ANZ journal of surgery · 2026
Computed Tomography-Derived Abdominal Aortic Calcification Independently Predicts Survival in Rectal Cancer Surgery: A Retrospective Cohort Study.
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Rouse Michael, Hadi Arwa, Kaleem Yumna, Besson Alex, Reid Fiona, Yeung Justin M
Аннотация
BACKGROUND: Contemporary rectal cancer treatment pathways remain predominantly guided by tumour-related characteristics, including stage and histopathology, with comparatively limited objective assessment of physiological reserve for treatment planning. Aortic calcification represents a potential imaging biomarker reflecting systemic vascular disease, chronic inflammation and physiological reserve. We evaluated computed tomography (CT)-derived abdominal aortic calcification as a prognostic imaging biomarker for postoperative outcomes and long-term survival.
METHODS: A retrospective cohort study was conducted using the prospectively maintained Australian Comprehensive Cancer Outcomes and Research Database (ACCORD) of rectal cancer patients treated between 2013 and 2022. Pre-treatment staging CT was subjected to semi-automated volumetric quantification of calcium using 3D Slicer software. Calcification volume was assessed segmentally at vertebral levels L1-L4 and at the iliac vessels. Primary outcomes were major postoperative complications (Clavien-Dindo ≥ III) and overall survival. Cox proportional hazards modelling was performed using a prespecified parsimonious multivariable model.
RESULTS: A total of 174 patients were included in the analysis. Increasing calcification burden demonstrated no statistically significant association with major postoperative complications (OR 1.09 per 1000-unit increase; 95% CI 0.99-1.19; p = 0.07). Increasing calcification independently predicted worse 5-year survival after multivariable adjustment (HR 1.17 per 1000-unit increase ([CI 1.08-1.28, p = 0.001]). Kaplan-Meier analyses showed separation between calcification groups, although dichotomised analyses did not reach statistical significance.
CONCLUSION: Aortic calcification independently predicts long-term survival following rectal cancer surgery but not short-term postoperative complications. Quantitative CT-derived calcification assessment may provide a rapid, objective imaging biomarker that reflects physiological reserve and represents a potential adjunct to future risk stratification pathways.
METHODS: A retrospective cohort study was conducted using the prospectively maintained Australian Comprehensive Cancer Outcomes and Research Database (ACCORD) of rectal cancer patients treated between 2013 and 2022. Pre-treatment staging CT was subjected to semi-automated volumetric quantification of calcium using 3D Slicer software. Calcification volume was assessed segmentally at vertebral levels L1-L4 and at the iliac vessels. Primary outcomes were major postoperative complications (Clavien-Dindo ≥ III) and overall survival. Cox proportional hazards modelling was performed using a prespecified parsimonious multivariable model.
RESULTS: A total of 174 patients were included in the analysis. Increasing calcification burden demonstrated no statistically significant association with major postoperative complications (OR 1.09 per 1000-unit increase; 95% CI 0.99-1.19; p = 0.07). Increasing calcification independently predicted worse 5-year survival after multivariable adjustment (HR 1.17 per 1000-unit increase ([CI 1.08-1.28, p = 0.001]). Kaplan-Meier analyses showed separation between calcification groups, although dichotomised analyses did not reach statistical significance.
CONCLUSION: Aortic calcification independently predicts long-term survival following rectal cancer surgery but not short-term postoperative complications. Quantitative CT-derived calcification assessment may provide a rapid, objective imaging biomarker that reflects physiological reserve and represents a potential adjunct to future risk stratification pathways.