Prediction of Hyperfibrinogenemia Combined with Multi-Slice Spiral Computed Tomography Image for Identification of Metastatic Lymph Node in Colorectal Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Xiaodong ¹ , OUYANG Shurui ² , LV Donghao ² , ZHUANG Lei ² , JIANG Shanming ² , DENG Lei ² , LI Zhengyan ³ , LI Li ¹

1.Department of Anal-Colorectal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China;;
2.West China Medical School, Sichuan University, Chengdu 610041, China;;
3.Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, ChinaCorresponding Author: LI Li, E-mail: drlili116@126.com;

Corresponding author：

Keywords：

Colorectal cancer; Multi-slice spiral computed tomography; Preoperative staging; Lymph node metastasis; Morphological criteria; Fibrinogen; Multimodal preoperative evaluation

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective 　To establish the optimal morphological criteria combined with fibrinogen level for evaluation of lymph node metastasis in colorectal cancer.
Methods 　A consecutive series of 690 patients who underwent curative surgery for colorectal cancer, were examined by abdominopelvic enhanced multi-slice spiral computed tomography (MSCT) scan. If regional lymph nodes appeared, the maximal long-axis diameter (MLAD), maximal short-axis diameter (MSAD), and axial ratio (MSAD/MLAD) were recorded. At each lymph node size cut-off value, the following were calculated: accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Moreover, preoperative plasma level of fibrinogen was retrospectively examined to identify metastatic or inflammatory lymph node combined with MSCT image. Both modalities, MSCT plus fibrinogen and MSCT alone, were compared based on the pathologic findings.
Results 　The study population consisted of 100 patients with regional lymph nodes show. No significant difference was found between metastatic and inflammatory lymph nodes in imaging characteristics (P gt;0.05). The best cut-off value of MSAD was 6 mm for lymph node metastasis with the sensitivity of 46.8%, specificity of 68.4%, accuracy of 55.0%, PPV of 70.7% and NPV of 44.1%. The best cut-off value of MLAD was 8 mm with the sensitivity of 43.5%, specificity of 63.2%, accuracy of 51.0%, PPV of 65.9% and NPV of 40.7%. Using hyperfibrinogenemia (FIB ≥3.5 g/L) to identify small metastatic lymph node, of which MSAD lt;6 mm or MLAD lt;8 mm, showed statistical diagnostic value (Kappa=0.256, P=0.047). Compared with MSAD (6 mm) alone, MSAD (6 mm) combined with hyperfibrinogenemia had a higher sensitivity (79.0% vs. 46.8%, P lt;0.001), but a similar accuracy (66.0% vs. 55.0%, P gt;0.05) and a lower specificity (44.7% vs. 68.4%, P=0.037). MLAD (8 mm) combined with hyperfibrinogenemia led to a greater diagnostic value in sensitivity (80.6% vs. 43.5%, P lt;0.001) and accuracy (66.0% vs. 51.0%, P=0.031) than MLAD (8 mm) alone, with a no-significantly decreasing specificity (42.1% vs. 63.2%, P gt;0.05).
Conclusions 　This present study recommend MSAD ≥6 mm or MLAD ≥8 mm as the optimal criteria for preoperative N staging in colorectal cancer. Moreover, the sensitivity and even accuracy could be improved by combining hyperfibrinogenemia for lymph node metastasis identification.

Citation： WANG Xiaodong,OUYANG Shurui,LV Donghao,ZHUANG Lei,JIANG Shanming,DENG Lei,LI Zhengyan,LI Li. Prediction of Hyperfibrinogenemia Combined with Multi-Slice Spiral Computed Tomography Image for Identification of Metastatic Lymph Node in Colorectal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(9): 757-762. doi: Copy

1.	Lafreniere R. What’s new in general surgery: surgical oncology [Ｊ]. J Am Coll Surg, 2004; 198(6): 966-988.
2.	汪晓东, 宋欢, 吕东昊, 等. 术前联合评估直肠上段癌与手术方案选择的随机对照试验 [Ｊ]. 中国普外基础与临床杂志, 2009; 16(4): 322-326.
3.	Dworák O. Number and size of lymph nodes and node metastases in rectal carcinomas [Ｊ]. Surg Endosc, 1989; 3(2): 96-99.
4.	Monig SP, Baldus SE, Zirbes TK, et al. Lymph node size and metastatic infiltration in colon cancer [Ｊ]. Lancet, 1986; 6(6): 579-581.
5.	Karantanas AH, Yarmenitis S, Papanikolaou N, et al. Preoperative imaging staging of rectal cancer [Ｊ]. Dig Dis, 2007; 25(1): 20-32.
6.	汪晓东, 刘丹, 吕东昊, 等. 术前纤维蛋白原水平与结直肠癌病理分期的关系 [Ｊ]. 中华实用诊断与治疗杂志, 2009; 23(7): 643- 645.
7.	汪晓东, 高强, 周小雁, 等. 多层螺旋CT联合纤维蛋白原或血清淀粉样蛋白A对直肠癌外科决策的随机对照研究 [Ｊ]. 中国普外基础与临床杂志, 2009; 16(7): 575-580.
8.	Greene FL, Page DL, Fleming ID, et al Eds. AJCC cancer staging manual [M]. 6th ed. New York (NY): Springer Verlag, 2002: 113-124.
9.	Kulinna C, Scheidler J, Strauss T, et al. Local staging of rectal cancer: assessment with double-contrast multislice computed tomography and transrectal ultrasound [Ｊ]. J Comput Assist Tomogr, 2004; 28(1): 123-130.
10.	Grabbe E, Lierse W, Winkler R. The perirectal fascia: morphology and use in staging of rectal carcinoma [Ｊ]. Radiology, 1983; 149(1): 241-246.
11.	Hodgman CG, MacCarty RL, Wolff BG, et al. Preoperative staging of rectal carcinoma by computed tomography and 0.15 T magnetic resonance imaging. Preliminary report [Ｊ]. Dis Colon Rectum, 1986; 29(7): 446-450.
12.	Noji T, Kondo S, Hirano S, et al. Computed tomography evaluation of regional lymph node metastases in patients with biliary cancer [Ｊ]. Br J Surg, 2008; 95(1): 92-96.
13.	Theoni RF. Colorectal cancer: cross-sectional imaging for st-aging of primary tumor and detection of local recurrence [Ｊ]. AJR Am J Roentgenol, 1991; 156(5): 909-915.
14.	Matsuoka H, Nakamura A, Masaki T, et al. Preoperative staging by multidetector-row computed tomography in patients with rectal carcinoma [Ｊ]. Am J Surg, 2002; 184(2): 131-135.
15.	McCormick JT, Gregorcyk SG. Preoperative evaluation of colorectal cancer [Ｊ]. Surg Oncol Clin N Am, 2006; 15(1): 39-49.
16.	Pomerri F, Maretto I, Pucciarelli S, et al. Prediction of rectal lymph node metastasis by pelvic computed tomography measurement [Ｊ]. Eur J Surg Oncol, 2009; 35(2): 168-173.
17.	Muthusamy VR, Chang KJ. Optimal methods for staging re-ctal cancer [Ｊ]. Clin Cancer Res, 2007; 13(22 Pt 2): 6877s-6884s.
18.	王琼, 谢嵘, 张青云, 等. 结直肠癌患者血浆纤维蛋白原的检测及其临床意义 [Ｊ]. 中华肿瘤杂志, 2005; 27(9): 544-546.
19.	Costantini V, Zacharski LR. The role of fibrin in tumor metastasis [Ｊ]. Cancer Metastasis Rev, 1992; 11(3-4): 283-290.
20.	Palumbo JS, Potter JM, Kaplan LS, et al. Spontaneous he-matogenous and lymphatic metastasis, but not primary tumor growth or angiogenesis, is diminished in fibrinogen-deficient mice [Ｊ]. Cancer Res, 2002; 62(23): 6966-6972.
21.	Rickles FR, Hancock WW, Edwards RL, et al. Antimetastatic agents. Ⅰ. Role of cellular procoagulants in the pathogenesis of fibrin deposition in cancer and the use of anticoagulants and/or antiplatelet drugs in cancer treatment [Ｊ]. Semin Thromb Hemost, 1988; 14(1): 88-94.
22.	汪晓东, 张琼文, 吕东昊, 等. 64排多层螺旋CT和血清淀粉样蛋白A联合评估结肠癌对手术方案选择的影响 [Ｊ]. 中国普外基础与临床杂志, 2009; 16(3): 232-237.
23.	汪晓东, 尹源, 陆玫竹, 等. 经直肠超声联合血清淀粉样蛋白A术前评估中低位直肠癌与手术决策的随机对照试验 [Ｊ]. 中国普外基础与临床杂志, 2009; 16(5): 404-409.
24.	吴俊华, 汪晓东, 高强, 等. 64排多层螺旋CT和血清淀粉样蛋白A联合评估下段直肠癌对手术方案选择的影响 [Ｊ]. 中国普外基础与临床杂志, 2009; 16(2): 156-161.
25.	汪晓东, 吕东昊, 宋欢, 等. 多模式术前评估系统对中低位直肠癌手术方案选择的价值：一项随机对照试验 [Ｊ]. 中国普外基础与临床杂志, 2009; 16(6): 487-492.

1. Lafreniere R. What’s new in general surgery: surgical oncology [Ｊ]. J Am Coll Surg, 2004; 198(6): 966-988.
2. 汪晓东, 宋欢, 吕东昊, 等. 术前联合评估直肠上段癌与手术方案选择的随机对照试验 [Ｊ]. 中国普外基础与临床杂志, 2009; 16(4): 322-326.
3. Dworák O. Number and size of lymph nodes and node metastases in rectal carcinomas [Ｊ]. Surg Endosc, 1989; 3(2): 96-99.
4. Monig SP, Baldus SE, Zirbes TK, et al. Lymph node size and metastatic infiltration in colon cancer [Ｊ]. Lancet, 1986; 6(6): 579-581.
5. Karantanas AH, Yarmenitis S, Papanikolaou N, et al. Preoperative imaging staging of rectal cancer [Ｊ]. Dig Dis, 2007; 25(1): 20-32.
6. 汪晓东, 刘丹, 吕东昊, 等. 术前纤维蛋白原水平与结直肠癌病理分期的关系 [Ｊ]. 中华实用诊断与治疗杂志, 2009; 23(7): 643- 645.
7. 汪晓东, 高强, 周小雁, 等. 多层螺旋CT联合纤维蛋白原或血清淀粉样蛋白A对直肠癌外科决策的随机对照研究 [Ｊ]. 中国普外基础与临床杂志, 2009; 16(7): 575-580.
8. Greene FL, Page DL, Fleming ID, et al Eds. AJCC cancer staging manual [M]. 6th ed. New York (NY): Springer Verlag, 2002: 113-124.
9. Kulinna C, Scheidler J, Strauss T, et al. Local staging of rectal cancer: assessment with double-contrast multislice computed tomography and transrectal ultrasound [Ｊ]. J Comput Assist Tomogr, 2004; 28(1): 123-130.
10. Grabbe E, Lierse W, Winkler R. The perirectal fascia: morphology and use in staging of rectal carcinoma [Ｊ]. Radiology, 1983; 149(1): 241-246.
11. Hodgman CG, MacCarty RL, Wolff BG, et al. Preoperative staging of rectal carcinoma by computed tomography and 0.15 T magnetic resonance imaging. Preliminary report [Ｊ]. Dis Colon Rectum, 1986; 29(7): 446-450.
12. Noji T, Kondo S, Hirano S, et al. Computed tomography evaluation of regional lymph node metastases in patients with biliary cancer [Ｊ]. Br J Surg, 2008; 95(1): 92-96.
13. Theoni RF. Colorectal cancer: cross-sectional imaging for st-aging of primary tumor and detection of local recurrence [Ｊ]. AJR Am J Roentgenol, 1991; 156(5): 909-915.
14. Matsuoka H, Nakamura A, Masaki T, et al. Preoperative staging by multidetector-row computed tomography in patients with rectal carcinoma [Ｊ]. Am J Surg, 2002; 184(2): 131-135.
15. McCormick JT, Gregorcyk SG. Preoperative evaluation of colorectal cancer [Ｊ]. Surg Oncol Clin N Am, 2006; 15(1): 39-49.
16. Pomerri F, Maretto I, Pucciarelli S, et al. Prediction of rectal lymph node metastasis by pelvic computed tomography measurement [Ｊ]. Eur J Surg Oncol, 2009; 35(2): 168-173.
17. Muthusamy VR, Chang KJ. Optimal methods for staging re-ctal cancer [Ｊ]. Clin Cancer Res, 2007; 13(22 Pt 2): 6877s-6884s.
18. 王琼, 谢嵘, 张青云, 等. 结直肠癌患者血浆纤维蛋白原的检测及其临床意义 [Ｊ]. 中华肿瘤杂志, 2005; 27(9): 544-546.
19. Costantini V, Zacharski LR. The role of fibrin in tumor metastasis [Ｊ]. Cancer Metastasis Rev, 1992; 11(3-4): 283-290.
20. Palumbo JS, Potter JM, Kaplan LS, et al. Spontaneous he-matogenous and lymphatic metastasis, but not primary tumor growth or angiogenesis, is diminished in fibrinogen-deficient mice [Ｊ]. Cancer Res, 2002; 62(23): 6966-6972.
21. Rickles FR, Hancock WW, Edwards RL, et al. Antimetastatic agents. Ⅰ. Role of cellular procoagulants in the pathogenesis of fibrin deposition in cancer and the use of anticoagulants and/or antiplatelet drugs in cancer treatment [Ｊ]. Semin Thromb Hemost, 1988; 14(1): 88-94.
22. 汪晓东, 张琼文, 吕东昊, 等. 64排多层螺旋CT和血清淀粉样蛋白A联合评估结肠癌对手术方案选择的影响 [Ｊ]. 中国普外基础与临床杂志, 2009; 16(3): 232-237.
23. 汪晓东, 尹源, 陆玫竹, 等. 经直肠超声联合血清淀粉样蛋白A术前评估中低位直肠癌与手术决策的随机对照试验 [Ｊ]. 中国普外基础与临床杂志, 2009; 16(5): 404-409.
24. 吴俊华, 汪晓东, 高强, 等. 64排多层螺旋CT和血清淀粉样蛋白A联合评估下段直肠癌对手术方案选择的影响 [Ｊ]. 中国普外基础与临床杂志, 2009; 16(2): 156-161.
25. 汪晓东, 吕东昊, 宋欢, 等. 多模式术前评估系统对中低位直肠癌手术方案选择的价值：一项随机对照试验 [Ｊ]. 中国普外基础与临床杂志, 2009; 16(6): 487-492.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Prediction of Hyperfibrinogenemia Combined with Multi-Slice Spiral Computed Tomography Image for Identification of Metastatic Lymph Node in Colorectal Cancer

Abstract Full text Figures/Tables Video References Cited by

Format

Content