Factors Influencing Intraoperative T-stage Overestimation In T3/T4 Colorectal Cancer And Its Association With Prognosis

Objective: A retrospective analysis was conducted to explore the accuracy of intraoperative T stage in colorectal cancer,analyze the factors leading to the overestimation of intraoperative T stage elucidate the clinical significance of intraoperative T stage,and lay the foundation for the clinical application of intraoperative T stage.Methods: The base data,preoperative data,intraoperative staging data,postoperative pathological data,and postoperative survival follow-up data of patients who underwent radical colorectal cancer surgery in the Department of Gastrointestinal Surgery of the Second Hospital of the Second Hospital of Dalian Medical University from December 2017 to December 2020 were retrospectively analyzed.Patients were divided into an intraoperative T-stage overestimation group and an intraoperative T stage nonoverestimation group for comparative analysis based on the results of the intraoperative T stage compared with postoperative pathological T stage.All data were statistically analyzed using IBM SPSS Statistics Version 26.0 software.The t-test was used to compare the normal distribution measurement data of the two groups;the Kruskal-Wallis test was used to compare the skewed distribution measurement data;the chi-square test was used to compare the count data of the two groups.To investigate the effect of preoperative clinical data on the overestimation of intraoperative T stage of tumors,the measures were classified by cutoff value using the receiver operating characteristic curves characteristics curves,and the logistic regression model was used to perform univariate and multifactor analysis.Survival curves were plotted using Kaplan-Meier,and differences between survival curves of different subgroups were compared using the Logrank test.Graph Pad Prism was used for all figures.Results: The rate of intraoperative T stage overestimation was 53.45%.In the univariate analysis of factors affecting intraoperative T stage overestimation,body mass index,maximum tumor diameter,gross type,carcinoembryonic antigen,glycoantigen125,white blood cell count,neutrophil count,neutrophil-to-lymphocyte ratio and platelet count were the risk factors for intraoperative T stage overestimation(P < 0.05).In the multifactorial analysis of factors influencing intraoperative T stage overestimation,carcinoembryonic antigen,absolute neutrophil value,maximum tumor diameter,and gross morphology were independent risk factors for intraoperative T stage overestimation(P < 0.05);there was a significant difference between the group with intraoperative T stage overestimation and the group with non-intraoperative T stage overestimation in p N stage and total stage(P < 0.05).The overall postoperative survival time was better in the intraoperative T stage non-overestimation group than in the intraoperative T stage overestimation group,and the difference in the four-year overall survival rate was statistically significant(P=0.002).Conclusions: Among colorectal cancer patients with postoperative pathological T stage of T3/T4,intraoperative T stage tended to be overestimated.Overestimation of intraoperative T stage is correlated with tumor size,gross type,preoperative carcinoembryonic antigen level and neutrophil count.The assessment of intraoperative T complements postoperative pathological T stage and helps to assess the patient’s prognosis.