Extent of enhancement on multiphase contrast-enhanced CT images is a potential prognostic factor of stage I–III colon cancer
- 112 Downloads
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.
• 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.
KeywordsMultidetector computed tomography Colonic neoplasms Prognosis
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.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional review board approval was obtained.
• performed at one institution
- 4.Mols F, Beijers T, Lemmens V, van den Hurk CJ, Vreugdenhil G, van de Poll-Franse LV (2013) Chemotherapy-induced neuropathy and its association with quality of life among 2- to 11-year colorectal cancer survivors: results from the population-based PROFILES registry. J Clin Oncol 31:2699-2707Google Scholar
- 5.Sobrero A, Grothey A, Iveson T et al (2018) The hard road to data interpretation: three or six months of adjuvant chemotherapy for patients with stage III colon cancer? Ann Oncol https://doi.org/10.1093/annonc/mdy064
- 8.Greene FL, Page DL, Flemming ID, Fritz AG, Balch CM (eds) (2010) AJCC cancer staging manual, 7th edn. Springer, New YorkGoogle Scholar
- 13.Choi H, Charnsangavej C, Faria SC et al (2007) Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated at a single institution with imatinib mesylate: proposal of new computed tomography response criteria. J Clin Oncol 25:1753–1759CrossRefGoogle Scholar
- 14.Wang SH, Sun YF, Liu Y, Zhou Y, Liu Y (2015) CT contrast enhancement correlates with pathological grade and microvessel density of pancreatic cancer tissues. Int J Clin Exp Pathol 8:5443–5449Google Scholar
- 20.National Comprehensive Cancer Network (2018) NCCN clinical practice guidelines in oncology, V.1.2018. https://www.nccn.org/professionals/physician_gls/default.aspx