Abstract

Preoperative TNM stratification of colon cancer on computed tomography (CT) does not identify patients who are at high risk of recurrence that could be selected for preoperative treatment. To evaluate the utility of CT findings for prognosis of sigmoid colon cancer. This prognostic study used retrospective data from patients who underwent bowel resection for sigmoid colon cancer between January 1, 2006, and January 1, 2015, at a tertiary care center receiving international and national referrals for colorectal cancer. Statistical analysis was performed in April 2019. Cox proportional hazards regression analysis was performed to investigate CT findings associated with disease recurrence. Kaplan-Meier survival plots were calculated for disease-free survival using CT staging systems. Of the 414 patients who had sigmoid colon cancer (248 [60.0%] men; mean [SD] age, 66.1 [12.7] years), with median follow-up of 61 months (interquartile range, 40-87 months), 122 patients (29.5%) developed disease recurrence. On multivariate analysis, nodal disease was not associated with disease recurrence; only tumor deposits (hazard ratio [HR], 1.90; 95% CI, 1.21-2.98; P = .006) and extramural venous invasion (HR, 1.97; 95% CI, 1.26-3.06; P = .003) on CT were associated with disease recurrence. Significant differences in disease-free survival were found using CT-T3 substage classification (HR, 1.88; 95% CI, 1.32-2.68) but not CT-TNM (HR, 1.55; 95% CI, 0.94-2.55). The presence of tumor deposits or extramural venous invasion on CT (HR, 2.45; 95% CI, 1.68-3.56) had the strongest association with poor outcome. In this study, T3 substaging and detection of tumor deposits or extramural venous invasion on preoperative CT scans of sigmoid colon cancer were prognostic factors for disease-free survival, whereas TNM and nodal staging on CT had no prognostic value. T3 substaging and detection of tumor deposits or extramural venous invasion of sigmoid colon cancer was superior to TNM on CT and could be used to preoperatively identify patients at high risk of recurrence.

Highlights

  • There is increasing awareness that preoperative identification of high-risk tumors on imaging has improved rectal cancer outcomes.[1,2,3] To date, such a strategy does not exist for colon cancer and may partly explain why rectal cancer outcomes have improved and have overtaken colon cancer outcomes.[4,5,6,7] Novel treatment options for advanced, nonmetastatic colon cancer, such asOpen Access

  • Nodal disease was not associated with disease recurrence; only tumor deposits and extramural venous invasion (HR, 1.97; 95% CI, 1.26-3.06; P = .003) on computed tomography (CT) were associated with disease recurrence

  • The preoperative CT findings associated with overall recurrence included T stage (HR, 1.24; 95% CI, 1.12-1.39; P < .001), N stage (HR, 1.51; 95% CI, 1.27-1.80; P < .001), extramural venous invasion (EMVI) (HR, 2.69; 95% CI, 1.87-3.86; P < .001), tumor deposits (HR, 2.95; 95% CI, 2.04-4.29; P < .001), and peritoneal disease (HR, 2.22; 95% CI, 1.31-3.76; P = .003) (Table 2)

Read more

Summary

Introduction

There is increasing awareness that preoperative identification of high-risk tumors on imaging has improved rectal cancer outcomes.[1,2,3] To date, such a strategy does not exist for colon cancer and may partly explain why rectal cancer outcomes have improved and have overtaken colon cancer outcomes.[4,5,6,7] Novel treatment options for advanced, nonmetastatic colon cancer, such as. Staging System for Sigmoid Colon Cancer Based on Computed Tomography Findings neoadjuvant chemotherapy,[8] complete mesocolic excision, or hyperthermic intraperitoneal therapy,[9] may improve outcomes among patients with an otherwise poor prognosis but require accurate preoperative imaging to identify locally advanced tumors. Preoperative clinical staging of colon cancer by computed tomography (CT) is based on the TNM system.[10]

Methods
Results
Discussion
Conclusion
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call