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• W4382806907 abstract "With the FOxTROT and NICHE trials, neoadjuvant chemotherapy and immunotherapy for resectable colon cancer (CC) is gaining momentum. However, patient selection for neoadjuvant treatment relies on radiologic staging using routinely performed computed tomography (CT) scans. Given the limited accuracy of CT staging for CC, especially for nodal disease, over-treating patients is a concern. Therefore, we sought to evaluate the accuracy of CT staging in CC and to identify specific imaging characteristics that can improve radiologic nodal staging. We performed a prospective, blinded radiology study of patients with stage I-III CC who underwent primary resection at a single institution from 2018-2021. Pre-operative staging CT scans were reviewed by an expert abdominal radiologist, who was blinded to the histopathologic stage of the patients. Tumor (T) stage, presence/absence of nodal (N) disease, and 5 imaging features (>3 prominent lymph nodes (LNs), single LN>1cm, irregular LN borders, heterogenous enhancement, and extramural vascular invasion (EMVI)) were assessed and documented. Radiologic staging was compared to histopathologic staging of the resection specimen for each patient. A total of 112 patients with stage I-III CC treated with primary resection were identified. The median age of our cohort was 67.5 years old with 56.3% males. The most common race/ethnicity was non-Hispanic white (NHW, 49.1%), followed by Asian (21.4%) and Hispanic (17.0%). Tumor characteristics included: 80.4% pT3/T4, 46.4% pN1/N2, 79.5% moderately differentiated, 19.6% poorly differentiated, and 80.4% proficient mismatch repair (pMMR). Radiologic staging for pT3/T4 had an over-staging rate of 8.0% (sensitivity 80.0%, specificity 59.1%, AUC 0.695) while radiologic staging for pN1/N2 based on the presence/absence of nodal disease alone had an over-staging rate of 12.5% (sensitivity 53.8%, specificity 76.7%, AUC 0.653). On univariate analysis of 5 imaging features, irregular LN borders (Wald Chi-Square 6.20, p=0.01) and EMVI (Wald Chi-Square 6.54, p=0.01) were significant in predicting pN1/N2 disease, with heterogenous enhancement of LN trending towards significance (Wald Chi-Square 3.14, p=0.077). The presence of any of these three imaging features (n=33) improved specificity (80.0% vs. 68.3%) and decreased the over-staging rate (10.7% vs. 17.0%) for nodal disease compared to when any of the five imaging features (n=45) were present. Radiologic CT nodal staging for CC has an acceptable over-staging rate for pT3/T4 and pN1/N2 disease. The presence of irregular LN borders, heterogenous enhancement, and/or EMVI further increased specificity and decreased the over-staging rate in our cohort. These results can inform the design of future clinical trials for neoadjuvant therapy in CC." @default.
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• W4382806907 date "2023-06-01" @default.
• W4382806907 modified "2023-10-13" @default.
• W4382806907 title "P-112 Assessing the accuracy of CT staging for tumor and nodal staging in colon cancer" @default.
• W4382806907 doi "https://doi.org/10.1016/j.annonc.2023.04.168" @default.
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