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