Extramural vascular invasion detected by contrast-enhanced multiple-row detectors computed tomography (ceMDCT) as a predictor of synchronous metastases in colon cancer
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Su-Xing Yang1, Xun Yao1, Xing-He Song1, Yan-Cheng Cui2, Ying-Jiang Ye2 and Yi Wang1
1Department of Radiology, Aerospace Center Hospital, Beijing 100049, China
2Department of Gastrointestinal Surgery, Peking University People’s Hospital, Beijing 100044, China
Yi Wang, email: firstname.lastname@example.org
Keywords: colon cancer; synchronous metastases; contrast-enhanced computed tomography; extramural vascular invasion
Received: October 21, 2016 Accepted: August 28, 2017 Published: October 25, 2017
Background: Extramural Vascular Invasion (EMVI) is histologically defined as the presence of tumor cells beyond the muscularis propria in vessels resulting in disease metastases.
Objective: To determine whether EMVI, detected by contrast-enhanced multiple-row detectors computed tomography (MDCT), has closely association with synchronous metastases in colon cancer.
Methods: Patients with pathology proven colon cancer were included in this retrospective study. Preoperative imaging status, including Extramural tumor depth, Lymph nodes, tumor location, and ctEMVI status, were defined on MDCT. Postoperative pathological tumor stage, lymph node stage, and tumor differentiation, were defined in accordance with the American Joint Committee on Cancer (AJCC) 7th Edition. Synchronous metastases were detected on follow-up MDCT 3 months after initial diagnosis or by surgery, if available. Associations between ctEMVI and other preoperative and postoperative factors were analyzed using Chi-squared tests. Logistic regression analyses were performed to analyze the preoperative and postoperative factors of synchronous metastases in colon cancer.
Results: ctEMVI was observed in 96 patients (96/241, 39.8%). The presence of ctEMVI varied significantly depending on ctEMD (χ2 = 66.557, P<0.001), lymph nodes status on MDCT (χ2 =24.533, P=0.001), pathological tumor status (χ2 = 36.267, P <0.001) and pathological lymph nodes status analyses (χ2 =32.103, P <0.001). Synchronous metastases were seen in 36 patients (36/96, 37.5%) with ctEMVI and 11 (11/145, 7.6%) patients without ctEMVI. The incidence of synchronous metastases was significantly higher in the cohort of positive ctEMVI with odds ratio (OR) of 7.309 (95% CI 3.485~15.330, P<0.001). Positive ctEMVI (Odds ratio 4.654, 95%CI: 1.987~10.898, P <0.001) and ctEMD larger than 5 mm (Odds ratio 2.654, 95%CI: 1.116~6.309, P =0.027) were demonstrated to be significant preoperative factors in predicting synchronous metastases.
Conclusion: MDCT-detected EMVI could be used as a preoperative factor to predict synchronous metastases in colon cancer.
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