Randomized Controlled Trial of Preoperatively Combinative Assessment of Transrectal Ultrasound and Serum Amyloid A Protein in Middle and Lower Rectal Cancer for Surgical Decision Making_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Xiaodong ¹ , YIN Yuan ² , LU Meizhu ² , LU Donghao ² , BAI Liping ² , SHI Yingyu ³ , LI Zhenhui 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 Sonography, West China Hospital, Sichuan University, Chengdu 610041, China;;
4.Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Rectal cancer; Transrectal ultrasound; Serum amyloid A protein; Preoperative assessment; Surgical operation

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Objective To determine the influence of combinative assessment of transrectal ultrasound (TRUS) and serum amyloid A protein (SAA) on the assessment of preoperative staging selection of operative procedures in the middle and lower rectal cancer. Methods Prospectively enrolled 130 patients, who diagnosed definitely as middle and lower rectal cancer at West China Hospital of Sichuan University from June 2008 to February 2009 were randomly assigned into two groups with 65 participants, respectively. In one group named TRUS combined SAA group, both TRUS and SAA combinative assessment were made for the preoperative evaluation. In another group named TRUS group, only the preoperative TRUS was made. The preoperative staging and predicted operative procedures were compared with postoperative pathologic staging and practical operation program, respectively.Results Of 118 patients with rectal cancer were actually included　into TRUS combined SAA group (n=59) and TRUS group (n=59). The baselines of characteristics of two groups were basically identical. For TRUS combined SAA group， the accuracies of preoperative T and N staging were 79.7% (47/59) and 77.8% (42/54) respectively; For TRUS group the corresponding rates were 86.4% (51/59) and 57.7% (30/52), respectively. There was no statistically significant difference of the accuracy of preoperative T staging （P=0.609） while preoperative N staging had statistical difference (P=0.027) between two groups. There was a statistically significant difference of the accuracy of prediction to operative procedures in two groups 〔96.6% (57/59) vs. 83.1% (49/59), P=0.015〕. The preoperative T staging was related to the selection of operative procedures (P=0.037) when analyzing the relationship between the operative procedures and the multiple clinicopathological factors in middle and lower rectal cancer. ConclusionCombinative assessment of TRUS and SAA could improve the accuracy of preoperative staging in middle and lower rectal cancer, thus provide higher predictive coincidence rate to operative procedures for surgeon.

Citation： WANG Xiaodong,YIN Yuan,LU Meizhu,LU Donghao,BAI Liping,SHI Yingyu,LI Zhenhui,LI Li. Randomized Controlled Trial of Preoperatively Combinative Assessment of Transrectal Ultrasound and Serum Amyloid A Protein in Middle and Lower Rectal Cancer for Surgical Decision Making. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(5): 407-412. doi: Copy

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10.	Davila RE, Rajan E, Adler D, et al. ASGE guideline: the role of endoscopy in the diagnosis, staging, and management of colorectal cancer [Ｊ]. Gastrointest Endosc, 2005; 61(1): 1-7.
11.	Kwok H, Bissett IP, Hill GL. Preoperative staging of rectal cancer [Ｊ]. Int J Colorectal Dis, 2000; 15(1): 9-20.
12.	Rafaelsen SR, Srensen T, Jakobsen A, et al. Transrectal ultrasonography and magnetic resonance imaging in the staging of rectal cancer. Effect of experience [Ｊ]. Scand J Gastroenterol, 2008; 43(4): 440-446.
13.	Gollub MJ, Schwartz LH, Akhurst T. Update on colorectal cancer imaging [Ｊ]. Radiol Clin North Am, 2007; 45(1): 85-118.
14.	Coussens LM, Werb Z. Inflammation and cancer [Ｊ]. Nature, 2002; 420(6917): 860-867.
15.	Renckens R, Roelofs JJ, Knapp S, et al. The acute-phase response and serum amyloid A inhibit the inflammatory response to Acinetobacter baumannii Pneumonia [Ｊ]. J Infect Dis, 2006; 193(2): 187-195.
16.	Kokubun M, Imafuku Y, Okada M, et al. Serum amyloid A (SAA) concentration varies among rheumatoid arthritis patients estimated by SAA/CRP ratio [Ｊ]. Clin Chim Acta, 2005; 360(1-2): 97-102.
17.	Tolson J, Bogumil R, Brunst E, et al. Serum protein profiling by SELDI mass spectrometry: detection of multiple variants of serum amyloid alpha in renal cancer patients [Ｊ]. Lab Invest, 2004; 84(7): 845-856.
18.	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): 368-373.
19.	Miwata H, Yamada T, Okada M, et al. Serum amyloid A protein in acute viral infections [Ｊ]. Arch Dis Child, 1993; 68(2): 210-214.
20.	d’Eril GM, Anesi A, Maggiore M, et al. Biological variation of serum amyloid A in healthy subjects [Ｊ]. Clin Chem, 2001; 47(8): 1498-1499.
21.	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.

1. ASGE Standards of Practice Committee, Gan SI, Rajan E, et al. Role of EUS [Ｊ]. Gastrointest Endosc， 2007;　66(3): 425-334.
2. Bipat S, Glas AS, Slors FJ,　 et al. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging—a meta-analysis　 [Ｊ].　 Radiology，　 2004;　232(3): 773-783.
3. Glojnaric＇ I, Casl MT, Simic＇ D, et al. Serum amyloid A protein (SAA) in colorectal carcinoma [Ｊ]. Clin Chem Lab Med, 2001; 39(2): 129-133.
4. Hildebrandt U, Feifel G. Preoperative staging of rectal cancer by intrarectal ultrasound [J]. Dis Colon Rectum, 1985; 28(1): 42-46.
5. Greene FL, Page DL, Fleming ID, et al Eds. AJCC cancer staging manual　[Ｍ]. 6th ed. New York (NY): Springer-Verlag, 2002: 113-124.
6. 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): 106-109.
7. 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): 222-226.
8. 蔡三军. 直肠癌的外科治疗进展 [Ｊ]. 中国癌症杂志, 2004; 14(5): 410-414.
9. 汪晓东，吕东昊，曾天芳, 等. 多学科协作诊治模式下结直肠癌术前辅助检查系统的临床应用初步探索 [Ｊ]. 中国普外基础与临床杂志, 2009; 16(1): 70-74.
10. Davila RE, Rajan E, Adler D, et al. ASGE guideline: the role of endoscopy in the diagnosis, staging, and management of colorectal cancer [Ｊ]. Gastrointest Endosc, 2005; 61(1): 1-7.
11. Kwok H, Bissett IP, Hill GL. Preoperative staging of rectal cancer [Ｊ]. Int J Colorectal Dis, 2000; 15(1): 9-20.
12. Rafaelsen SR, Srensen T, Jakobsen A, et al. Transrectal ultrasonography and magnetic resonance imaging in the staging of rectal cancer. Effect of experience [Ｊ]. Scand J Gastroenterol, 2008; 43(4): 440-446.
13. Gollub MJ, Schwartz LH, Akhurst T. Update on colorectal cancer imaging [Ｊ]. Radiol Clin North Am, 2007; 45(1): 85-118.
14. Coussens LM, Werb Z. Inflammation and cancer [Ｊ]. Nature, 2002; 420(6917): 860-867.
15. Renckens R, Roelofs JJ, Knapp S, et al. The acute-phase response and serum amyloid A inhibit the inflammatory response to Acinetobacter baumannii Pneumonia [Ｊ]. J Infect Dis, 2006; 193(2): 187-195.
16. Kokubun M, Imafuku Y, Okada M, et al. Serum amyloid A (SAA) concentration varies among rheumatoid arthritis patients estimated by SAA/CRP ratio [Ｊ]. Clin Chim Acta, 2005; 360(1-2): 97-102.
17. Tolson J, Bogumil R, Brunst E, et al. Serum protein profiling by SELDI mass spectrometry: detection of multiple variants of serum amyloid alpha in renal cancer patients [Ｊ]. Lab Invest, 2004; 84(7): 845-856.
18. 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): 368-373.
19. Miwata H, Yamada T, Okada M, et al. Serum amyloid A protein in acute viral infections [Ｊ]. Arch Dis Child, 1993; 68(2): 210-214.
20. d’Eril GM, Anesi A, Maggiore M, et al. Biological variation of serum amyloid A in healthy subjects [Ｊ]. Clin Chem, 2001; 47(8): 1498-1499.
21. 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.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Randomized Controlled Trial of Preoperatively Combinative Assessment of Transrectal Ultrasound and Serum Amyloid A Protein in Middle and Lower Rectal Cancer for Surgical Decision Making

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