Diagnostic value of preoperative CT scan to stratify colon cancer for neoadjuvant therapy

Wiegering, Armin; Kunz, Meik; Hussein, Mohamed; Klein, Ingo; Wiegering, Verena; Uthe, Friedrich W.; Dietz, Ulrich; Jurowich, Christian; Bley, Thorsten Alexander; Dandekar, Thomas; Germer, Christoph‐Thomas; Ritter, Christian

doi:10.1007/s00384-015-2265-z

Cited by 17 publications

(8 citation statements)

References 19 publications

(28 reference statements)

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“…The potential for using CT to produce a valid cTN stage has been discussed in several other studies. Some previous studies have shown acceptable agreement between cTN and pTN (5, 9), while others have, as in the present study, shown poor levels of agreement (10,11). Although some studies have presented moderately superior results compared to the current study, they have all struggled to identify high-risk tumors (4,6,9–11).…”

Section: Discussionsupporting

confidence: 46%

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Tumor and nodal staging of colon cancer: accuracy of preoperative computed tomography at a Swedish high-volume center

Korsbakke

Dahlbäck

Karlsson

et al. 2019

Acta Radiologica Open

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Background: When deciding treatment options for patients with colon cancer, accurate staging is required. In Sweden, the main preoperative evaluation modality to determine tumor and nodal stage is computed tomography (CT). Purpose: The aim of this study was to investigate how well the preoperative (CT-determined) clinical tumor and nodal stage (cTN) correlated with the postoperative histopathological stage (pTN). Another aim was to validate the tumor and nodal stage data in the Swedish Colorectal Cancer Registry (SCRCR). Material and Methods: The SCRCR was used to identify patients with colon cancer, treated at a Swedish high-volume center during 2013-2016 (n ¼ 974). Data were gathered from medical records regarding cTN and pTN stage, and predefined patient and tumor variables. The agreement between cTN and pTN was analyzed using kappa statistics. Results: After excluding patients with either pre-or postoperative TN stage missing, 383 patients remained for further analyses. The analyses showed an agreement between cT and pT of j: 0.27 and between cN and pN of j: 0.21 (fair agreement). When comparing tumors with low (T1-3; N0) versus high risk (T4; N1-2), the kappa value was 0.19 (slight agreement). When comparing the SCRCR to medical records, 78% of completely staged tumors had been correctly reported. Conclusion: The agreement between cTN and pTN was low in this study population, indicating a need for enhanced precision of the preoperative staging process. A high frequency of erroneous preoperative staging data in the SCRCR shows the need for further efforts of ensuring correct data transfers into the registry.

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Section: Discussionsupporting

confidence: 46%

“…The modality most often used is computed tomography (CT) (3). Usage of CT in the staging of distant metastases (M) is well established (3) and some studies have indicated that CT is a valid method for determining tumor and nodal stage (4,5). These results, however, have been contradicted by a recent study from Sweden by Sjövall et al.…”

Section: Introductionmentioning

confidence: 99%

Tumor and nodal staging of colon cancer: accuracy of preoperative computed tomography at a Swedish high-volume center

Korsbakke

Dahlbäck

Karlsson

et al. 2019

Acta Radiologica Open

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“…The presence of KRAS mutation in CRC is always associated with advanced tumor stage and presence of lymph node metastasis with poor response to treatment and outcome [2,20,23,33,41,42]. For most CRC, CT is the routinely used imaging modality for tumor diagnosis, tumor staging, identifying patients who require neo-adjuvant therapy, and assessing treatment response [43][44][45][46]. Recently, some reports have found that new generation CT scanners can offer high spatial resolution images with reliable rectal staging with low dose of radiation, particularly useful in patients who have contraindication to MRI [47,48].…”

Section: Discussionmentioning

confidence: 99%

Imaging features associated with survival outcomes among colorectal cancer patients with and without KRAS mutation

Promsorn

Chadbunchachai

Somsap

et al. 2021

Egypt J Radiol Nucl Med

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Background Mutations in Kirsten rat sarcoma proto-oncogene (KRAS) have been shown to be associated with advanced-stage colorectal cancer (CRC), negative disease outcomes, and poor response to treatment. The purpose of this study was to investigate which CT features are biomarkers for KRAS gene mutation and impact the survival outcomes of colorectal cancer patients. Results Of the 113 CRC patients included in the study, 46 had KRAS mutations (40.71%) and 67 had no mutations (59.29%). Regional lymph node necrosis was the only imaging feature significantly associated with KRAS mutation (P = 0.011). Higher T staging and liver, lung, and distant metastasis were prognostic factors for CRC (P = 0.014, P < 0.001, P = 0.022, P < 0.001, respectively). There were no significant differences in overall survival between patients with KRAS mutations and those without (P = 0.159). However, in patients with no KRAS mutation, those with CRC on the left side had a significantly higher rate of survival than those with CRC on the right (P = 0.005). Conclusion Regional lymph node necrosis may be an imaging biomarker of CRC with KRAS mutation, possibly indicating poor prognosis.

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“…Even though the rationale underlying the decision to limit preventive measures to avoid peritoneal recurrence only to patients with pT4 tumors seems correct, in clinical practice identifying pT4 tumors preoperatively with the current diagnostic tools seems an almost impossible task. Multidetector computed tomography (MDCT) is highly accurate in distinguishing pT1-2 from pT3-4 tumors, but differentiating between pT3 and pT4 tumors remains a challenging task [81][82][83][84]. A correct differential diagnosis between pT3 and pT4 tumors is even difficult macroscopically unless tumor filtrates clearly into adjacent organs, and often requires a thorough pathologic assessment [85].…”

Section: Proactive Management Of Peritoneal Metastases From Colorectamentioning

confidence: 99%

Proactive Management for Gastric, Colorectal and Appendiceal Malignancies: Preventing Peritoneal Metastases with Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Sammartino

Biacchi

Cornali

et al. 2016

Indian J Surg Oncol

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An integrated treatment strategy using peritonectomy procedures plus hyperthermic intraperitoneal chemotherapy (HIPEC) is now a clinical standard of care in selected patients with peritoneal metastases and primary peritoneal tumors. This comprehensive approach can offer many patients, who hitherto had no hope of cure, a good quality of life and survival despite limited morbidity. The increasingly successful results and chance of interfering in the natural history of disease has prompted research to develop for some clinical conditions a therapeutic strategy designed to prevent malignant peritoneal dissemination before it becomes clinically evident and treat it microscopically (tertiary prevention). The main factor governing successful cytoreductive surgery and predicting outcome is the extent of peritoneal spread assessed with the peritoneal cancer index (PCI). In peritoneal metastases from colorectal and gastric cancer the PCI score acquires a specific role acting as the cut-off between patients who can undergo curative surgery or palliation. Long-term results show that the only group enjoying favorable results are patients with limited disease (a statistical minority). By applying to appropriately selected patients with primary malignancies a proactive management strategy including HIPEC we can treat patients with microscopic peritoneal dissemination and therefore at PCI 0. Among treated conditions pseudomyxoma peritonei enjoys the best results. But a major future advance comes from identifying among lesions at major risk of pseudomyxoma.

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Diagnostic value of preoperative CT scan to stratify colon cancer for neoadjuvant therapy

Abstract: Computer tomography represents an effective tool for identifying patients with colon cancer suitable for neoadjuvant therapy according to the guidelines for rectal cancer.

Cited by 17 publications

References 19 publications

Tumor and nodal staging of colon cancer: accuracy of preoperative computed tomography at a Swedish high-volume center

Tumor and nodal staging of colon cancer: accuracy of preoperative computed tomography at a Swedish high-volume center

Imaging features associated with survival outcomes among colorectal cancer patients with and without KRAS mutation

Proactive Management for Gastric, Colorectal and Appendiceal Malignancies: Preventing Peritoneal Metastases with Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

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