European Radiology

, Volume 29, Issue 3, pp 1114–1123 | Cite as

Extent of enhancement on multiphase contrast-enhanced CT images is a potential prognostic factor of stage I–III colon cancer

  • Zhanhuai Wang
  • Yao Ye
  • Yeting Hu
  • Shugao HanEmail author
  • Lifeng Sun
  • Dong Xu
  • Kefeng DingEmail author



By evaluating extent of tumour enhancement on preoperative contrast-enhanced MDCT, we aimed to establish an imaging-based model to predict cancer-specific survival in stage I–III colon cancer.


A total of 548 stage I–III colon cancer patients who underwent curative resection from 2007 to 2013 were retrospectively included and divided into primary cohort and validation cohort according to admission time. The attenuation coefficient of each colon cancer was measured on the workstation by drawing the ROI in CT images. The enhancement ratio was calculated using maximum tumour attenuation value in triphasic MDCT scanning divided by the minimum. Patients were divided into low/high-enhancement groups according to the optimal cut-off value derived from time-dependent ROC curve. Kaplan–Meier method and COX regression analysis were adopted to evaluate prognostic value of variables. A nomogram for prognosis was conducted on the basis of a multivariate Cox proportional hazard model.


No significant differences were observed in age, sex, pTNM stage, perioperative chemoradiotherapy, serum CEA, tumour size, tumour localisation and histologic type between low- and high-enhancement groups. The high-enhancement group had a significantly shorter cancer-specific survival rate (69.5%) than the low-enhancement group (85.9%) (p < 0.001). Subgroup analysis indicated that high-enhancement state was closely associated with increased risk of colon cancer mortality in stage I (p = 0.033), stage II (p = 0.002) and stage III (p = 0.014). Cox regression analysis indicated the extent of enhancement was an independent prognostic factor (HR 2.258, 95% CI 1.476–3.455; p < 0.001).


The extent of tumour enhancement on MDCT can serve as a potential risk factor for stage I–III colon cancer.

Key Points

Survival rates of stage I–III colon cancer vary widely even within the same stage.

Prognostic value of the extent of tumour enhancement on MDCT was assessed.

The high-enhancement group had a significantly shorter cancer-specific survival rate.


Multidetector computed tomography Colonic neoplasms Prognosis 



Colorectal cancer


Multidetector-row computed tomography



We thank Dr. Ying Chen from the Department of Radiology for analysing CT images, Dr. Yue Liu from the Cancer Institute for collecting colon cancer tissues in the tissue bank and Dr. Zexin Chen from the Center of Clinical Epidemiology and Biostatistics for statistical analysis.


This work was supported by grants from the National Key R&D Program of China (2017YFC0908200) to KF Ding, Educational Department of Zhejiang Province of China (Y201738820 to ZH Wang) and National Natural Science Foundation of China (No. 81472664 to KF Ding; No. 81472819 to LF Sun; No. 81773181 to Dong Xu). The sponsors of the study had no role in study design, data collection, data analysis, results interpretation, writing the paper and the decision to submit the paper for publication.

Compliance with ethical standards


The scientific guarantor of this publication is Prof. Kefeng Ding.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Dr. Zexing Chen kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.


• retrospective

• observational

• performed at one institution

Supplementary material

330_2018_5689_MOESM1_ESM.docx (290 kb)
ESM 1 (DOCX 290 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of Surgical Oncology, Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
  2. 2.The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of EducationZhejiang UniversityHangzhouChina
  3. 3.Department of Radiology, Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina

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