术前放化疗前后MRI对N0期直肠癌的预测比较

Prediction of N0 Irradiated Rectal Cancer Comparing MRI Before and After Preoperative Chemoradiotherapy.

作者信息

Pomerri Fabio, Crimì Filippo, Veronese Nicola, Perin Alessandro, Lacognata Carmelo, Bergamo Francesca, Boso Caterina, Maretto Isacco

机构信息

1 Department of Medicine, Institute of Radiology, University of Padova, Padova, Italy 2 Department of Medicine, Geriatric Section, University of Padova, Padova, Italy 3 Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy 4 Department of Radiology, Azienda Ospedaliera of Padova, Padova, Italy 5 Medical Oncology 1, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy 6 Radiation Oncology, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy.

出版信息

Dis Colon Rectum. 2017 Nov;60(11):1184-1191. doi: 10.1097/DCR.0000000000000894.

DOI:10.1097/DCR.0000000000000894

PMID:28991083

Abstract

BACKGROUND

The prediction of lymph node status using MRI has an impact on the management of rectal cancer, both before and after preoperative chemoradiotherapy.

OBJECTIVE

The purpose of this study was to maximize the negative predictive value and sensitivity of mesorectal lymph node imaging after chemoradiotherapy because postchemoradiation node-negative patients may be treated with rectum-sparing approaches.

DESIGN

This was a retrospective study.

SETTINGS

The study was conducted at a tertiary care hospital.

PATIENTS

Sixty-four patients with locally advanced rectal cancer who underwent preoperative chemoradiotherapy and MRI for staging and the assessment of response were evaluated.

MAIN OUTCOME MEASURES

The sums of the sizes of all mesorectal lymph nodes in each patient on both prechemoradiotherapy and postchemoradiotherapy imaging data sets were calculated to determine the lymph node global size reduction rates, taking these to be the outcomes of the histopathologic findings. Other included measures were interobserver agreement regarding the prediction of node status based on morphologic criteria and the diagnostic performance of contrast-enhanced images.

RESULTS

Using a cutoff value of a 70% lymph node global size reduction rate with only 15 node-positive patients on histopathology, the sensitivity in the prediction of nodal status and negative predictive value were 93% (95% CI, 70.2%-98.8%) and 97% (95% CI, 82.9%-99.8%) for observer 1 and 100% (95% CI, 79.6%-100%) and 100% (95% CI, 62.9%-100%) for observer 2. The areas under the receiver operating characteristic curves for the 2 observers were 0.90 (95% CI, 0.82-0.98; p < 0.0001) for observer 1 and 0.65 (95% CI, 0.50-0.79; p = 0.08) for observer 2. The efficacy of the morphologic criteria and contrast-enhanced images in predicting node status was limited after chemoradiotherapy.

LIMITATIONS

This study is limited by its small sample size and retrospective nature.

CONCLUSIONS

Assessing the lymph node global size reduction rate value reduces the risk of undetected nodal metastases and may be helpful in better identifying suitable candidates for the local excision of early stage rectal cancer. See Video Abstract at http://links.lww.com/DCR/A412.

摘要

背景

利用磁共振成像（MRI）预测淋巴结状态对直肠癌术前及术后放化疗的治疗管理均有影响。

目的

本研究旨在最大化放化疗后直肠系膜淋巴结成像的阴性预测值和敏感性，因为放化疗后淋巴结阴性的患者可采用保留直肠的方法进行治疗。

设计

这是一项回顾性研究。

地点

研究在一家三级医疗中心进行。

患者

对64例局部晚期直肠癌患者进行了评估，这些患者均接受了术前放化疗及MRI检查以进行分期和评估疗效。

主要观察指标

计算每位患者放化疗前后成像数据集中所有直肠系膜淋巴结大小之和，以确定淋巴结总体积缩小率，并将其作为组织病理学检查结果的指标。其他纳入的指标包括基于形态学标准预测淋巴结状态的观察者间一致性以及增强图像的诊断性能。

结果

以淋巴结总体积缩小率70%为临界值，组织病理学检查仅发现15例淋巴结阳性患者，观察者1预测淋巴结状态的敏感性和阴性预测值分别为93%（95%CI，70.2%-98.8%）和97%（95%CI，82.9%-99.8%），观察者2分别为100%（95%CI，79.6%-100%）和100%（95%CI，62.9%-100%）。两位观察者的受试者操作特征曲线下面积，观察者1为0.90（95%CI，0.82-0.98；p<0.0001），观察者2为0.65（95%CI，0.50-0.79；p = 0.08）。放化疗后，形态学标准和增强图像预测淋巴结状态的效能有限。