Randomized Controlled Trial of Combining MultiSlice Spiral Computer Tomography with Serum Amyloid A Protein or Fibrinogen on Rectal Cancer Surgical Decision Making_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Xiaodong ¹ , GAO Qiang ² , ZHOU Xiaoyan ² , LuDonghao ² , NA Feifei ² , PENG Xiaying ² , WU Junhua ³ , LI Li ¹

1.Department of Anal-Colorectal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China;;
2.West China School of Medicine, Sichuan University, Chengdu 610041, China;;
3.Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Rectal neoplasm; Surgical operation; Multi-slice spiral computer tomography; Serum amyloid A protein; Fibrinogen; Preoperative evaluation

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Objective To determine the influence and significance of combinative assessment of 64 multi-slice spiral computer tomography (MSCT) with serum amyloid A protein (SAA) or fibrinogen (FIB) on the selection of operative procedures of rectal cancer under the multidisciplinary team.
Methods Prospectively enrolled 240 patients diagnosed definitely as rectal cancer at West China Hospital of Sichuan University from February to June 2009 were randomly assigned into two groups. In one group named MSCT+SAA group, both MSCT and SAA combinative assessment were made for the preoperative evaluation. In another group named MSCT+FIB group, both MSCT and FIB combinative assessment were made for preoperative evaluation. Furthermore, the preoperative staging and predicted operation procedures were compared with postoperative pathologic staging and practical operation procedures, respectively, and the relationship between the choice of operation procedures and clinicopathologic factors was analyzed.
Results According to the criteria, 234 patients were actually included into MSCT+SAA group (n=118) and MSCT+FIB group (n=116). The baseline characteristics of two groups were statistically similar (P gt;0.05). For MSCT+SAA group, the accuracies of preoperative staging T, N, M and TNM were 72.9%, 83.1%, 100% and 80.1%, respectively. For MSCT+FIB group, the accuracies of preoperative staging T, N, M and TNM were 68.1%, 75.0%, 100% and 74.1%, respectively, and there was not a statistically significant difference (P gt;0.05). There was also not a statistically significant difference of the accuracy of prediction to operative procedures in two groups (99.6% vs. 96.6%, P gt;0.05). The preoperative T staging (P＜0.001), N staging (P＜0.001), TNM staging (P＜0.001), serum level of SAA (P＜0.001), serum level of FIB (P lt;0.001) and distance of tumor to the dentate line (P＜0.05) were associated to the operative procedures.
Conclusions Combinative assessment of MSCT and FIB could improve the accuracy of preoperative staging and operative procedures prediction, however, it may be not superior to MSCT plus SAA.

Citation： WANG Xiaodong ,GAO Qiang,ZHOU Xiaoyan,LuDonghao,NA Feifei,PENG Xiaying,WU Junhua,LI Li. Randomized Controlled Trial of Combining MultiSlice Spiral Computer Tomography with Serum Amyloid A Protein or Fibrinogen on Rectal Cancer Surgical Decision Making. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(7): 575-580. doi: Copy

1.	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.
2.	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.
3.	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.
4.	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): 407412.
5.	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.
6.	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.
7.	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): 911.
8.	Theoni RF. Colorectal cancer: crosssectional imaging for staging of primary tumor and detection of local recurrence [Ｊ]. AJR Am J Roentgenol, 1991; 156(5): 909915.
9.	Greene FL, Page DL, Fleming ID, et al. AJCC cancer staging manual [M]. 6th ed. New York： SpringerVerlag, 2002: 113124.
10.	Costantini V, Zacharski LR. The role of fibrin in tumor metastasis [Ｊ]. Cancer Metastasis Rev, 1992; 11(34): 283290.
11.	Palumbo JS, Potter JM, Kaplan LS, et al. Spontaneous hematogenous and lymphatic metastasis, but not primary tumor growth or angiogenesis, is diminished in fibrinogendeficient mice [Ｊ]. Cancer Res, 2002; 62(23): 69666972.
12.	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.
13.	汪晓东, 吕东昊, 高命, 等. 结直肠癌患者术前血清CRP与SAA检测的意义 [Ｊ]. 中国肿瘤, 2009; 18(5): 416419.
14.	汪晓东, 邓磊, 吕东昊, 等. 结直肠癌患者术前SAA、CRP、CEA和CA199水平的临床诊断价值 [Ｊ]. 四川医学, 2009; 30(3): 340342.
15.	Gutfeld O, Prus D, Ackerman Z, et al. Expression of serum amyloid A, in normal, dysplastic, and neoplastic human colonic mucosa: implication for a role in colonic tumorigenesis [Ｊ]. J Histochem Cytochem, 2006; 54(1): 6373.
16.	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.
17.	Yamashita H, Kitayama J, Nagawa H. Hyperfibrinogenemia is a useful predictor for lymphatic metastasis in human gastric cancer [Ｊ]. Jpn J Clin Oncol, 2005; 35(10): 595600.
18.	Palumbo JS, Kombrinck KW, Drew AF, et al. Fibrinogen is an important determinant of the metastatic potential of circulating tumor cells [Ｊ]. Blood, 2000; 96(10): 33023309.
19.	Verhovsek M, Moffat KA, Hayward CP. Laboratory testing for fibrinogen abnormalities [Ｊ]. Am J Hematol, 2008; 83(12): 928931.
20.	汪晓东, 吕东昊, 宋欢, 等. 64排螺旋CT术前评估对直肠癌手术方案选择的价值 [Ｊ]. 中华普通外科杂志, 2009; 24(3): 210214.
21.	汪晓东, 宋欢, 李立, 等. 经直肠超声术前评估直肠癌保肛与非保肛手术方案的选择 [Ｊ]. 西部医学, 2009; 21(2): 253255.
22.	赵文军, 张才全, 王青. 直肠癌远端肠壁浸润的研究 [Ｊ]. 中国普外基础与临床杂志, 2006; 13(1): 9496.
23.	汪晓东, 曹霖, 罗德云, 等. 多学科协作诊治模式下运行结直肠癌综合治疗的临床对照研究 [Ｊ]. 中国普外基础与临床杂志, 2008; 15(1): 6366.
24.	汪晓东, 李立. 结直肠肿瘤多学科协作诊治模式下整体构建理念及基本组织构架 [Ｊ]. 中国普外基础与临床杂志, 2007; 14(3): 339342.
25.	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116.

1. 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.
2. 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.
3. 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.
4. 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): 407412.
5. 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.
6. 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.
7. 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): 911.
8. Theoni RF. Colorectal cancer: crosssectional imaging for staging of primary tumor and detection of local recurrence [Ｊ]. AJR Am J Roentgenol, 1991; 156(5): 909915.
9. Greene FL, Page DL, Fleming ID, et al. AJCC cancer staging manual [M]. 6th ed. New York： SpringerVerlag, 2002: 113124.
10. Costantini V, Zacharski LR. The role of fibrin in tumor metastasis [Ｊ]. Cancer Metastasis Rev, 1992; 11(34): 283290.
11. Palumbo JS, Potter JM, Kaplan LS, et al. Spontaneous hematogenous and lymphatic metastasis, but not primary tumor growth or angiogenesis, is diminished in fibrinogendeficient mice [Ｊ]. Cancer Res, 2002; 62(23): 69666972.
12. 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.
13. 汪晓东, 吕东昊, 高命, 等. 结直肠癌患者术前血清CRP与SAA检测的意义 [Ｊ]. 中国肿瘤, 2009; 18(5): 416419.
14. 汪晓东, 邓磊, 吕东昊, 等. 结直肠癌患者术前SAA、CRP、CEA和CA199水平的临床诊断价值 [Ｊ]. 四川医学, 2009; 30(3): 340342.
15. Gutfeld O, Prus D, Ackerman Z, et al. Expression of serum amyloid A, in normal, dysplastic, and neoplastic human colonic mucosa: implication for a role in colonic tumorigenesis [Ｊ]. J Histochem Cytochem, 2006; 54(1): 6373.
16. 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.
17. Yamashita H, Kitayama J, Nagawa H. Hyperfibrinogenemia is a useful predictor for lymphatic metastasis in human gastric cancer [Ｊ]. Jpn J Clin Oncol, 2005; 35(10): 595600.
18. Palumbo JS, Kombrinck KW, Drew AF, et al. Fibrinogen is an important determinant of the metastatic potential of circulating tumor cells [Ｊ]. Blood, 2000; 96(10): 33023309.
19. Verhovsek M, Moffat KA, Hayward CP. Laboratory testing for fibrinogen abnormalities [Ｊ]. Am J Hematol, 2008; 83(12): 928931.
20. 汪晓东, 吕东昊, 宋欢, 等. 64排螺旋CT术前评估对直肠癌手术方案选择的价值 [Ｊ]. 中华普通外科杂志, 2009; 24(3): 210214.
21. 汪晓东, 宋欢, 李立, 等. 经直肠超声术前评估直肠癌保肛与非保肛手术方案的选择 [Ｊ]. 西部医学, 2009; 21(2): 253255.
22. 赵文军, 张才全, 王青. 直肠癌远端肠壁浸润的研究 [Ｊ]. 中国普外基础与临床杂志, 2006; 13(1): 9496.
23. 汪晓东, 曹霖, 罗德云, 等. 多学科协作诊治模式下运行结直肠癌综合治疗的临床对照研究 [Ｊ]. 中国普外基础与临床杂志, 2008; 15(1): 6366.
24. 汪晓东, 李立. 结直肠肿瘤多学科协作诊治模式下整体构建理念及基本组织构架 [Ｊ]. 中国普外基础与临床杂志, 2007; 14(3): 339342.
25. 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116.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Randomized Controlled Trial of Combining MultiSlice Spiral Computer Tomography with Serum Amyloid A Protein or Fibrinogen on Rectal Cancer Surgical Decision Making

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