the validation cohort (1/3 of 556, n = 185). The cutoff was 2.429 ng/mL per cm. Comparison of the baseline data showed that high CEA/tumor size was correlated with older age, high TNM stage, the presence of perineural invasion, high CEA, and high carbohydrate antigen 19-9 (CA 19-9). Kaplan-Meier curves showed a manifest reduction in 5-year OS (training cohort: 56.7% vs 81.1%, P < 0.001; validation cohort: 58.8% vs 85.6%, P < 0.001) and DFS (training cohort: 52.5% vs 71.9%, P = 0.02; validation cohort: 50.3% vs 79.3%, P = 0.002) in the high CEA/tumor size group compared with the low CEA/tumor size group. Univariate and multivariate analyses identified CEA/tumor size as an independent prognostic factor for OS (training cohort: hazard ratio (HR) = 2.18, 95% confidence interval (CI): 1.28-3.73, P = 0.004; validation cohort: HR = 4.83, 95%CI: 2.21-10.52, P < 0.001) as well as DFS (training cohort: HR = 1.47, 95%CI: 0.93-2.33, P = 0.096; validation cohort: HR = 2.61, 95%CI: 1.38-4.95, P = 0.003).
CONCLUSION Preoperative CEA/tumor size is an independent prognostic factor for patients with stage I-III rectal cancer. Higher CEA/tumor size is associated with worse OS and DFS.
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Affiliation(s)
- Du Cai
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease (Supported by National Key Clinical Discipline), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Zeng-Hong Huang
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease (Supported by National Key Clinical Discipline), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Department of Biochemistry and Molecular Medicine, School of Medicine, University of California, Davis, Sacramento, CA 95817, United States
| | - Hui-Chuan Yu
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease (Supported by National Key Clinical Discipline), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Xiao-Lin Wang
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease (Supported by National Key Clinical Discipline), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Liang-Liang Bai
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease (Supported by National Key Clinical Discipline), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Guan-Nan Tang
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease (Supported by National Key Clinical Discipline), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Shao-Yong Peng
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease (Supported by National Key Clinical Discipline), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Ying-Jie Li
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease (Supported by National Key Clinical Discipline), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Mei-Jin Huang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Guang-Wen Cao
- Department of Epidemiology, Second Military Medical University, Shanghai 200433, China
| | - Jian-Ping Wang
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease (Supported by National Key Clinical Discipline), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Yan-Xin Luo
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease (Supported by National Key Clinical Discipline), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
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