摘要:目的: 探讨64排多层螺旋CT(MSCT)和血清淀粉样蛋白A(serum amyloid A protein, SAA)联合术前评估直肠癌在肿瘤分期诊断中的作用。 方法 :纳入经根治术治疗的直肠癌患者通过MSCT扫描进行评估,同时取患者静脉血测量术前SAA水平,行MSCT分期与MSCT和SAA联合分期以比较二者的诊断价值。 结果 :本研究纳入患者121例。MSCT检测T分期的准确度为851%。在评估淋巴结转移方面,MSCT和SAA联合分期的准确度为760%,明显高于MSCT分期(595%, 〖WTBX〗P lt;0001)。MSCT正确判断所有远处转移。同单一的MSCT检测相比,MSCT和SAA联合评估能显著的提高术前TNM分期的准确率(785% vs. 636%,〖WTBX〗P =0011)。 结论 :MSCT联合SAA检测比单一的MSCT检测显著提高了直肠癌术前肿瘤分期和淋巴结转移方面的准确度。这种新的术前评估方法的为肿瘤进展评估和术前治疗决策提供了更加可靠的信息。Abstract: Objective: To determine the role of combinative assessment of 64 multislice spiral computer tomography (MSCT) and serum amyloid A protein (SAA) in preoperative rectal cancer staging. Methods : Enrolled consecutive rectal cancer patients undergoing curative surgery were evaluated by MSCT scan. Meanwhile venous blood specimens were taken to measure preoperative SAA concentration. Both MSCT staging and MSCT plus SAA staging were performed to compare with each other. Results : The study population consisted of 121 patients. The accuracy of T staging was 851% for MSCT. The accuracy in evaluating lymph nodes metastases was 760% for MSCT plus SAA compared with 595% for MSCT alone (〖WTBX〗P lt;0001). All the distant metastases were correctly detected by MSCT. The method combining MSCT with SAA led to significant improvement on preoperative TNM staging compared with MSCT alone (785% vs. 636%, 〖WTBX〗P =0011). Conclusion : MSCT plus SAA showed greater accuracy than MSCT alone in rectal cancer staging and lymph node metastases. This novel strategy of preoperative evaluation appears to provide more accurate information on tumor progression and preoperative therapy decisionmaking.
Objective To summarize progress of imagings and tumor markers in preoperative TN staging of colorectal cancer. Methods The domestic and international published literatures related to application of imagings such as EUS, CT, and MRI and tumor markers such as CEA, CA19-9, and CA-242 in preoperative TN staging of colorectal cancer were collected and reviewed. Results The imagings and tumor markers have different values in the preoperative TN staging of colorectal cancer, but the value of a single application is limited. The combination of imagings and tumor markers could improve the diagnostic accuracy of the preoperative TN staging of colorectal cancer. Conclusion In clinical work, combination of imagings and tumor markers should be selected basing on actual situation of patients so as to improve accuracy of preoperative TN staging of colorectal cancer, and guide clinical treatment and improve prognosis of patients.
Objective To compare diagnosis values of computed tomography (CT) and magnetic resonance imaging (MRI) in preoperative staging of rectal carcinoma. Methods The imaging data of 81 patients with rectal carcinoma from January 2013 to January 2017 in the Hefei Second People’s Hospital were retrospectively analyzed. Based on the postoperative pathological results, the diagnostic accordance rates of CT and MRI on the T staging and N staging were calculated. Results The sensitivities of the CT and MRI on the preoperative T staging of rectal carcinoma were 69.1% (56/81) and 82.5% (52/63), the difference was not statistically significant (χ2=3.396, P=0.065), the Kappa values was 0.521 and 0.371, respectively, the MRI on the T staging was in a good agreement with the pathological diagnosis. The sensitivitie of the T1-2, T3, and T4 stagings with CT was 70.0%, 66.7%, and 72.0%, respectively, with MRI was 83.3%, 83.3%, and 81.0%, respectively, which had no significant difference respectively between the CT and the MRI. The areas under the receiver operating characteristic curve of the T1-2, T3, and T4 stagings with the CT and MRI were 0.809, 0.689, 0.798 and 0.897, 0.826, 0.869, respectively. The sensitivities of the CT and MRI on the preoperative N staging of rectal carcinoma were 59.3% (48/81) and 65.1% (41/63), the difference was not statistically significant (χ2=0.509, P=0.476), the Kappa values were 0.371 and 0.463, respectively. The sensitivities of the N0, N1, N2 stagings with CT were 64.7%, 45.5%, 64.0%, with MRI were 70.3%, 63.2%, 72.5%, which had no significant difference respectively between the CT and the MRI. Conclusions Results of in this study show that MRI is superior to CT for judgment of tumor infiltration. Neither CT nor MRI is able to provide satisfactory assessment of lymph node metastasis.
ObjectiveTo analyze the association between preoperative staging (cTNM) and neoadjuvant therapy regimen decision-making and efficacy in patients with rectal cancer in the current version of Database from Colorectal Cancer (DACCA). MethodsThe data analysis for this study selected the DACCA version updated on April 20, 2024. The patient information was collected and categorized into three stages (Ⅱ, Ⅲ, and Ⅳ). The differences in neoadjuvant treatment decision-making and therapeutic effects, including gross changes, imaging changes, and tumor regression grade (TRG), were analyzed. ResultsA total of 3 158 eligible cases were collected in this study, with complete preoperative staging and neoadjuvant therapy decision-making data available for 2 370 patients. There were statistically significant differences in the overall comparison among the patients with rectal cancer in terms of the selection of combined targeted therapy, radiotherapy regimens, and the intensity of neoadjuvant chemotherapy by patients at different preoperative stages (χ²=42.239, P<0.001; χ²=41.615, P<0.001; H=1.161, P=0.004). Specifically, the proportion of patients choosing combined targeted therapy and combined radiotherapy gradually increased as the stage advanced. Among patients at different stages, the proportion of those choosing medium-course chemotherapy was the highest, and the proportion of patients choosing long-course chemotherapy was the highest among those with more advanced stages. Regarding the gross changes, imaging changes, and TRG results after neoadjuvant treatment in the patients at different preoperative stages, there were statistically significant differences in the overall comparison among patients with stage Ⅱ, Ⅲ, and Ⅳ rectal cancer (H=7.860, P=0.020; H=9.845, P=0.007; H=6.680, P=0.035). The proportion of partial response was the highest across all response metrics (macroscopic, radiographic, and TRG) in each stage. Notably, stage Ⅱ patients demonstrated the highest rate of complete response. For TRG evaluation, grade 2 (TRG2) was the most common outcome across all stages. ConclusionsData analysis from DACCA reveals that patients with advanced stages are more likely to choose chemotherapy combined with targeted therapy or radiotherapy, and had a higher proportion of intermediate range chemotherapy and the intensity of neoadjuvant chemotherapy is stronger. In terms of neoadjuvant treatment effects, the earlier the staging, the better the gross and imaging changes, and the lower the TRG level.
ObjectiveTo analyze the relation between preoperative staging and surgical decision-making in rectal cancer patients from the West China Colorectal Cancer Database (DACCA) and to identify key factors influencing the selection of surgical approaches. MethodsBased on the updated DACCA dataset as of April 24, 2024, the patients with rectal cancer were included. Chi-square tests and logistic regression analyses were performed to evaluate the correlation between preoperative staging [(y)cTNM stage] and the selection of sphincter-preserving surgery or intersphincteric resection (ISR). Additional factors, including age, body mass index (BMI), tumor location, and nutritional score, were assessed for their impact on surgical choices. ResultsA total of 2 733 rectal cancer patients were included. Preoperative (y)cTNM staging distribution was as follows: Stage 0 (0.8%, n=23), stageⅠ (14.2%, n=388), stage Ⅱ (27.8%, n=760), stage Ⅲ (31.9%, n=873), and stage Ⅳ (25.2%, n=689). Advanced preoperative staging (Stages II–IV) was independently associated with non–sphincter-preserving surgery (Stage II: OR=0.073; Stage III: OR=0.068; Stage IV: OR=0.039; all P<0.001). Low/ultralow rectal tumors were a risk factor for sphincter preservation failure (OR=0.491, 95% CI: 0.358–0.672) but significantly increased ISR utilization (OR=76.658, P<0.001). Nutritional scores of 4 (OR=0.261) and 6 (OR=0.098) correlated with reduced ISR implementation (both P<0.05). ConclusionsPreoperative staging serves as the cornerstone for surgical decision-making in rectal cancer, with advanced stages favoring non–sphincter-preserving and non-ISR approaches. While low/ultralow tumors challenge sphincter preservation, ISR remains a predominant option. Tumor anatomy and nutritional status critically influence surgical strategy, necessitating comprehensive preoperative evaluation.