Influence of Combinative Assessment of 64 Multi-Slice Spiral Computer Tomography and Serum Amyloid A Protein on Surgery Strategy of Colon Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Xiaodong ¹ , ZHANG Qiongwen ² , L Donghao ² , WU Junhua ³ , ZENG Rong ⁴ , 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, China;;
4.Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, ChinaCorresponding Author: LI Li, E-mail: drlili116@126.com;

Corresponding author：

Keywords：

Colonic neoplasm; Surgical operation; Multi-slice spiral computer tomography; Preoperative assessment; Serum amyloid protein A

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　Objective 　To discuss the influence of combination of 64 multi-slice spiral computer tomography (MSCT) and serum amyloid A protein (SAA) for preoperative assessment on colon cancer surgery strategy.
　Methods 　Ｔhe examination data of 110 patients diagnosed definitely as colon cancer in the West China Hospital of Sichuan University from Nov. 2007 to Nov. 2008 were studied prospectively, and randomly assigned into the MSCT+SAA group and MSCT group, respectively. Both MSCT and SAA combinative assessment were made for preoperative evaluation in MSCT+SAA group, while only MSCT was made preoperatively in MSCT group. Furthermore, the preoperative staging and prediction of operative procedures were compared with postoperative pathologic staging and practical of operative procedures, respectively.
　Results 　According to the inclusion criteria, 99 colon cancer patients were actually included into MSCT+SAA group (n=49) and MSCT group (n=50). The baseline characteristics of two groups were statistically identical. For MSCT+SAA group, The accuracies of preoperative staging T, N, M and TNM were 81.6%, 79.6%, 100% and 77.6%, respectively. For MSCT group, the corresponding rates were 82.0%, 60.0%, 98.0% and 62.0%, respectively. The difference of accuracies on staging N between two groups was observed statistically (χ2=4.498, P=0.034). There was also a statistically significant difference of the accuracy of prediction of operative procedures in MSCT+SAA group and MSCT group (95.9% vs. 82.0%, χ2=4.854, P=0.028). The preoperative staging N (P=0.008), M (P=0.010), TNM (P=0.009) and level of SAA (P=0.004) were related to the selection of operative procedures when analyzed the relationship between the operative procedures and multiple clinicopathologic factors in colon cancer.
　Conclusion 　The strategy of the combinative assessment of MSCT and SAA could advance the accuracy of preoperative staging, thus serve surgeon the more accurate prediction to surgery strategy in colon cancer.

Citation： WANG Xiaodong,ZHANG Qiongwen,L Donghao,WU Junhua,ZENG Rong,LI Li. Influence of Combinative Assessment of 64 Multi-Slice Spiral Computer Tomography and Serum Amyloid A Protein on Surgery Strategy of Colon Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(3): 232-237. doi: Copy

1.	Moss AA, Thoeni RF, Schnyder P, et al. Value of computed tomography in the detection and staging of recurrent rectal carcinomas [Ｊ]. J Comput Assist Tomogr, 1981; 5(6):870.
2.	吴俊华, 汪晓东, 高强, 等. 64排螺旋CT和SAA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.
3.	Glojnaric1 I, Casl MT, Simic D, et al. Serum amyloid A protein (SAA) in colorectal carcinoma [Ｊ]. Clin Chem Lab Med, 2001; 39(2):129.
4.	Harvey CJ, Amin Z, Hare CM, et al. Helical CT pneumocolon to assess colonic tumors: radiologic-pathologic correlation [Ｊ]. AJR Am J Roentgenol, 1998; 170(6):1439.
5.	〖ＪＰ３〗Nelson H, Petrelli N, Carlin A, et al. Guidelines 2000 for colon and rectal cancer surgery [Ｊ]. J Natl Cancer Inst, 2001; 93(8):583.
6.	〖ＪＰ３〗Mitry E, Barthod F, Penna C, et al. Surgery for colon and rectal cancer [Ｊ]. Best Pract Res Clin Gastroenterol, 2002; 16(2):253.
7.	Gollub MJ, Schwartz LH, Akhurst T. Update on colorectal cancer imaging [Ｊ]. Radiol Clin North Am, 2007; 45(1):85.
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9.	Smith NJ, Bees N, Barbachano Y, et al. Preoperative computed tomography staging of nonmetastatic colon cancer predicts outcome: implications for clinical trials [Ｊ]. Br J Cancer, 2007; 96(7):1030.
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11.	Biran H, Friedman N, Neumann L, et al. Serum amyloid A (SAA) variations in patients with cancer: correlation with disease activity, stage, primary site, and prognosis [Ｊ]. J Clin Pathol, 1986; 39(7):794.
12.	Kimura M, Tomita Y, Imai T, et al. Significance of serum amyloid A on the prognosis in patients with renal cell carcinoma [Ｊ]. Cancer, 2001; 92(8):2072.
13.	Kaneti J, Winikoff Y, Zimlichman S, et al. Importance of serum amyloid A (SAA) level in monitoring disease activity and response to therapy in patients with prostate cancer [Ｊ]. Urol Res, 1984; 12(5):239.
14.	Chan DC, Chen CJ, Chu HC, et al. Evaluation of serum amyloid A as a biomarker for gastric cancer [Ｊ]. Ann Surg Oncol, 2007; 14(1):84.
15.	Michaeli A, Finci-Yeheskel Z, Dishon S, et al. Serum amyloid A enhances plasminogen activation: implication for a role in colon cancer [Ｊ]. Biochem Biophys Res Commun, 2008; 368(2):368.
16.	李立. 结直肠癌外科应用技术的规范与创新(一) [Ｊ]. 中国普外基础与临床杂志, 2006; 13(1):106.
17.	李立. 结直肠癌外科应用技术的规范与创新(二) [Ｊ]. 中国普外基础与临床杂志, 2006; 13(2):222.
18.	Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer [Ｊ]. N Engl J Med, 2004; 350(20):2050.
19.	徐忠法, 孙燕来. 结肠癌的分期与腹腔镜结肠癌手术治疗的选择 [Ｊ]. 肿瘤预防与治疗, 2008; 21(3):239.
20.	Miwata H, Yamada T, Okada M, et al. Serum amyloid A protein in acute viral infections [Ｊ]. Arch Dis Child, 1993; 68(2):210.
21.	d’Eril GM, Anesi A, Maggiore M, et al. Biological variation of serum amyloid A in healthy subjects [Ｊ]. Clin Chem, 2001; 47(8):1498.
22.	刘展, 汪晓东, 李立. 在结直肠癌领域引入多学科协作管理模式的现状 [Ｊ]. 中国普外基础与临床杂志, 2007; 14(1): 114.

1. Moss AA, Thoeni RF, Schnyder P, et al. Value of computed tomography in the detection and staging of recurrent rectal carcinomas [Ｊ]. J Comput Assist Tomogr, 1981; 5(6):870.
2. 吴俊华, 汪晓东, 高强, 等. 64排螺旋CT和SAA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.
3. Glojnaric1 I, Casl MT, Simic D, et al. Serum amyloid A protein (SAA) in colorectal carcinoma [Ｊ]. Clin Chem Lab Med, 2001; 39(2):129.
4. Harvey CJ, Amin Z, Hare CM, et al. Helical CT pneumocolon to assess colonic tumors: radiologic-pathologic correlation [Ｊ]. AJR Am J Roentgenol, 1998; 170(6):1439.
5. 〖ＪＰ３〗Nelson H, Petrelli N, Carlin A, et al. Guidelines 2000 for colon and rectal cancer surgery [Ｊ]. J Natl Cancer Inst, 2001; 93(8):583.
6. 〖ＪＰ３〗Mitry E, Barthod F, Penna C, et al. Surgery for colon and rectal cancer [Ｊ]. Best Pract Res Clin Gastroenterol, 2002; 16(2):253.
7. Gollub MJ, Schwartz LH, Akhurst T. Update on colorectal cancer imaging [Ｊ]. Radiol Clin North Am, 2007; 45(1):85.
8. Hundt W, Braunschweig R, Reiser M. Evaluation of spiral CT in staging of colon and rectum carcinoma [Ｊ]. Eur Radiol, 1999; 9(1):78.
9. Smith NJ, Bees N, Barbachano Y, et al. Preoperative computed tomography staging of nonmetastatic colon cancer predicts outcome: implications for clinical trials [Ｊ]. Br J Cancer, 2007; 96(7):1030.
10. Mazhar D, Ngan S. C-reactive protein and colorectal cancer [Ｊ]. QJM, 2006; 99(8):555.
11. Biran H, Friedman N, Neumann L, et al. Serum amyloid A (SAA) variations in patients with cancer: correlation with disease activity, stage, primary site, and prognosis [Ｊ]. J Clin Pathol, 1986; 39(7):794.
12. Kimura M, Tomita Y, Imai T, et al. Significance of serum amyloid A on the prognosis in patients with renal cell carcinoma [Ｊ]. Cancer, 2001; 92(8):2072.
13. Kaneti J, Winikoff Y, Zimlichman S, et al. Importance of serum amyloid A (SAA) level in monitoring disease activity and response to therapy in patients with prostate cancer [Ｊ]. Urol Res, 1984; 12(5):239.
14. Chan DC, Chen CJ, Chu HC, et al. Evaluation of serum amyloid A as a biomarker for gastric cancer [Ｊ]. Ann Surg Oncol, 2007; 14(1):84.
15. Michaeli A, Finci-Yeheskel Z, Dishon S, et al. Serum amyloid A enhances plasminogen activation: implication for a role in colon cancer [Ｊ]. Biochem Biophys Res Commun, 2008; 368(2):368.
16. 李立. 结直肠癌外科应用技术的规范与创新(一) [Ｊ]. 中国普外基础与临床杂志, 2006; 13(1):106.
17. 李立. 结直肠癌外科应用技术的规范与创新(二) [Ｊ]. 中国普外基础与临床杂志, 2006; 13(2):222.
18. Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer [Ｊ]. N Engl J Med, 2004; 350(20):2050.
19. 徐忠法, 孙燕来. 结肠癌的分期与腹腔镜结肠癌手术治疗的选择 [Ｊ]. 肿瘤预防与治疗, 2008; 21(3):239.
20. Miwata H, Yamada T, Okada M, et al. Serum amyloid A protein in acute viral infections [Ｊ]. Arch Dis Child, 1993; 68(2):210.
21. d’Eril GM, Anesi A, Maggiore M, et al. Biological variation of serum amyloid A in healthy subjects [Ｊ]. Clin Chem, 2001; 47(8):1498.
22. 刘展, 汪晓东, 李立. 在结直肠癌领域引入多学科协作管理模式的现状 [Ｊ]. 中国普外基础与临床杂志, 2007; 14(1): 114.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Influence of Combinative Assessment of 64 Multi-Slice Spiral Computer Tomography and Serum Amyloid A Protein on Surgery Strategy of Colon Cancer

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