Apparent diffusion coefficient is a good marker in predicting the prognosis in colorectal cancer liver metastases: a diagnostic study

Abstract

Background: Colorectal cancer (CRC) is one of the most common malignant tumors. Up to 10% CRC patients can have liver metastases at the first diagnosis. At present, clinical diagnosis of CRC liver metastasis (CRCLM) is mostly based on imaging, and there is a certain false-positive rate and false-negative rate.Improving the diagnostic accuracy of imaging for CRCLM is highly significant. Apparent diffusion coefficients showed high predicting value in other cancers. The aim of the present study was to explore the diagnostic value of apparent diffusion coefficients based on magnetic resonance diffusion weighted imaging for CRCLM.Methods: Fifty patients with CRCLM admitted to Hebei Yanda Hospital from January 2018 to December 2018 were retrospectively collected, and the data of 50 patients with benign liver nodules were collected at the same time. The diagnostic value of apparent diffusion coefficients on liver metastatic cancer was analyzed using receiver operating characteristic curve. The correlation between apparent diffusion coefficients and clinical pathological features of patients with CRCLM was also analyzed. The diagnosis of liver metastatic cancer was based on pathological biopsy. Three-year follow up after surgery was conducted in clinic or via phone.Results: Compared with the benign liver nodule group, the apparent diffusion coefficients of patients in the CRCLM group were significantly decreased [(1.14±0.26 vs. 2.06±0.57)×10−3 mm 2 /s, P<0.001]. The apparent diffusion coefficient was of high value in differentiating between benign liver nodules and liver metastatic cancer. The area under the curve was 0.927 [95% confidence interval (CI): 0.879-0.975, P<0.001]. Compared with patients with highly differentiated tumors, the apparent diffusion coefficients of patients with moderately and poorly differentiated tumors were significantly reduced [(1.08±0.26 vs. 1.29±0.22)×10−3 mm 2 /s, P=0.010]. Compared with patients who survived 3 years after operation, the apparent diffusion coefficients of patients who died were significantly lower [(1.05±0.26 vs. 1.23±0.23)×10−3 mm 2 /s, P=0.011]. The apparent diffusion coefficients of liver nodules in patients with CRCLM is a good marker in predicting postoperative 3-year survival, and the area under the curve was 0.728 (95% CI: 0.580-0.876, P=0.006). Conclusions:The apparent diffusion coefficient can sever as a marker in diagnosing CRCLM and predicting prognosis.

Predictive value of apparent diffusion coefficient for neoadjuvant chemotherapy in locally advanced colorectal cancer patients

“…Therefore, patients with low ADC are relatively prone to metastasis, leading to poor prognosis of patients. This had been confirmed in patients with CRC and other malignant tumors ( 18 , 25 - 27 ), supporting this study.…”

“…Due to the high cell density in solid malignant tumor tissue, the ADC in malignant tumor tissue is often in a reduced state. At present, the ADC is used to predict the prognosis of patients with malignant tumor ( 19 - 21 ), and has also been reported in patients with CRC ( 18 ). In the field of neoadjuvant chemotherapy, studies have also confirmed that the ADC is significantly related to the efficacy of neoadjuvant chemotherapy in patients with breast cancer and osteosarcoma ( 16 , 22 , 23 ).…”

“…In addition, exploring prognostic indicators of malignant tumors is also one of the purposes of clinical research ( 17 ). A study in patients with liver metastasis of CRC showed that ADC had good value in predicting the prognosis of patients with CRC ( 18 ). Therefore, we speculated that the ADC was related to the efficacy of neoadjuvant chemotherapy in locally advanced CRC patients, but there is no relevant research at present.…”