ArticleAbdominal radiology (New York)2026
Development and external validation of a preoperative CT body composition-based model for predicting postoperative metastasis in colorectal cancer: a multicenter retrospective cohort study.
Article in Abdominal radiology (New York), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesMost postoperative metastases in nonmetastatic colorectal cancer (CRC) occur within 2 years after curative-intent surgery, but tools for quantifying early metastasis risk remain limited. We aimed to develop and externally validate a nomogram integrating preoperative CT body composition with clinicopathologic variables.
methodsThis multicenter retrospective study included 451 patients with nonmetastatic CRC who underwent curative-intent surgery from January 2019 to December 2022. The training cohort comprised 250 patients from the primary center and the validation cohort 201 patients from 2 external centers. L3-level CT was used to quantify visceral adipose tissue index (VATI). Metastasis-free survival was the primary endpoint, and early metastasis was defined as distant metastasis within 24 months. Independent predictors were identified with Cox regression and used to build a nomogram.
resultsPostoperative metastasis occurred in 61 of 250 patients (24.4%) in the training cohort and 50 of 201 patients (24.9%) in the validation cohort. Elevated CA19-9, positive N stage, lymphovascular invasion, and higher VATI were independent predictors. The nomogram yielded a C-index of 0.793 in the training cohort and 0.754 in the validation cohort; the 24-month area under the curve was 0.818 and 0.804, respectively.
conclusionsA nomogram combining CT-derived VATI with N stage, CA19-9, and lymphovascular invasion showed good discrimination and calibration for predicting postoperative metastasis and 24-month early metastasis in CRC.
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