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Differences in the distribution of peritoneal metastases in right- versus left-sided colon cancer on MRI
Maurits P Engbersen1,2, Elias Nerad2, Charlotte J V Rijsemus1,3,2
1Department of Radiology, Antoni Van Leeuwenhoek-Netherlands Cancer Institute, PO Box 900203, 1006 BE, Amsterdam, The Netherlands.
Purpose:
Right-sided colon tumors with peritoneal metastases (PM) are associated with a poorer prognosis than left-sided tumors. We hypothesized that a different pattern of spread could be characterized with abdominopelvic MRI. The objective of this study was to explore the spread of PM in relation to the primary tumor location on MRI.
Methods:
This is a retrospective cohort study of patients with PM from colon cancer referred to be considered for CRS-HIPEC at a single tertiary referral center. Patients with colon cancer were eligible if they had undergone an abdominopelvic MRI scan following a clinical diagnosis of PM. The frequency of affected PCI regions on MRI (MRI-PCI) was assessed and compared between tumor sidedness.
Results:
One hundred eighteen patients were included with a median age of 65 (IQR: 56-72). 46% percent were male. The median MRI-PCI was 10 (IQR: 5-16) and 8 (IQR: 4-11) for right- and left-sided tumors, respectively (p = 0.39), and the median number of affected regions was 4 (IQR: 2-7 for right-sided and IQR 2-5 for left-sided tumors). PM was most frequently found close to the primary tumor. The odds ratio of patients with PM of left sided to be affected with PM in the upper abdominal regions was 0.42 (95% CI: 0.20-0.90) and with PM on the small bowels or mesentery was 0.42 (95% CI: 0.19-0.92) over a patient with PM of right-sided colon cancer.
Conclusion:
MRI can help to assess the spread of PM in colonic cancer. In right-sided tumors, the small bowel and upper abdominal regions are more frequently affected.
Insights
Right-sided colon tumors with peritoneal metastases (PM) spread differently than left-sided tumors. Abdominopelvic MRI can help assess this spread, showing more upper abdominal and small bowel involvement in right-sided cases.
Area of Science:
- Oncology
- Radiology
- Surgical Oncology
Background:
- Peritoneal metastases (PM) from right-sided colon tumors are linked to poorer prognoses compared to left-sided tumors.
- Understanding the pattern of PM spread is crucial for treatment planning, such as cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC).
Purpose of the Study:
- To investigate the distinct patterns of peritoneal metastases (PM) spread in relation to primary tumor location (right-sided vs. left-sided colon cancer) using abdominopelvic MRI.
- To characterize the spread of PM and identify differences based on the origin of the colon cancer.
Main Methods:
- Retrospective cohort study including 118 patients with colon cancer and PM, who underwent abdominopelvic MRI.
- Assessment of the frequency and location of peritoneal cancer index (PCI) regions on MRI (MRI-PCI).
- Comparison of MRI-PCI findings between patients with right-sided and left-sided colon tumors.
Main Results:
- No significant difference in the median number of affected PCI regions (MRI-PCI) between right-sided (10) and left-sided (8) tumors.
- Peritoneal metastases were most frequently found near the primary tumor site.
- Patients with left-sided colon cancer had significantly lower odds of PM in upper abdominal regions (OR 0.42) and small bowel/mesentery (OR 0.42) compared to those with right-sided tumors.
Conclusions:
- Abdominopelvic MRI is a valuable tool for assessing the extent and pattern of peritoneal metastases in colon cancer.
- Right-sided colon tumors are associated with a higher frequency of peritoneal metastases in the upper abdomen and small bowel compared to left-sided tumors.
