The predictive value of tumor growth patterns assessed on preoperative CT for the recurrence and metastasis of colon cancer
Objective:To investigate the predictive value of tumor growth patterns on computed tomography(CT-TGP)for the postoperative recurrence and metastasis in non-metastatic colon cancer.Methods:Data of 426 patients with non-metastatic colon cancer who underwent surgical resection was retrospectively analyzed from two independent research centers(center1,n=204;center2,n=222).Preoperative CT images were analyzed to assess CT-TGP and tumor(CT-T)stage of enrolled patients.According to the signs of tumor outer margin,CT-TGP was classified as G1(with smooth and clear tumor outer margin)or G2(tumor outer margin was indistinct with irregular protrusions).CT-T stage was categorized into T1/2-T3ab(≤5 mm)or T3cd-T4(>5 mm)based on the depth of tumor infiltration beyond the outer contour of the intestinal wall.Cox regression analysis was used to evaluate the association of the risk of recurrence and metastasis in colon cancer with CT-TGP and CT-T stages.Disease-free survival(DFS)of different CT-TGP or CT-T stage was compared using Kaplan-Meier survival curves.The prognostic value of CT-TGP and CT-T stage was quantified using Harrell's concordance index(C-index).The interobserver agreements of CT-TGP and CT-T stage were quantified utilizing Cohen's kappa and Light's kappa.Results:CT-TGP was identified significantly associated with DFS in both center 1and center 2.The hazard ratios(HRs)of CT-TGP in center 1 and center 2 were 2.48(95%confidence interval[CI]1.32~4.64,P<0.01,C-index 0.61)and 2.59(95%CI 1.50~4.48,P<0.001,C-index 0.62)respectively.CT-T staging was only found significantly prognostic for DFS in center 1(HR 2.65,95%CI,1.32~5.34,P<0.01,C-index 0.60).In center 2,there was no statistically significant difference in DFS between T3cd-T4 stage and T1/2-T3ab stage patients(HR 1.54,95%CI,0.83~2.83,P=0.17,C-index 0.55).Additionally,CT-TGP demonstrated better interobserver consistency than CT-T stage(Light's kappa 0.67 vs 0.52).Conclusion:CT-TGP was associated with postoperative recurrence and metastasis in patients with non-metastatic colon cancer and exhibited good prognostic value in different centers.Compared to CT-T stage,CT-TGP possessed better inter-observer consistency.Therefore,CT-TGP was an effective prognostic biomarker and could be used for the analysis of risk stratification in patients with non-metastatic colon cancer.
colon cancercomputed tomographypredictrecurrence and metastasis