CT Imaging And Clinical Prognostic Factors In Patients With Synchronous Liver-metastasis Colorectal Cancer

Background: Colorectal cancer(CRC) is the third most common malignant tumor in the world,and its mortality rate ranks the second.Liver metastasis is the cause of death in 20%-30% of patients,and about 14%-20% of patients will have liver metastasis at the same time.The 1-year and 5-year survival rates of colorectal cancer with synchronous liver metastasis(s CRLM)patients were less than 30% and 6%,respectively.Colorectal cancer with independent liver metastasis is a difficult clinical management problem.For the treatment of patients with s CRLM,radical resection of primary lesions and liver metastases is recognized as the most effective treatment.In the actual clinical work,it is necessary to choose the surgical method of simultaneous or secondary resection of metastases,or to dynamically monitor the change process of patients who cannot undergo radical resection.Therefore,how to provide more prognosis related characteristics for patients before or during treatment is of great significance to make clinical individual treatment plan.Objective: To investigate the imaging features and clinical risk factors related to survival time of patients with s CRLM under different treatment methods,so as to guide the decisionmaking of clinical treatment.Materials and methods: According to the inclusion and exclusion criteria established in advance,the patients diagnosed as colorectal cancer with liver metastasis in Guangdong Provincial People’s Hospital from January 2012 to December 2017 were retrospectively collected and divided into radical group(n = 91) and palliative group(n = 157) and analysis separately.The contact information of the patients and their families was obtained by the medical record system of our hospital,and the prognosis information was obtained through the system or telephone follow-up.Patients who lost the follow-up or could not obtain the time of the end-point event were excluded.The overall survival time(OS) was defined as the time from diagnosis to the end point.Clinical and imaging data were collected.In the radical group,the patients were scored according to the Clinical Risk Score(CRS) standard,and in the palliative group,the curative effect was evaluated according to Response Evaluation Criteria in Solid Tumors1.1(RECIST1.1) and modified Response Evaluation Criteria in Solid Tumors(m RECIST)criteria.Results: A total of 217 patients,radical group(n = 76) and the palliative group(n = 141)got effective follow-up information.The survival time of radical group was higher than that of palliative group(P=0.100).Multivariate Cox regression analysis showed that clinical CRS score(P<0.05),primary cancer location(P<0.05),metastatic necrosis in CT images(P<0.05)and primary tumor growth through the serous membrane in CT images(P<0.05)were independent prognostic factors.In the palliative group,the Kappa value between RESICT1.1 and m RESICT was 0.471.Multivariate Cox regression analysis showed that RESICT1.1 criteria(P<0.01),mRECIST criteria(P<0.01),CEA level(P<0.01),and number of metastases(P<0.05),metastatic necrosis in CT images(P<0.05)and EMVI in CT images(P<0.05) were risk factors for prognosis,and then established the nomogram,which the C-index were 0.853/0.921 separately.Conclusion: The survival time of radical resection was higher than that of palliative treatment.There was no significant difference in survival time between patients undergoing simultaneous or delay resection,and clinical CRS score,primary cancer location,metastatic necrosis in CT images and EMVI in CT image were prognostic factors for surgical patients.RECIST1.1/mRECIST criteria,CEA level,the number of metastatic foci,EMVI in CT images and the presence of necrosis in metastasis CT images can be used as prognostic factors for palliative treatment patients.