PRE-OPERATIVE STAGING OF RECTAL CANCER: THE SIGNIFICANCE OF FAT STREAKING ON COMPUTED TOMOGRAPHY E...
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PRE-OPERATIVE STAGING OF RECTAL CANCER: PRE-OPERATIVE STAGING OF RECTAL CANCER: THE SIGNIFICANCE OF FAT STREAKING ON THE SIGNIFICANCE OF FAT STREAKING ON COMPUTED TOMOGRAPHY COMPUTED TOMOGRAPHY E Leung, J Francombe E Leung, J Francombe Warwick Hospital, Lakin Road, Warwick, England Warwick Hospital, Lakin Road, Warwick, England INTRODUCTION INTRODUCTION MRI is gold standard in pre-operative staging of CRC MRI is gold standard in pre-operative staging of CRC Most British hospitals lack access, hence CT Most British hospitals lack access, hence CT Fat Streaking occasionally reported, ? significance Fat Streaking occasionally reported, ? significance COLORECTAL CANCER COLORECTAL CANCER 20,000 patients die of colorectal cancer every 20,000 patients die of colorectal cancer every year in UK year in UK Second to lung cancer as cause of cancer death Second to lung cancer as cause of cancer death Radiological imaging pre-operatively provides Radiological imaging pre-operatively provides essential information regards planning treatment essential information regards planning treatment STUDY AIMS STUDY AIMS TO DETERMINE THE FOLLOWING ASSOCIATIONS WITH: TO DETERMINE THE FOLLOWING ASSOCIATIONS WITH: • AGE OF PRESENTATION AGE OF PRESENTATION • REQUIREMENT OF ADJUVENT THERAPY REQUIREMENT OF ADJUVENT THERAPY • DUKE’S STAGING DUKE’S STAGING • RECURRENCE WITHIN 3 YEARS RECURRENCE WITHIN 3 YEARS • MORTALITY WITHIN 3 YEARS OF DIAGNOSIS MORTALITY WITHIN 3 YEARS OF DIAGNOSIS MATERIALS AND METHODS MATERIALS AND METHODS ALL PATIENTS WITH RC SINCE 2001 PRO DATA BASE ALL PATIENTS WITH RC SINCE 2001 PRO DATA BASE PATIENTS WITH PRESENCE OF FAT STREAKING ON CT PATIENTS WITH PRESENCE OF FAT STREAKING ON CT WERE IDENTIFIED WERE IDENTIFIED ALL DATA WAS TABULATED AMONGST THE PARAMETERS ALL DATA WAS TABULATED AMONGST THE PARAMETERS STANDARD STATISTICAL ANALYSIS WAS CARRIED OUT STANDARD STATISTICAL ANALYSIS WAS CARRIED OUT Chi SQUARE TEST WAS USED TO EVALUATE SIGNIFICANCE Chi SQUARE TEST WAS USED TO EVALUATE SIGNIFICANCE ON RECURRENCE AND MORTALITY RATE ON RECURRENCE AND MORTALITY RATE TOTAL NUMBER OF PATIENTS TOTAL NUMBER OF PATIENTS 73 73 39 MALE 39 MALE 34 FEMALE 34 FEMALE FS FS 40 40 PATIENT AGE RANGE PATIENT AGE RANGE 42-101 42-101 MEAN AGE OF PRESENTATION MEAN AGE OF PRESENTATION 72.5 72.5 FAT STREAKING / NONFS FAT STREAKING / NONFS 72.3/72.7 72.3/72.7 REQUIRMENTS TO ADJUVENT THERAPY: REQUIRMENTS TO ADJUVENT THERAPY: FAT STREAKING CASES FAT STREAKING CASES 50% 50% NON FAT STREAKING CASES NON FAT STREAKING CASES 24% 24% FS FS NFS NFS Pre-operative adjunct: Pre-operative adjunct: 8 (20%) 8 (20%) 3 (9%) 3 (9%) Nil pre-operative: Nil pre-operative: 32 32 30 30 Post-operative adjunct: Post-operative adjunct: 12 12 (30%) (30%) 5(15%) 5(15%) Nil post-operative: Nil post-operative: 28 28 28 28 DUKES STAGING DUKES STAGING 30% OF NFS CASES WERE DUKES A 30% OF NFS CASES WERE DUKES A 15% OF FS CASES ONLY WERE DUKES A 15% OF FS CASES ONLY WERE DUKES A SIMILAR PREVALENCES AMONGST OTHER DUKES STAGE SIMILAR PREVALENCES AMONGST OTHER DUKES STAGE DUKES DUKES A B C A B C D NS D NS FAT STREAKING FAT STREAKING 5 10(25%) 12(30%) 5(12%) 8 5 10(25%) 12(30%) 5(12%) 8 NON FAT STREAKING NON FAT STREAKING 9 6 (18%) 12(36%) 3(9%) 9 6 (18%) 12(36%) 3(9%) 3 3 RECURRENCE < 3 YEARS OF DIAGNOSIS (LOCAL-REGIONAL) RECURRENCE < 3 YEARS OF DIAGNOSIS (LOCAL-REGIONAL) 15 % v 0% OF FS v NFS RESPECTIVELY 15 % v 0% OF FS v NFS RESPECTIVELY FS FS NFS NFS Recurrence Recurrence 9 9 0 0 No recurrence No recurrence 31 31 33 33 Chi square value = 6.42, p= 0.025 Chi square value = 6.42, p= 0.025 MORTALITY 27.5% v 24.2% FS v NFS MORTALITY 27.5% v 24.2% FS v NFS Alive Alive 29 29 25 25 Died Died 11 11 8 8 Chi Square value = 0.00562, p is almost 1 Chi Square value = 0.00562, p is almost 1 THE PRESENCE OF FAT STREAKING IS ASSOCIATED WITH A SIGNIFICANTLY HIGHER RECURRENCE THE PRESENCE OF FAT STREAKING IS ASSOCIATED WITH A SIGNIFICANTLY HIGHER RECURRENCE RATE RATE FAT STREAKING ON PREOPERATIVE CT IS AN IMPORTANT PROGNOSTIC INDICATOR OF FAT STREAKING ON PREOPERATIVE CT IS AN IMPORTANT PROGNOSTIC INDICATOR OF DISEASE RECURRENCE DISEASE RECURRENCE RESULTS RESULTS CONCLUSIONS CONCLUSIONS
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Transcript of PRE-OPERATIVE STAGING OF RECTAL CANCER: THE SIGNIFICANCE OF FAT STREAKING ON COMPUTED TOMOGRAPHY E...
PRE-OPERATIVE STAGING OF RECTAL CANCER: PRE-OPERATIVE STAGING OF RECTAL CANCER: THE SIGNIFICANCE OF FAT STREAKING ON THE SIGNIFICANCE OF FAT STREAKING ON
COMPUTED TOMOGRAPHYCOMPUTED TOMOGRAPHY
E Leung, J FrancombeE Leung, J Francombe
Warwick Hospital, Lakin Road, Warwick, EnglandWarwick Hospital, Lakin Road, Warwick, England
PRE-OPERATIVE STAGING OF RECTAL CANCER: PRE-OPERATIVE STAGING OF RECTAL CANCER: THE SIGNIFICANCE OF FAT STREAKING ON THE SIGNIFICANCE OF FAT STREAKING ON
COMPUTED TOMOGRAPHYCOMPUTED TOMOGRAPHY
E Leung, J FrancombeE Leung, J Francombe
Warwick Hospital, Lakin Road, Warwick, EnglandWarwick Hospital, Lakin Road, Warwick, England
INTRODUCTIONINTRODUCTION
MRI is gold standard in pre-operative staging of CRCMRI is gold standard in pre-operative staging of CRC
Most British hospitals lack access, hence CTMost British hospitals lack access, hence CT
Fat Streaking occasionally reported, ? significanceFat Streaking occasionally reported, ? significance
INTRODUCTIONINTRODUCTION
MRI is gold standard in pre-operative staging of CRCMRI is gold standard in pre-operative staging of CRC
Most British hospitals lack access, hence CTMost British hospitals lack access, hence CT
Fat Streaking occasionally reported, ? significanceFat Streaking occasionally reported, ? significance
COLORECTAL CANCERCOLORECTAL CANCER
20,000 patients die of colorectal cancer every year 20,000 patients die of colorectal cancer every year in UKin UK
Second to lung cancer as cause of cancer deathSecond to lung cancer as cause of cancer death
Radiological imaging pre-operatively provides Radiological imaging pre-operatively provides essential information regards planning treatmentessential information regards planning treatment
COLORECTAL CANCERCOLORECTAL CANCER
20,000 patients die of colorectal cancer every year 20,000 patients die of colorectal cancer every year in UKin UK
Second to lung cancer as cause of cancer deathSecond to lung cancer as cause of cancer death
Radiological imaging pre-operatively provides Radiological imaging pre-operatively provides essential information regards planning treatmentessential information regards planning treatment
STUDY AIMSSTUDY AIMS
TO DETERMINE THE FOLLOWING ASSOCIATIONS WITH:TO DETERMINE THE FOLLOWING ASSOCIATIONS WITH:
•AGE OF PRESENTATIONAGE OF PRESENTATION
•REQUIREMENT OF ADJUVENT THERAPYREQUIREMENT OF ADJUVENT THERAPY
•DUKE’S STAGINGDUKE’S STAGING
•RECURRENCE WITHIN 3 YEARSRECURRENCE WITHIN 3 YEARS
•MORTALITY WITHIN 3 YEARS OF DIAGNOSISMORTALITY WITHIN 3 YEARS OF DIAGNOSIS
MATERIALS AND METHODSMATERIALS AND METHODS
ALL PATIENTS WITH RC SINCE 2001 PRO DATA BASEALL PATIENTS WITH RC SINCE 2001 PRO DATA BASE
PATIENTS WITH PRESENCE OF FAT STREAKING ON PATIENTS WITH PRESENCE OF FAT STREAKING ON CT WERE IDENTIFIEDCT WERE IDENTIFIED
ALL DATA WAS TABULATED AMONGST THE ALL DATA WAS TABULATED AMONGST THE PARAMETERSPARAMETERS
STANDARD STATISTICAL ANALYSIS WAS CARRIED STANDARD STATISTICAL ANALYSIS WAS CARRIED OUTOUT
Chi SQUARE TEST WAS USED TO EVALUATE Chi SQUARE TEST WAS USED TO EVALUATE SIGNIFICANCE ON RECURRENCE AND MORTALITY SIGNIFICANCE ON RECURRENCE AND MORTALITY RATERATE
TOTAL NUMBER OF PATIENTSTOTAL NUMBER OF PATIENTS 737339 MALE39 MALE34 FEMALE 34 FEMALE
FSFS 40 40
PATIENT AGE RANGEPATIENT AGE RANGE 42-10142-101MEAN AGE OF PRESENTATIONMEAN AGE OF PRESENTATION 72.572.5FAT STREAKING / NONFSFAT STREAKING / NONFS 72.3/72.772.3/72.7
TOTAL NUMBER OF PATIENTSTOTAL NUMBER OF PATIENTS 737339 MALE39 MALE34 FEMALE 34 FEMALE
FSFS 40 40
PATIENT AGE RANGEPATIENT AGE RANGE 42-10142-101MEAN AGE OF PRESENTATIONMEAN AGE OF PRESENTATION 72.572.5FAT STREAKING / NONFSFAT STREAKING / NONFS 72.3/72.772.3/72.7
REQUIRMENTS TO ADJUVENT THERAPY:REQUIRMENTS TO ADJUVENT THERAPY:
FAT STREAKING CASES FAT STREAKING CASES 50%50%NON FAT STREAKING CASES NON FAT STREAKING CASES 24%24%
FSFS NFSNFSPre-operative adjunct:Pre-operative adjunct: 8 8 (20%)(20%) 3 (9%)3 (9%)Nil pre-operative:Nil pre-operative: 3232 3030Post-operative adjunct:Post-operative adjunct: 12 12 (30%)(30%) 5(15%)5(15%)Nil post-operative:Nil post-operative: 2828 2828
REQUIRMENTS TO ADJUVENT THERAPY:REQUIRMENTS TO ADJUVENT THERAPY:
FAT STREAKING CASES FAT STREAKING CASES 50%50%NON FAT STREAKING CASES NON FAT STREAKING CASES 24%24%
FSFS NFSNFSPre-operative adjunct:Pre-operative adjunct: 8 8 (20%)(20%) 3 (9%)3 (9%)Nil pre-operative:Nil pre-operative: 3232 3030Post-operative adjunct:Post-operative adjunct: 12 12 (30%)(30%) 5(15%)5(15%)Nil post-operative:Nil post-operative: 2828 2828
DUKES STAGINGDUKES STAGING
30% OF NFS CASES WERE DUKES A30% OF NFS CASES WERE DUKES A15% OF FS CASES ONLY WERE DUKES A15% OF FS CASES ONLY WERE DUKES ASIMILAR PREVALENCES AMONGST OTHER DUKES STAGESIMILAR PREVALENCES AMONGST OTHER DUKES STAGE
DUKESDUKES A B C D A B C D NSNS
FAT STREAKINGFAT STREAKING 5 10(25%) 12(30%) 5(12%) 85 10(25%) 12(30%) 5(12%) 8NON FAT STREAKINGNON FAT STREAKING 9 6 (18%) 12(36%) 3(9%) 39 6 (18%) 12(36%) 3(9%) 3
DUKES STAGINGDUKES STAGING
30% OF NFS CASES WERE DUKES A30% OF NFS CASES WERE DUKES A15% OF FS CASES ONLY WERE DUKES A15% OF FS CASES ONLY WERE DUKES ASIMILAR PREVALENCES AMONGST OTHER DUKES STAGESIMILAR PREVALENCES AMONGST OTHER DUKES STAGE
DUKESDUKES A B C D A B C D NSNS
FAT STREAKINGFAT STREAKING 5 10(25%) 12(30%) 5(12%) 85 10(25%) 12(30%) 5(12%) 8NON FAT STREAKINGNON FAT STREAKING 9 6 (18%) 12(36%) 3(9%) 39 6 (18%) 12(36%) 3(9%) 3
RECURRENCE < 3 YEARS OF DIAGNOSIS (LOCAL-RECURRENCE < 3 YEARS OF DIAGNOSIS (LOCAL-REGIONAL)REGIONAL)
15 % v 0% OF FS v NFS RESPECTIVELY15 % v 0% OF FS v NFS RESPECTIVELY
FSFS NFSNFS
RecurrenceRecurrence 99 00
No recurrenceNo recurrence 3131 3333
Chi square value = 6.42, p= 0.025Chi square value = 6.42, p= 0.025
MORTALITY 27.5% v 24.2% FS v NFSMORTALITY 27.5% v 24.2% FS v NFS
AliveAlive 2929 2525
DiedDied 1111 88
Chi Square value = 0.00562, p is almost 1Chi Square value = 0.00562, p is almost 1
RECURRENCE < 3 YEARS OF DIAGNOSIS (LOCAL-RECURRENCE < 3 YEARS OF DIAGNOSIS (LOCAL-REGIONAL)REGIONAL)
15 % v 0% OF FS v NFS RESPECTIVELY15 % v 0% OF FS v NFS RESPECTIVELY
FSFS NFSNFS
RecurrenceRecurrence 99 00
No recurrenceNo recurrence 3131 3333
Chi square value = 6.42, p= 0.025Chi square value = 6.42, p= 0.025
MORTALITY 27.5% v 24.2% FS v NFSMORTALITY 27.5% v 24.2% FS v NFS
AliveAlive 2929 2525
DiedDied 1111 88
Chi Square value = 0.00562, p is almost 1Chi Square value = 0.00562, p is almost 1
THE PRESENCE OF FAT STREAKING IS ASSOCIATED WITH A SIGNIFICANTLY HIGHER THE PRESENCE OF FAT STREAKING IS ASSOCIATED WITH A SIGNIFICANTLY HIGHER RECURRENCE RATERECURRENCE RATE
FAT STREAKING ON PREOPERATIVE CT IS AN IMPORTANT PROGNOSTIC INDICATOR OF FAT STREAKING ON PREOPERATIVE CT IS AN IMPORTANT PROGNOSTIC INDICATOR OF
DISEASE RECURRENCEDISEASE RECURRENCE
RESULTSRESULTS RESULTSRESULTS
CONCLUSIONCONCLUSIONSSCONCLUSIONCONCLUSIONSS
