Calcification in colorectal hepatic metastases correlates with longer survival

Abstract

Background Calcification occurs in 12–27% of hepatic colorectal metastases, but its clinical significance and its influence on prognosis are unknown. Methods All patients diagnosed with colorectal liver metastases at the Ottawa Regional Cancer Centre in 1991 (n = 97), as well as those enrolled in chemotherapy trials in 1990–1992 (n = 51), were entered into a retrospective cohort study. Thirty‐six patients were excluded due to inadequate follow‐up. In the remaining 112, abdominal CT scans and/or ultrasound examinations were used to determine the presence of calcification. Charts were reviewed for variables, including primary tumour pathology, amount of liver involvement by tumour (<25%, 25–50%, >50%), and the chemotherapeutic agents received, and were subjected to multivariate and regression analysis. End point was survival in months or to December 1993 (median follow up 24 months). Results Patients with calcification (n = 31) (28%) were compared to those who did not have calcifications (n = 81). The groups were comparable with respect to sex, age, time to calcification, time to metastases, and treatment type. Calcification occurred independent of the degree of tumour differentiation, the presence of mucinous adenocarcinoma, or the hepatic tumour burden. Nine patients with calcified metastases (30%) had calcification at presentation. Biopsies showed calcification next to viable tumour cells with an absence of an inflammatory reaction. Survival was improved with better primary tumour differentiation and less tumour burden. The presence of calcification had a statistically highly significant improvement in survival (P < 10−6, relative risk = .19) independent of other variables. Conclusions The presence of calcification within a colorectal liver metastasis appears to imply a significantly better prognosis. © 1996 Wiley‐Liss, Inc.

Accurate characterization of 99mTc-MDP uptake in extraosseous neoplasm mimicking bone metastasis on whole-body bone scan: contribution of SPECT/CT

“…The exact mechanism of extraosseous uptake of 99m Tc-MDP in breast, lung, and colorectal cancer is that adenocarcinoma and its metastases possess a mucinous component that may calcify because of internal tumour glycoprotein that binds calcium [14, 15, 17]. In addition, studies reported that calcification in colorectal liver metastasis is generally considered a good indicator of the response to treatment [18]. Therefore, WBS and SPECT/CT may be a potentially useful imaging modality to evaluate responses to treatment for patients with colorectal liver metastasis.…”

Hepatic and Perihepatic Involvement in Pneumokonioses and Other Mineral-Induced Diseases

“…There are exceptional situations where psammoma body formation is a feature of cholangiocarcinoma (Yamada et al 2000). Secondary calcification is well known in carcinoma metastases, in particular colorectal carcinoma (CRC) metastases (Miele and Edmonds 1963;Green and Stephens 1971;Kutzner and Wagner 1973;Sanchez Perez et al 1995;Easson et al 1996). Calcified hepatic metastases may be the first manifestation of CRC (Sanchez Perez et al 1995), and they have characteristic CT features.…”

“…Among 265 patients with hepatic CRC metastases, 11 % had calcified metastases at presentation and 4 % developed calcification during chemotherapy (Hale et al 1998). Calcification in colorectal hepatic metastases has been found to correlate with longer patient survival (Easson et al 1996). Calcifications are also rather typical for certain vascular tumors.…”

Complete calcification of colorectal liver metastases on imaging after chemotherapy does not indicate sterilization of disease

“…Imaging, particularly helical computed tomography (CT) scan, is used to assess the response to treatment. Chemotherapy can result in images showing shrinkage, disappearance or calcification of liver metastases; these signs are generally good indicators of the response to treatment [1]. Liver metastases, especially in mucin-producing adenocarcinoma, may occasionally contain a few calcifications prior to therapy.…”