CT is unreliable in locoregional staging of early colon cancer : A nationwide registry-based study
Wetterholm, Erik LU ; Rosén, Roberto LU
; Rahman, Milladur
LU
and Rönnow, Carl-Fredrik
LU
(2023)
In Scandinavian Journal of Surgery
112(1).
p.33-40
- Abstract
BACKGROUND AND OBJECTIVE: The option to treat early colon cancer (CC) with local resection, as well as trials investigating neoadjuvant treatment, has increased the importance of identifying early-stage disease in the workup. Most CC patients are T- and N-staged preoperatively with CT, although its reliability in staging early CC remains elusive. The aim of this study was to investigate CT-staging accuracy in early CC by evaluating pT and pN stages in patients staged as cT1-2, and cT and cN stages in patients with pT1 tumors.
METHODS: Retrospective population-based cohort study on data from the nationwide Swedish colorectal cancer registry on all CC patients staged as cT1-2 and all patients with pT1 undergoing surgical resection... (More)
BACKGROUND AND OBJECTIVE: The option to treat early colon cancer (CC) with local resection, as well as trials investigating neoadjuvant treatment, has increased the importance of identifying early-stage disease in the workup. Most CC patients are T- and N-staged preoperatively with CT, although its reliability in staging early CC remains elusive. The aim of this study was to investigate CT-staging accuracy in early CC by evaluating pT and pN stages in patients staged as cT1-2, and cT and cN stages in patients with pT1 tumors.
METHODS: Retrospective population-based cohort study on data from the nationwide Swedish colorectal cancer registry on all CC patients staged as cT1-2 and all patients with pT1 undergoing surgical resection 2009-2018. CT-acquired T- and N-stages were compared with final histopathology. Factors potentially influencing accuracy were analyzed with uni- and multivariate logistic regression.
RESULTS: Computed tomography (CT) staged 4849 patients as cT1-2, whereas 2445 (50%) were pT3 and 453 (9%) pT4. Positive predictive value of the cT1-2 stage was 40%. Of 1401 pT1 patients, 624 (45%) were staged as cT1-2, 139 (10%) as cT3, 15 (1%) as cT4 and 623 (44%) as cTx. In all, 1474 (30%) of the cT1-2 patients were pN+, whereas CT staged 1062 (72%) as cN0. A total of 771 patients were staged as cN+, whereas 403 (52%) were pN0. Overall accuracy in determining N+ was 67%, with 26% sensitivity and 88% specificity. Positive and negative predictive values in determining N+ were 48% and 73%, respectively.
CONCLUSIONS: This nationwide population-based study shows that CT-staging carries a substantial risk of understaging locally advanced tumors as cT1-2 and pT1 tumors as cTx, in addition to poor N-staging. Thus, CT obtained T- and N-staging should not be used for deciding treatment strategies in early CC.
(Less)
- author
- Wetterholm, Erik
LU
; Rosén, Roberto
LU
; Rahman, Milladur
LU
and Rönnow, Carl-Fredrik
LU
- organization
- publishing date
- 2023
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- General surgery, colorectal surgery, CC, colorectal cancer, computed tomography, tumor staging, CT accuracy, staging accuracy, early cancer
- in
- Scandinavian Journal of Surgery
- volume
- 112
- issue
- 1
- pages
- 8 pages
- publisher
- Finnish Surgical Society
- external identifiers
-
- scopus:85142234156
- pmid:36377769
- ISSN
- 1799-7267
- DOI
- 10.1177/14574969221132648
- language
- English
- LU publication?
- yes
- id
- d3cd6213-979f-479e-a1e1-07b1010e2f05
- date added to LUP
- 2022-11-30 12:44:00
- date last changed
- 2024-04-17 21:59:13
@article{d3cd6213-979f-479e-a1e1-07b1010e2f05,
abstract = {{<p>BACKGROUND AND OBJECTIVE: The option to treat early colon cancer (CC) with local resection, as well as trials investigating neoadjuvant treatment, has increased the importance of identifying early-stage disease in the workup. Most CC patients are T- and N-staged preoperatively with CT, although its reliability in staging early CC remains elusive. The aim of this study was to investigate CT-staging accuracy in early CC by evaluating pT and pN stages in patients staged as cT1-2, and cT and cN stages in patients with pT1 tumors.</p><p>METHODS: Retrospective population-based cohort study on data from the nationwide Swedish colorectal cancer registry on all CC patients staged as cT1-2 and all patients with pT1 undergoing surgical resection 2009-2018. CT-acquired T- and N-stages were compared with final histopathology. Factors potentially influencing accuracy were analyzed with uni- and multivariate logistic regression.</p><p>RESULTS: Computed tomography (CT) staged 4849 patients as cT1-2, whereas 2445 (50%) were pT3 and 453 (9%) pT4. Positive predictive value of the cT1-2 stage was 40%. Of 1401 pT1 patients, 624 (45%) were staged as cT1-2, 139 (10%) as cT3, 15 (1%) as cT4 and 623 (44%) as cTx. In all, 1474 (30%) of the cT1-2 patients were pN+, whereas CT staged 1062 (72%) as cN0. A total of 771 patients were staged as cN+, whereas 403 (52%) were pN0. Overall accuracy in determining N+ was 67%, with 26% sensitivity and 88% specificity. Positive and negative predictive values in determining N+ were 48% and 73%, respectively.</p><p>CONCLUSIONS: This nationwide population-based study shows that CT-staging carries a substantial risk of understaging locally advanced tumors as cT1-2 and pT1 tumors as cTx, in addition to poor N-staging. Thus, CT obtained T- and N-staging should not be used for deciding treatment strategies in early CC.</p>}},
author = {{Wetterholm, Erik and Rosén, Roberto and Rahman, Milladur and Rönnow, Carl-Fredrik}},
issn = {{1799-7267}},
keywords = {{General surgery; colorectal surgery; CC; colorectal cancer; computed tomography; tumor staging; CT accuracy; staging accuracy; early cancer}},
language = {{eng}},
number = {{1}},
pages = {{33--40}},
publisher = {{Finnish Surgical Society}},
series = {{Scandinavian Journal of Surgery}},
title = {{CT is unreliable in locoregional staging of early colon cancer : A nationwide registry-based study}},
url = {{http://dx.doi.org/10.1177/14574969221132648}},
doi = {{10.1177/14574969221132648}},
volume = {{112}},
year = {{2023}},
}