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Abstract
Purpose
The aim of this study was to determine the radiologic risk factors of colorectal cancer (CRC) with synchronous liver metastases.
Materials and Methods
A total of 197 patients with CRC who had a visible tumor on contrast-enhanced abdominopelvic computed tomography and were treated be-tween January 2012 and December 2012 were included. Longitudinal diameter, mu-ral thickness, primary tumor attenuation, and other metastases were evaluated in-dependently. Univariate analysis and multivariate logistic regression analysis were used to identify risk factors associated with the presence of liver metastases.
Results
Cases were divided into two groups based on the presence or absence of liver metastases (n = 56 and 141, respectively). Primary tumors with enhancement of ≥ 90 Hounsfield units (HU) were found to have a higher risk of liver metastases than those with enhancement of < 90 HU [odds ratio (OR): 2.619, p = 0.034]. The presence of pulmonary metastases was associated with a higher risk of liver metas-tases (OR: 14.218, p = 0.025). The presence of lymph node metastases (N2 vs. N0) and carcinoembryonic antigen (CEA) level independently predicted the presence of liver metastases (OR: 8.766, p < 0.001; OR: 1.012, p = 0.048).
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Fig. 2.
Proximal sigmoid colon cancer in a 58-year-old woman. (A) Longitudinal tumor diameter, (B) tumor mural thickness, and (C) tumor en-hancement (region of interest) of the primary cancer were measured.
Fig. 3.
Liver metastasis from recto-sigmoid colon cancer in a 67-year-old woman. (A) Transverse CT image shows a tiny indeterminate hypoat-tenuating lesion (arrow) in hepatic segment VI. (B) Transverse CT image shows a primary tumor (arrows). Tumor enhancement was 126 HU, sug-gestive of high risk. (C) The tiny lesion had increased in size as determined by follow-up CT 9 months later (arrow). (D) Gadoxetic acid-enhanced hepatobiliary phase image shows a hypointense lesion (arrow) in hepatic segment VI. (E) Diffusion weighted images (b = 1000 sec/mm2) and (F) T2-weighted images demonstrate a hyperintense lesion (arrows). This lesion was considered to be metastasis based on analyses of serial CT and magnetic resonance images. CT = computed tomography
Fig. 4.
Liver metastasis from recto-sigmoid colon cancer in an 80-year-old man. (A) Transverse CT did not depict a definite abnormal lesion in hepatic segment V. (B) Coronal reconstruction image shows a primary tumor. Its enhancement was 92 Hounsfield units, suggestive of high risk. Magnetic resonance images were obtained 3 days after initial CT. (C) Gadoxetic acid-enhanced hepatobiliary phase image shows a hypointense lesion (arrow) in hepatic segment V. (D) Diffusion weighted images (b = 800 sec/mm2) and (E) T2-weighted images demonstrate a hyperintense lesion (arrows). This lesion was confirmed to be metastasis by tumorectomy. CT = computed tomography
Fig. 5.
Receiver operating characteristic curve analysis results for fac-tors that were found to be positively associated with the presence of liver metastasis by logistic regression analysis. CEA = carcinoembryonic antigen
Table 1.
Clinico-Pathological and Radiological Data of Colorectal Cancer Patients with or without Hepatic Metastases
| Variable | Patients with Liver Metastasis (n = 56) | Patients without Liver Metastasis (n = 141) | p-Value |
|---|---|---|---|
| Age | 66 ± 12.4 | 64 ± 12.8 | |
| Sex (M:F) | 33:23 | 89:52 | |
| Tumor location, n (%) | |||
| Right colon | 9 (16) | 32 (22.8) | |
| Left colon | 7 (12.5) | 24 (16.7) | |
| Rectosigmoid junction | 21 (37.5) | 44 (31.3) | |
| Rectal ampulla | 19 (34) | 39 (27.8) | |
| Synchronous | 0 | 2 (1.4) | |
| Cell type, n (%) | |||
| Adenocarcinoma | |||
| Well differentiated | 3 (5.4) | 12 (8.5) | |
| Moderate | 45 (80) | 115 (81.6) | |
| Poorly | 2 (3.6) | 3 (2.1) | |
| Mucinous adenocarcinoma | 5 (9.2) | 8 (5.7) | |
| Signet ring cell carcinoma | 1 (1.8) | 3 (2.1) | |
| pT staging | |||
| T1 | 0 | 6 (5) | |
| T2 | 0 | 24 (20) | |
| T3 | 24 (69) | 83 (69) | |
| T4 | 11 (31) | 7 (6) | |
| pN staging | |||
| N0 | 5 (14) | 81 (94.5) | |
| N1 | 11 (31) | 36 (3) | |
| N2 | 19 (55) | 3 (2.5) | |
| Unresectable condition, n (%) | 14 (25%, 14/56) | 8 (6%, 8/131) | |
| Neoadjuvant CRT, n (%) | 7 (13%, 7/56) | 13 (10%, 13/131) | |
| CEA (μg/L)* | 177.8 ± 593.3 | 10.4 ± 31.0 | 0.001 |
Table 2.
Characteristics of Liver Metastases
Table 3.
Radiological Finding of Primary Colorectal Cancer with or without Liver Metastases
| Variable | Patients with Liver Metastasis (n = 56) | Patients without Liver Metastasis (n = 141) | p-Value |
|---|---|---|---|
| Longitudinal diameter (mm)* | 54.9 ± 18.9 | 42.3 ± 19.5 | < 0.001 |
| Mural thickness (mm)* | 18.4 ± 8.8 | 14.4 ± 6.0 | 0.003 |
| Enhancement (ROI, HU)* | 91.4 ± 10.3 | 83.9 ± 11.1 | < 0.001 |
| Shape of tumor, n (%) | < 0.001 | ||
| Intraluminal polypoid | 0 (0) | 33 (23) | |
| Ulcerofungating or Ulceroinfiltrative pattern | 40 (71) | 102 (72) | |
| Bulky pattern | 16 (29) | 6 (5) | |
| Pericolic fat infiltration, n (%) | < 0.001 | ||
| None | 0 (0) | 33 (23) | |
| Hazy infiltration | 13 (23) | 36 (26) | |
| Linear infiltration | 29 (52) | 59 (42) | |
| Nodular infiltration | 14 (25) | 13 (9) | |
| Pulmonary metastases, n (%) | 14 (25) | 1 (0.7) | < 0.001 |
Table 4.
Risk Factors of Liver Metastases as Determined by Univari-ate Analysis
Table 5.
Risk Factors of Liver Metastases as Determined by Multi-variate Analysis
Table 6.
ROC Curve Analysis Results for Factors Identified by Logistic Regression Analysis
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