| Objective This study evaluated the value of preoperative staging by multidetector computed tomography for nonperitonealized colon cancer to provide evidence for the intraoperative decision making or preoperative and postoperative therapy.Methods From January 2009 to January 2015 the 189 patients of II staging nonperitonealized colon cancer at the Department of General Surgery,Peking University People's Hospital were enrolled in the study.Radiological staging was evaluated through preoperative MDCT and statistical analysis was performed to evaluate the prognosis of different stages.Results According to the principle of pathological pT stage,the cases were divided into pT3 and pT4,and there was no statistical difference in the clinical pathological data between the two phases(P<0.005).And the 3 DFS(66.10% vs 77.50%,2c =0.083,P=0.774)and 5 years OS(82.80% vs 67.10%,2c =2.610,P=0.106)showed that the difference was not statistically significant.According to the imaging T staging assessment by two observers.The observer 1 imaging T staging: 49 cases of T3,140 cases of T4 stage.The observer 2 image T staging: 45 cases of stage T3,T4 144 cases.By the consistency of Kappa analysis,it can be seen that the assessment of the two assessment of the T stage of the assessment of consistency is general(?=0.589,P<0.001).There were no statistical differences in the clinical pathological data between the two phases(P >0.05).Ultimately determine imaging T stage: 0 cases T1,T2 0 cases,42 cases of T3,T4(147 cases).Between the two periods of 3 DFS(90.10% vs 58.30%,2c =12.525,P=0.000)and 5 OS(83.60% vs 73.60%,c2=4.110,P=0.043),and there were significantly different.Multi-variant analysis showed that radiological T staging can be served as independent prognostic factors(RR=3.480,95%CI:1.507-8.036,P=0.030).According to the criteria of imaging extramural tumor depth(EMD)by two observers.Evaluation of observer 1 imaging EMD measurement : EMD<1mm 40 cases,the EMD in 1-5 mm between 50 cases,the EMD between 5-15 mm in 59 cases,EMD > 15 of the 40 cases.The observer 2 imaging EMD measurement: EMD<1mm38,EMD in 1-5 mm between 50 cases,the EMD between 5-15 mm in 59 cases,EMD > 15 mm 42 cases.By the consistency of Kappa analysis,it can be seen that the assessment of the two assessment of the EMD assessment of consistency is general(?=0.473,P<0.05).There were no statistical differences in the clinical pathological data between the two phases(P >0.05)Take the means of the method,the final determination of EMD<1mm29 cases,EMD between 1-5mm in 62 cases,EMD between 5-15 mm in 57 cases,EMD > 15mm41 cases.The analysis of each group of 3 DFS(92.70% vs 79.80% vs 61.50% vs 55.30%,2c =21.491,P<0.05),and the difference was statistically significant,by Log rank group differences analysis suggested that EMD in 1-5mm and EMD between 5-15 mm significant difference(2c =9.049 P = 0.003).Analysis between the groups and 5 OS(100% vs 93.80% vs 67.40% vs 52.00%,2c =17.238,P < 0.05),suggesting that the difference was statistically significant,by Log rank differences between groups of tip of EMD in 1-5mm and EMD between 5-15 mm significant difference(2c =4.625,P = 0.032).Therefore the image study of EMD with 5mm as a cut off from the evaluation of the new group to finalize EMD?5mm 91 cases,EMD > 5mm 98 cases.The analysis between the two groups of 3 DFS(56.40% vs 48.40%,2c =21.491,P < 0.05)and 5 OS(96.10% vs 60.20%,c2 =15.578 P<0.05),that difference was statistically significant.In Cox risk regression evaluation,EMD can be used as an independent factor of 3DFS(RR=3.073,95%CI: 1.421-6.644,P=0.004)and 5OS(RR=4.670,95%CI:1.252-17.418,P=0.022)in colon cancer.On the basis of violating the imaging extramural vascular invasion(EMVI)evaluation criteria and by two observers: it is obvious that the observer 1 image EMVI assessment: Grade 1 in 49 cases,61 cases of grade 2,grade 3 in 51 cases with 4 grade of 32 cases.Observer 2 imaging EMVI assessment: Grade 1 in 25 cases,65 cases of grade 2,grade 3 in 60 cases with 4 grade of 39 cases.By the consistency of Kappa analysis,it was found that the two assessment of the EMVI assessment of poor consistency(?=0.292,P<0.001,).Final imaging EMVI classification: Grade 1 in 32 cases,53 cases of grade 2,grade 3 in 56 cases with 4 grade of 48 cases.There were no significant differences in clinical pathological data between all levels(P>0.05).Analysis of 3 DFS(86.70% vs 83.10% vs vs 51.50% vs 63.20%,P<0.05 =12.399),the difference was statistically significant.By Log rank group differences analysis tip: between grade 2 and 3 of EMVI significant difference(2c =12.556 P<0.05).Similarly analysis between the various grades of the 5 OS(89.10% vs 90.90% vs 65.40% vs 57.40%,2c =7.524,P = 0.006),and the difference has statistical significance.The difference between Log rank group showed that EMVI was significantly different between grade 2 and grade 3(2c =4.226,P=0.04).Therefore,this study is greater than 2 grade of EMVI,when the EMVI is greater than grade 2 that is positive,and less than grade 2 is negative,and ultimately determine the EMVI: positive: 84 cases;negative: 105 cases.The analysis of the two groups of 3DFS(84.30% vs 56.40%,2c =18.115,P<0.05)and 5 OS(92.90% vs 61.50%,c2=10.248,P=0.001),the difference has statistical significance.Analysis of chemotherapy in the treatment of 65 cases of stage pT4 affect the prognosis of colorectal cancer.The difference between chemotherapy and non chemotherapy of 3 DFS(89.60% vs 53.00%,2c =2.646,P = 0.104),was not statistically significant;but the difference of 5 OS(89.60% vs 53.00%,2c=5.066,P= 0.024)was statistically significant.Conclusions MDCT owns a capability of pre-operative staging for the nonperitonealized colon cancer and the radiological T staging and EMD are the independently prognostic factors in colonic neoplasms.Therefore they can hopefully provide the radiological evidence for a change in the intraoperative surgical plan,or indicate the need for preoperative neoadjuvant therapy and postoperative decision.The EMVI assessment of imaging may have some influence on the prognosis of colon cancer,but it has a great influence by individual experience. |
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