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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (6): 1078-1084. doi: 10.19723/j.issn.1671-167X.2019.06.018

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Relationship between the CT features of colorectal cancer metastases calcification and tumor response to chemotherapy

Jing ZHANG1,2,Yu-wen ZHOU3,Meng QIU3,Lan-qing YANG1,Bing WU1,△()   

  1. 1. Departments of Radiology, West China Hospital,Sichuan University, Chengdu 610041, China
    2. Departments of Radiology, Chongqing University Cancer Hospital, Chongqing 400030, China
    3. Departments of Oncology, West China Hospital,Sichuan University, Chengdu 610041, China
  • Received:2018-01-09 Online:2019-12-18 Published:2019-12-19
  • Contact: Bing WU E-mail:bingwu69@163.com
  • Supported by:
    Supported by the Project of the Science and Technology Department in Sichuan Province(2014SZ0150)

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Abstract:

Objective: To investigate the relationship between CT features of metastatic calcification and the response to chemotherapy in colorectal cancer metastases.Methods: A total of 27 patients with 30 sites of calcified metastases who underwent chemotherapy combined with targeted therapy (cetuximab) between January 2011 and December 2016 comprised this retrospective study population. Two radiologists independently evaluated the occurrence of tumor calcification before and after treatment, and evaluated the tumor response after therapy. According to the response evaluation criteria in solid tumors (version 1.1), the best curative effect evaluation of the patients was recorded. The patients were divided into groups as below: (1) Patients who showed complete response (CR) and partial response (PR) were assigned to the response group, and the stable disease (SD) and progressive disease (PD) were assigned to the non-response group. (2) Patients showed CR or PR, or patients showed SD with longer progress free survival (PFS) were assigned to the benefit group, and the remaining patients were assigned to the no benefit group. The difference of different imaging calcification features (morphology, maximum density, and density-time slope) were analyzed.Results: The most common site of metastases calcification was liver (63.3%), followed by lymph nodes (26.7%). There were 12 cases in the response group, 15 cases in the non-response group; and 13 cases in the benefit group, 14 cases in the no benefit group. The density time growth slope was higher in the response group when compared with the non-response group (P=0.025). The proportion of thhe patients with increased number of calcified foci in the benefit group (61.5%) was higher than that in the no benefit group (14.3%), P=0.018. There was no significant difference in the maximum density between the groups. The calcification of liver metastases were all amorphous calcification, with central calcification (36.8%), eccentric calcification (36.8%), garland calcification (15.8%) and diffuse calcification (10.6%). The lymph node metastases could be diffuse (75.0%), and curve or egg-shell calcification (25.0%). There was no statistical difference between the groups.Conclusion: In patients with advanced colorectal cancer metastases treated with cetu-ximab combined chemotherapy, rapid growth of calcification density and increased calcification number may be valuable imaging features of therapeutic efficacy. The maximal calcification density and morphology of calcification are not related to the therapeutic efficacy.

Key words: Colorectal carcinoma, Metastases, Calcification

CLC Number: 

  • R445

Figure 1

Patients including process and grouping mCRC, metastatic colorectal cancer; CR, complete response; PR, partial response; SD, stable disease; PD, progressive disease; PFS, progress free survival;RECIST1.1, response evaluation criteria in solid tumors (version 1.1)."

Table 1

Patient characteristics"

Characteristic All patients
(n=111)		 Patients with tumor
calcification(n=27)
Age/years, x?±s 59±12 52±12
Gender, n
Male 70 17
Female 41 10
Primary tumor site, n
Rectum 47 12
Left colon 35 9
Right colon 29 6
Degree of differentiation, n
Poorly differentiated 34 4
Moderately differentiated 52 18
Well differentiated 1 0
Unknown 24 5
Combined chemotherapy lines, n
First line 77 21
Second line 31 6
Other 3 0
Combined chemotherapy regimen, n
FOLFOX 36 10
FOLFIRI 69 15
Irinotecan 6 2
Response to therapy, n
Complete response 2 0
Partial response 37 12
Stable disease 57 14
Progressive disease 15 1

Table 2

Comparative analysis of the calcification imaging features in different groups"

Groups Maximum density/HU Density-time growth slope/
(HU/month)		 Changes of calcification number
Increasing Invariant
Grouped by tumor response
Response group 125(94-191) 11.9±13.8 7 5
Non-response group 136(87-226) 7.9±6.6 3 12
P 0.622 0.025 0.057
Grouped by whether patients benefit from therapy
Benefit group 130(98-202) 12.0±13.2 8 5
No benefit group 133(86-230) 7.7±6.7 2 12
P 0.839 0.059 0.018

Figure 2

Typical case 1, a significant density increasing in metastases calcification Male, 65 years old, left colon cancer with liver metastasis; PFS was 487; the best curative effect of RECIST1.1 was PR.A, before treatment, unenhanced CT images showed a slightly higher density in the lesion; B, 2 months after treatment, unenhanced CT images showed that the calcification density of intrahepatic metastases increased slightly; C, 4 months after treatment, unenhanced CT images showed that the calcification density of intrahepatic metastases was significantly increased,the density-time slope was 10.2 HU/month. PR, partial response; PFS, progress free survival; RECIST1.1, response evaluation criteria in solid tumors (version 1.1)."

Figure 3

Typical case 2, the number of calcification increased with time Female, 61 years old, left colon cancer with liver metastasis; PFS was 658; the best curative effect of RECIST1.1 was PR.A, before treatment, there was no significant high density in the left internal lobe of the liver; B, C, 14 months and 20 months after treatment, unenhanced CT images showed multiple metastatic calcification in the left internal lobe, and the size of lesions were significantly reduced. PR, partial response; PFS, progress free survi-val; RECIST1.1, response evaluation criteria in solid tumors (version 1.1)."

Figure 4

Typical case 4, no changes neither in the density nor in the number of tumor calcification Male, 63 years old, with rectal cancer with liver metastasis, PFS was 241; the best curative effect of RECIST1.1 was PD. A, before treatment, unenhanced CT images showed a slightly higher density in the lesion; B, C, 3 months and 6 months after treatment, unenhanced CT images showed that the calcification density of intrahepatic metastatic foci had no obvious change, and the size of lesions did not change significantly. PD, progressive disease; PFS, progress free survival; RECIST1.1, response evaluation criteria in solid tumors (version 1.1)."

Figure 5

Imaging patterns of metastases calcification according to location and morphology"

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