Kim I Y, Cha S W, Ahn J H, Kim Y W
Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
Department of Radiology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
Eur J Surg Oncol. 2015 Apr;41(4):493-8. doi: 10.1016/j.ejso.2014.12.008. Epub 2015 Jan 28.
We evaluated patient or tumor factors associated with the preoperative restaging accuracy of magnetic resonance imaging (MRI) for determining T and N stages as well as circumferential resection margin (CRM) involvement after chemoradiation (CRT) in patients with locally advanced rectal cancer.
Seventy-seven patients with rectal cancer that were treated with preoperative CRT (50.4 Gy) followed by radical resection were included. Post-CRT MRI was performed approximately 4 weeks after preoperative CRT.
The median tumor distance from the anal verge was 6 cm, 48 (62%) of which were anterior and 29 (38%) posterior. The median tumor diameter was 3 cm. A stage-by-stage comparison showed that correct staging occurred in 62%, 43%, and 86% of patients for T staging, N staging, and CRM prediction, respectively. Shorter distance to the anal verge (<5 cm), smaller tumor diameter (<1 cm), and anterior tumor location were associated with incorrect T staging. There were no significant variables in terms of N staging accuracy. Shorter tumor distance and anterior tumor location were associated with incorrect CRM prediction.
Our findings suggest that specific tumor factors such as small, distal, or anterior rectal tumors are closely associated with the accuracy of MRI after preoperative CRT.
我们评估了与局部晚期直肠癌患者术前磁共振成像（MRI）重新分期准确性相关的患者或肿瘤因素，该重新分期用于确定放化疗（CRT）后T和N分期以及环周切缘（CRM）受累情况。
纳入77例接受术前CRT（50.4 Gy）然后进行根治性切除的直肠癌患者。术前CRT后约4周进行CRT后MRI检查。
肿瘤距肛缘的中位距离为6 cm，其中48例（62%）位于前方，29例（38%）位于后方。肿瘤中位直径为3 cm。逐阶段比较显示，T分期、N分期和CRM预测的正确分期分别发生在62%、43%和86%的患者中。距肛缘距离较短（<5 cm）、肿瘤直径较小（<1 cm）和肿瘤位于前方与T分期错误相关。在N分期准确性方面没有显著变量。肿瘤距离较短和肿瘤位于前方与CRM预测错误相关。
我们的研究结果表明，特定的肿瘤因素，如直肠小肿瘤、远端肿瘤或前方肿瘤，与术前CRT后MRI的准确性密切相关。
