Randomized Controlled Trial of Preoperatively Combinative Assessment of Upper Rectal Cancer in Prediction to Operative Strategies_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Xiaodong ¹ , SONG Huan ² , LU Donghao ² , QIN Changlong ² , WU Junhua ³ , LI Zhenhui ⁴ , LI Li ¹

1.Department of Anal-Colorectal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China;;
2.West China Medical School, Sichuan University, Chengdu 610041, China;;
3.Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China;;
4.Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, ChinaCorresponding Author: LI Li, E-mail: drlili116@126.com;

Corresponding author：

Keywords：

Rectal neoplasm; Surgical operation; Multi-slice spiral computer tomography; Preoperative assessment; Serum amyloid protein A; Multi-disciplinary team

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Objective 　To determine the influence of combinative assessment of 64 multi-slice spiral computer tomography (MSCT) and serum amyloid A protein (SAA) on the selection of operative procedures of upper rectal cancer in multi-disciplinary team.
Methods 　Prospectively enrolled 110 patients, who were diagnosed definitely as upper rectal cancer (distance of tumor to the dentate line gt;7 cm) at West China Hospital of Sichuan University from August 2007 to October 2008, randomly assigned into two groups. In one group named MSCT+SAA group, both MSCT and SAA combinative assessment were made for the preoperative evaluation. In another group named MSCT group, only MSCT was made preoperatively. Then, the pooled data were analyzed for the correlative relationship between the choice of surgery strategy and clinicopathologic factors. Furthermore, the preoperative staging and predicted operative procedures were compared with postoperative pathologic staging and practical operative procedures, respectively.
Results 　According to the criteria, 106 patients with upper rectal cancer were randomly assigned into MSCT+SAA group (n=52) and MSCT group (n=54). The baseline characteristics of two groups were statistically identical. When analyzing the proportion of multiple clinicopathologic factors in different operative procedures of upper rectal cancer, there were statistical differences in the preoperative N staging (P=0.003), M staging (P=0.022), TNM staging (P=0.003), serum level of SAA (P=0.005) and general category of tumor (P=0.027). For MSCT+SAA group the accuracies of preoperative staging T, N, M and TNM were 84.6%, 86.5%, 100% and 86.5%, respectively; For MSCT group the corresponding rates were 83.3%, 2.9%, 100% and 64.8%, respectively. There were statistically significant differences accuracies of preoperative N staging and TNM staging (P=0.005, P=0.009, respectively) in two groups. There was a statistically significant difference of the accuracy of prediction to operative procedures in two groups (96.2% vs. 81.5%, P=0.017).
Conclusion　 Combinative assessment of 64 MSCT and SAA could improve the accuracy of preoperative staging, and thus provide higher predictive coincidence rate to operative procedures for surgeon.

Citation： WANG Xiaodong,SONG Huan,LU Donghao,QIN Changlong,WU Junhua,LI Zhenhui,LI Li. Randomized Controlled Trial of Preoperatively Combinative Assessment of Upper Rectal Cancer in Prediction to Operative Strategies. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(4): 322-326. doi: Copy

1.	Moss AA, Thoeni RF, Schnyder P, et al. Value of computed tomography in the detection and staging of recurrent rectal carcinomas [Ｊ]. J Comput Assist Tomogr, 1981; 5(6): 870-874.
2.	GlojnaricI, Casl MT, Simic D, et al. Serum amyloid A protein (SAA) in colorectal carcinoma [Ｊ]. Clin Chem Lab Med, 2001; 39(2): 129-133.
3.	Greene FL, Page DL, Fleming ID, et al Eds. AJCC cancer staging manual [M]. 6th ed. New York (NY): Springer Verlag, 2002: 113-124.
4.	李立. 结直肠癌外科应用技术的规范与创新(一) [Ｊ]. 中国普外基础与临床杂志, 2006; 13(1): 106-109.
5.	李立. 结直肠癌外科应用技术的规范与创新(二) [Ｊ]. 中国普外基础与临床杂志, 2006; 13(2): 222-226.
6.	蔡三军. 直肠癌的外科治疗进展 [Ｊ]. 中国癌症杂志, 2004; 14(5): 41-45.
7.	Gollub MJ, Schwartz LH, Akhurst T. Update on colorectal cancer imaging [Ｊ]. Radiol Clin North Am, 2007; 45(1): 85-118.
8.	Bipat S, Glas AS, Slors FJ, et al. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging—a meta-analysis [Ｊ]. Radiology, 2004; 232(3): 773-783.
9.	Coussens LM, Werb Z. Inflammation and cancer [Ｊ]. Nature, 2002; 420(6917): 860-867.
10.	Gutfeld O, Prus D, Ackerman Z, et al. Expression of serum amyloid A, in normal, dysplastic, and neoplastic human colonic mucosa: implication for a role in colonic tumorigenesis [Ｊ]. J Histochem Cytochem, 2006; 54(1): 63-73.
11.	Malle E, De Beer FC. Human serum amyloid A (SAA) protein: a prominent acute-phase reactant for clinical practice [Ｊ]. Eur J Clin Invest, 1996; 26(6): 427-435.
12.	Renckens R, Roelofs JJ, Knapp S, et al. The acute-phase response and serum amyloid A inhibit the inflammatory response to Acinetobacter baumannii Pneumonia [Ｊ]. J Infect Dis, 2006; 193(2): 187-195.
13.	Kokubun M, Imafuku Y, Okada M, et al. Serum amyloid A (SAA) concentration varies among rheumatoid arthritis patients estimated by SAA/CRP ratio [Ｊ]. Clin Chim Acta, 2005; 360(1-2): 97-102.
14.	Tolson J, Bogumil R, Brunst E, et al. Serum protein profiling by SELDI mass spectrometry: detection of multiple variants of serum amyloid alpha in renal cancer patients [Ｊ]. Lab Invest, 2004; 84(7): 845-856.
15.	Weinstein PS, Skinner M, Sipe JD, et al. Acute-phase proteins or tumour markers: the role of SAA, SAP, CRP and CEA as indicators of metastasis in a broad spectrum of neoplastic diseases [Ｊ]． Scand J Immunol, 1984; 19(3): 193-208.
16.	Khan N, Cromer CJ, Campa M, et al. Clinical utility of serum amyloid A and macrophage migration inhibitory factor as serum biomarkers for the detection of nonsmall cell lung carcinoma [Ｊ]． Cancer, 2004; 101(2): 379-384.
17.	Cho WC, Yip TT, Yip C, et al. Identification of serum amyloid a protein as a potentially useful biomarker to monitor relapse of nasopharyngeal cancer by serum proteomic profiling [Ｊ]. Clin Cancer Res, 2004; 10(1 Pt 1): 43-52.
18.	Biran H, Friedman N, Neumann L, et al. Serum amyloid A (SAA) variations in patients with cancer: correlation with disease activity, stage, primary site, and prognosis [Ｊ]. J Clin Pathol, 1986; 39(7): 794-797.
19.	Le L, Chi K, Tyldesley S, et al. Identification of serum amyloid A as a biomarker to distinguish prostate cancer patients with bone lesions [Ｊ]. Clin Chem, 2005; 51(4): 695-707.
20.	Yokoi K, Shih LC, Kobayashi R, et al. Serum amyloid A as a tumor marker in sera of nude mice with orthotopic human pancreatic cancer and in plasma of patients with pancreatic cancer [Ｊ]. Int J Oncol, 2005; 27(5): 1361-1369.
21.	Michaeli A, Finci-Yeheskel Z, Dishon S, et al. Serum amyloid A enhances plasminogen activation: implication for a role in colon cancer [Ｊ]. Biochem Biophys Res Commun, 2008; 368(2): 368-373.
22.	Miwata H, Yamada T, Okada M, et al. Serum amyloid A protein in acute viral infections [Ｊ]. Arch Dis Child, 1993; 68(2): 210-214.
23.	d’Eril GM, Anesi A, Maggiore M, et al. Biological variation of serum amyloid A in healthy subjects [Ｊ]. Clin Chem, 2001; 47(8): 1498-1499.
24.	刘展, 汪晓东, 李立. 在结直肠癌领域引入多学科协作管理模式的现状 [Ｊ]. 中国普外基础与临床杂志, 2007; 14(1): 114-116.
25.	汪晓东, 李立. 结直肠肿瘤多学科协作诊治模式下整体构建理念及基本组织构架 [Ｊ]. 中国普外基础与临床杂志, 2007; 14(3): 339-342.

1. Moss AA, Thoeni RF, Schnyder P, et al. Value of computed tomography in the detection and staging of recurrent rectal carcinomas [Ｊ]. J Comput Assist Tomogr, 1981; 5(6): 870-874.
2. GlojnaricI, Casl MT, Simic D, et al. Serum amyloid A protein (SAA) in colorectal carcinoma [Ｊ]. Clin Chem Lab Med, 2001; 39(2): 129-133.
3. Greene FL, Page DL, Fleming ID, et al Eds. AJCC cancer staging manual [M]. 6th ed. New York (NY): Springer Verlag, 2002: 113-124.
4. 李立. 结直肠癌外科应用技术的规范与创新(一) [Ｊ]. 中国普外基础与临床杂志, 2006; 13(1): 106-109.
5. 李立. 结直肠癌外科应用技术的规范与创新(二) [Ｊ]. 中国普外基础与临床杂志, 2006; 13(2): 222-226.
6. 蔡三军. 直肠癌的外科治疗进展 [Ｊ]. 中国癌症杂志, 2004; 14(5): 41-45.
7. Gollub MJ, Schwartz LH, Akhurst T. Update on colorectal cancer imaging [Ｊ]. Radiol Clin North Am, 2007; 45(1): 85-118.
8. Bipat S, Glas AS, Slors FJ, et al. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging—a meta-analysis [Ｊ]. Radiology, 2004; 232(3): 773-783.
9. Coussens LM, Werb Z. Inflammation and cancer [Ｊ]. Nature, 2002; 420(6917): 860-867.
10. Gutfeld O, Prus D, Ackerman Z, et al. Expression of serum amyloid A, in normal, dysplastic, and neoplastic human colonic mucosa: implication for a role in colonic tumorigenesis [Ｊ]. J Histochem Cytochem, 2006; 54(1): 63-73.
11. Malle E, De Beer FC. Human serum amyloid A (SAA) protein: a prominent acute-phase reactant for clinical practice [Ｊ]. Eur J Clin Invest, 1996; 26(6): 427-435.
12. Renckens R, Roelofs JJ, Knapp S, et al. The acute-phase response and serum amyloid A inhibit the inflammatory response to Acinetobacter baumannii Pneumonia [Ｊ]. J Infect Dis, 2006; 193(2): 187-195.
13. Kokubun M, Imafuku Y, Okada M, et al. Serum amyloid A (SAA) concentration varies among rheumatoid arthritis patients estimated by SAA/CRP ratio [Ｊ]. Clin Chim Acta, 2005; 360(1-2): 97-102.
14. Tolson J, Bogumil R, Brunst E, et al. Serum protein profiling by SELDI mass spectrometry: detection of multiple variants of serum amyloid alpha in renal cancer patients [Ｊ]. Lab Invest, 2004; 84(7): 845-856.
15. Weinstein PS, Skinner M, Sipe JD, et al. Acute-phase proteins or tumour markers: the role of SAA, SAP, CRP and CEA as indicators of metastasis in a broad spectrum of neoplastic diseases [Ｊ]． Scand J Immunol, 1984; 19(3): 193-208.
16. Khan N, Cromer CJ, Campa M, et al. Clinical utility of serum amyloid A and macrophage migration inhibitory factor as serum biomarkers for the detection of nonsmall cell lung carcinoma [Ｊ]． Cancer, 2004; 101(2): 379-384.
17. Cho WC, Yip TT, Yip C, et al. Identification of serum amyloid a protein as a potentially useful biomarker to monitor relapse of nasopharyngeal cancer by serum proteomic profiling [Ｊ]. Clin Cancer Res, 2004; 10(1 Pt 1): 43-52.
18. Biran H, Friedman N, Neumann L, et al. Serum amyloid A (SAA) variations in patients with cancer: correlation with disease activity, stage, primary site, and prognosis [Ｊ]. J Clin Pathol, 1986; 39(7): 794-797.
19. Le L, Chi K, Tyldesley S, et al. Identification of serum amyloid A as a biomarker to distinguish prostate cancer patients with bone lesions [Ｊ]. Clin Chem, 2005; 51(4): 695-707.
20. Yokoi K, Shih LC, Kobayashi R, et al. Serum amyloid A as a tumor marker in sera of nude mice with orthotopic human pancreatic cancer and in plasma of patients with pancreatic cancer [Ｊ]. Int J Oncol, 2005; 27(5): 1361-1369.
21. Michaeli A, Finci-Yeheskel Z, Dishon S, et al. Serum amyloid A enhances plasminogen activation: implication for a role in colon cancer [Ｊ]. Biochem Biophys Res Commun, 2008; 368(2): 368-373.
22. Miwata H, Yamada T, Okada M, et al. Serum amyloid A protein in acute viral infections [Ｊ]. Arch Dis Child, 1993; 68(2): 210-214.
23. d’Eril GM, Anesi A, Maggiore M, et al. Biological variation of serum amyloid A in healthy subjects [Ｊ]. Clin Chem, 2001; 47(8): 1498-1499.
24. 刘展, 汪晓东, 李立. 在结直肠癌领域引入多学科协作管理模式的现状 [Ｊ]. 中国普外基础与临床杂志, 2007; 14(1): 114-116.
25. 汪晓东, 李立. 结直肠肿瘤多学科协作诊治模式下整体构建理念及基本组织构架 [Ｊ]. 中国普外基础与临床杂志, 2007; 14(3): 339-342.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Randomized Controlled Trial of Preoperatively Combinative Assessment of Upper Rectal Cancer in Prediction to Operative Strategies

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