The impact of mismatch repair status to the preoperative staging of local colon cancer: Implications for clinical management.

16 Background: Computed tomography (CT) scan is standard in preoperative local staging of colon cancer. Tumours with a deficient mismatch repair (dMMR) system are characterised by unique clinical and pathophysiologic aspects that may impact on the accuracy of the preoperative CT staging. Methods: Data from the Danish Colorectal Cancer Group national clinical database addressing a cohort of patients operated for stage I-III colon cancer in 2010-15 was analysed. The analyses of MMR status had been conducted consecutively through means of immunohistochemistry. All CT scans were blindly assessed by a certified radiologist. Results: Data from 590 patients, operated at a specialised cancer centre were available for analyses. A dMMR phenotype was detected in 135 (22.9%) of the patients. The overall correlation of the clinical and pathological T-category was significant for both groups. There was inferior correlation between cN and pN (p > 0.05) in pMMR cancers with a higher degree of over-staging assessed by CT-scan, compared to a significant correlation between cN and pN stage in pMMR cancers (p < 0.01). Of the 91 dMMR tumours judged node-positive by the preoperative CT scan, 59 (64.8%) showed no sign of metastatic involvement at the postoperative assessment. Conclusions: The accuracy of preoperative CT lymph node staging in colon cancer seems to differ depending on MMR status and may impact the clinical management including the neoadjuvant setting.

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The impact of mismatch repair status to the preoperative staging of colon cancer: implications for clinical management

Colorectal Cancer ◽

10.2217/crc-2020-0001 ◽

2020 ◽

Vol 9 (2) ◽

pp. CRC20

Author(s):

Emilie Erbs ◽

Søren Rafael Rafaelsen ◽

Jan Lindebjerg ◽

Lars Henrik Jensen ◽

Torben Frøstrup Hansen

Keyword(s):

Colon Cancer ◽

Mismatch Repair ◽

Preoperative Staging ◽

Lymph Node Staging ◽

Clinical Database ◽

National Clinical Database ◽

Cancer Group ◽

Metastatic Involvement ◽

Mismatch Repair Status ◽

The Impact

Aims: We sought to investigate if mismatch repair (MMR) status influences the preoperative staging of local colon cancer. Methods: Data from 590 patients in the Danish Colorectal Cancer Group national clinical database who were operated on for stage I-III colon cancer in 2010-15 were included. MMR status was determined by immunohistochemistry. Results: 22.9% had deficient(d) MMR tumors. Correlation of the clinical and pathological T-category was significant for both groups. The correlation of pre- and postoperative N-category was inferior (p >0.05) in dMMR cancers compared to a significant (p <0.01) correlation in proficient MMR cancers. 64.8% of dMMR tumors assessed node-positive demonstrated no sign of metastatic involvement at the postoperative assessment. Conclusion: MMR status seems to impact the accuracy of preoperative lymph node staging.

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The Impact of Patient Characteristics and Tumor Biology on the Accuracy of Preoperative Staging of Colon Cancer in Denmark. A Nationwide Cohort Study

Cancers ◽

10.3390/cancers13174384 ◽

2021 ◽

Vol 13 (17) ◽

pp. 4384

Author(s):

Malene Roland V. Pedersen ◽

Søren Rafael Rafaelsen ◽

Jan Lindebjerg ◽

Torben Frøstrup Hansen ◽

Hans Bjarke Rahr

Keyword(s):

Colon Cancer ◽

Bowel Resection ◽

Preoperative Staging ◽

Clinical Staging ◽

Resected Specimen ◽

Common Disease ◽

Curative Intent ◽

Mmr Deficiency ◽

The Impact ◽

Histopathological Type

Background: Colon cancer is a common disease in western populations. The aim of this study was to assess the impact of mismatch repair (MMR) deficiency and other patient and tumor characteristics on the accuracy of preoperative staging by comparing histopathological T- and N-categories of the resected specimen with the preoperative clinical stage in a nationwide cohort of patients treated for colon cancer by elective bowel resection with curative intent. Methods: A register study of a cohort extracted from the Danish Colorectal Cancer Group (DCCG) database, which holds prospective data on all new cases of colon and rectum cancer in Denmark. Patients diagnosed with colon cancer and treated with an elective bowel resection with curative intent in the years 2016–2019 were analyzed. Results: A total of 6102 patients were included (n = 3161 (52%) men and n = 2941 (48%) women) with a median age of 72 years (range 23–97 years). MMR was deficient in 24% of the patients and proficient in 76%. MMR deficiency, tumor sidedness and histopathological type were significant predictors of the accuracy of preoperative staging of colon cancer in univariate and multivariate analysis. MMR status in particular showed a strong impact on the risk of overstaging. Conclusions: MMR deficiency, but also tumor sidedness and to some degree histopathological type, impacted the accuracy of preoperative staging of colon cancer. MMR status should be taken into consideration in everyday clinical staging.

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Diagnostic value of preoperative CT scan to stratify colon cancer for neoadjuvant therapy

International Journal of Colorectal Disease ◽

10.1007/s00384-015-2265-z ◽

2015 ◽

Vol 30 (8) ◽

pp. 1067-1073 ◽

Cited By ~ 10

Author(s):

Armin Wiegering ◽

Meik Kunz ◽

Mohamed Hussein ◽

Ingo Klein ◽

Verena Wiegering ◽

...

Keyword(s):

Colon Cancer ◽

Ct Scan ◽

Neoadjuvant Therapy ◽

Diagnostic Value ◽

Preoperative Ct

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The Role of Carcinoembryonic Antigen as a Predictor of the Need for Preoperative Computed Tomography in Colon Cancer Patients

The American Surgeon ◽

10.1177/000313480607201012 ◽

2006 ◽

Vol 72 (10) ◽

pp. 897-901

Author(s):

Alicia D. Holt ◽

Justin T. Kim ◽

Zuri Murrell ◽

Richard Huynh ◽

Michael J. Stamos ◽

...

Keyword(s):

Computed Tomography ◽

Colon Cancer ◽

Ct Scan ◽

Carcinoembryonic Antigen ◽

Cancer Patients ◽

Clinical Utility ◽

Stage Iv ◽

Stage Iv Disease ◽

Preoperative Ct

A retrospective study of 117 patients with the diagnosis of colon cancer was performed to evaluate the clinical utility of the preoperative computed tomography (CT) scan and to assess the role of carcinoembryonic antigen (CEA) as a predictor of the need for CT scan in colon cancer patients. Forty-nine patients had a CT scan that altered their treatment. One hundred per cent of stage IV patients versus only 26.5 per cent of stage I, II, and III patients had their operative and/or treatment planning altered by the preoperative CT. The sensitivity of CT scan in predicting metastatic disease was 90.3 per cent. All patients with stage IV disease had an abnormal CEA (>3 ng/mL). There was 89.7 per cent of stage IV patients who had a CEA twice that of normal or above. By using a CEA level of 3.1 ng/mL or above as a prerequisite for preoperative tomography, 34 nonmetastatic patients would not have had preoperative CT scans. Using a prerequisite of 6.1 ng/mL or above, 49 nonmetastatic patients would not have had a preoperative CT scan, and 90 per cent of the stage IV patients would have been imaged. We recommend obtaining a preoperative CT scan on those patients with a CEA value twice that of normal or greater.

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Selection of colon cancer patients for neoadjuvant chemotherapy by preoperative CT scan

Scandinavian Journal of Gastroenterology ◽

10.3109/00365521.2013.862294 ◽

2013 ◽

Vol 49 (2) ◽

pp. 202-208 ◽

Cited By ~ 29

Author(s):

Anne Nørgaard ◽

Claus Dam ◽

Anders Jakobsen ◽

John Pløen ◽

Jan Lindebjerg ◽

...

Keyword(s):

Colon Cancer ◽

Neoadjuvant Chemotherapy ◽

Ct Scan ◽

Cancer Patients ◽

Preoperative Ct ◽

Selection Of

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Minimal residual calcification and recurrence after gross-total resection of craniopharyngioma in children

Journal of Neurosurgery Pediatrics ◽

10.3171/2009.1.peds08335 ◽

2009 ◽

Vol 3 (4) ◽

pp. 276-283 ◽

Cited By ~ 18

Author(s):

Robert E. Elliott ◽

Yaron A. Moshel ◽

Jeffrey H. Wisoff

Keyword(s):

Ct Scan ◽

Early Recurrence ◽

Senior Author ◽

Gross Total Resection ◽

Total Resection ◽

Time To Recurrence ◽

Preoperative Ct ◽

The Impact ◽

Minimal Residual

Object The purpose of this study was to assess the impact of minimal residual calcification without enhancing tumor on the rate of recurrence after gross-total resection (GTR) of craniopharyngioma in children. Methods Data were retrospectively collected in 86 patients younger than 21 years of age in whom 103 craniopharyngioma resections were performed by the senior author between 1986 and 2008. Forty-nine patients (27 boys and 22 girls, with a mean age of 8.6 years) fulfilled the criteria for inclusion in this study by having tumor calcification on the preoperative CT scan, undergoing GTR, and having complete postoperative CT and MR imaging and clinical follow-up. Results Thirteen patients (27%) had residual calcification (≤ 2 mm in 12 patients; 3.5 mm in 1 patient) on their postoperative CT scan. At a mean follow-up of 9.4 years (median 10 years), 2 (15%) of 13 patients with and 10 (28%) of 36 patients without residual calcification experienced tumor recurrence. There were no significant differences between these groups in terms of the duration of follow-up, time to recurrence, rate of recurrence, or recurrence-free survival. Conclusions The absence or presence of minimal residual calcification does not have an impact on the risk of recurrence after GTR in pediatric craniopharyngiomas. The authors recommend withholding irradiation or other adjuvant therapy in the setting of minimal residual calcification without enhancing tumor. Close follow-up with frequent serial imaging in all patients after GTR is imperative to identify and treat early recurrence.

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Duration of FOLFOX Adjuvant Chemotherapy in High-Risk Stage II and Stage III Colon Cancer With Deficient Mismatch Repair

Frontiers in Oncology ◽

10.3389/fonc.2020.579478 ◽

2020 ◽

Vol 10 ◽

Author(s):

Huabin Hu ◽

Zehua Wu ◽

Chao Wang ◽

Yan Huang ◽

Jianwei Zhang ◽

...

Keyword(s):

Colon Cancer ◽

High Risk ◽

Adjuvant Chemotherapy ◽

Propensity Score ◽

Mismatch Repair ◽

Therapy Group ◽

Stage Ii ◽

Stage Iii ◽

Deficient Mismatch Repair ◽

The Impact

BackgroundWe evaluated the impact of 3 months of mFOLFOX6 adjuvant chemotherapy or surgery alone in comparison with 6 months of mFOLFOX6 on disease-free survival (DFS) in deficient mismatch repair (dMMR) colon cancer (CC) patients.MethodsThis retrospective study identified a cohort of patients with high-risk stage II and III dMMR CC who underwent curative surgery between May 2011 and July 2019. DFS was compared using the Kaplan-Meier survival methods and Cox proportional hazards models. Propensity-score matching was performed to reduce imbalance in baseline characteristics.ResultsA total of 242 dMMR CC patients were identified; 66 patients received 6 months of mFOLFOX6, 87 patients received 3 months of mFOLFOX6, and 89 patients were treated with surgery alone. The 3-year DFS rate was 72.8% in 3-month therapy group and 86.1% in 6-month therapy group, with a hazard ratio (HR) of 2.78 (95CI%, 1.18 to 6.47; P= 0.019). The difference in DFS between surgery alone group and 6-month therapy group was also observed but was nonsignificant (HR= 2.30, 95%CI, 0.99 to 5.38; P=0.054). The benefit of 6-month therapy in DFS compared with 3-month therapy group was pronounced for patients with stage III (HR=2.81, 95%CI, 1.03 to 7.67; P=0.044) but not for high-risk stage II patients. Propensity score matched analysis confirmed a DFS benefit in the 6-month therapy group.ConclusionThis study suggested that a 6-month duration of mFOLFOX6 adjuvant chemotherapy in dMMR CC patients may be associated with improved DFS compared with 3-month therapy, particularly in patients with stage III. The observational nature of the study implies caution should be taken in the interpretation of these results.

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