*Centre for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin, Ireland †Beaumont Hospital, Dublin, Ireland ‡University of Minnesota Medical Center, Minnesota, Minneapolis, MN.
Ann Surg. 2014 Apr;259(4):723-7. doi: 10.1097/SLA.0b013e31828f6c91.
The aim of this study was to evaluate the utility of reimaging rectal cancer post-CRT (chemoradiotherapy) with magnetic resonance (MR) imaging of the pelvis for local staging and computed tomography of thorax, abdomen, and pelvis (CT TAP) to identify distant metastases.
The success of neoadjuvant CRT for locally advanced rectal cancer has changed an already complex management algorithm. There is no consensus whether patients should be restaged before surgery.
Data from 5 institutions with prospectively maintained databases including patients who received neoadjuvant CRT for locally advanced rectal cancer were acquired. Only patients who had been staged pre- and post-CRT with MR imaging and CT TAP were included. MR findings were correlated with histopathological stage using weighted κ (kappa) statistics to test agreement, where a κ value of less than 0.5 was deemed unacceptable.
A total of 285 patients fulfilled the criteria for the study; 84% had American Joint Committee for Cancer stage 3 disease pre-CRT, and the remainder had stage 2 disease. Fourteen patients did not proceed to surgery post-CRT-2 were observed as "complete responders," and the remainder either had unresectable disease or were unfit for surgery. MR imaging could not predict T stage (κ = 0.212) or nodal involvement (κ = 0.336). Most pertinently, MR imaging was unable to detect a complete pathological response (κ = 0.021), nor could it discriminate T4 disease (κ = 0.445). CT TAP restaging altered management in 6.7% of patients, who had metastatic disease.
MR reimaging using standard protocols is of limited value in determining surgical approaches; a better modality of local restaging is required.
本研究旨在评估盆腔磁共振成像（MRI）对接受放化疗（CRT）后直肠癌的局部分期，以及胸部、腹部和盆腔 CT 扫描（CT TAP）对识别远处转移的作用。
新辅助 CRT 治疗局部晚期直肠癌的成功改变了本已复杂的治疗方案。对于术前是否需要重新分期，目前尚无共识。
收集了 5 家机构前瞻性维护的数据库中接受新辅助 CRT 治疗局部晚期直肠癌的患者数据。仅纳入了接受术前和术后 MRI 与 CT TAP 分期的患者。采用加权 Kappa（kappa）统计检验 MR 结果与组织病理学分期的一致性，kappa 值<0.5 认为一致性不可接受。
共 285 例患者符合研究标准；84%的患者在 CRT 前为美国癌症联合委员会（AJCC）分期 3 期，其余为 2 期。14 例患者在 CRT 后未行手术-2 例为“完全缓解者”，其余患者为不可切除疾病或不适合手术。MRI 无法预测 T 分期（kappa = 0.212）或淋巴结受累（kappa = 0.336）。更重要的是，MRI 无法检测到完全病理缓解（kappa = 0.021），也无法区分 T4 疾病（kappa = 0.445）。CT TAP 重新分期改变了 6.7%有转移疾病患者的治疗管理。
使用标准方案进行 MRI 再成像对确定手术方法的价值有限；需要更好的局部重新分期方式。
