使用EMD/直肠系膜比率进行T3亚分类可预测T3期直肠癌患者新辅助放化疗的结果。

T3 subclassification using the EMD/mesorectum ratio predicts neoadjuvant chemoradiation outcome in T3 rectal cancer patients.

作者信息

Shen Lijun, Sun Yiqun, Zhang Hui, Zhang Jing, Deng Weijuan, Wang Yaqi, Yao Ye, Yang Lifeng, Zhu Ji, Tong Tong, Liang Liping, Zhang Zhen

机构信息

1 Department of Radiation Oncology,Fudan University Shanghai Cancer Center , Fudan University Shanghai Cancer Center , Shanghai , China.

2 Department of Oncology,Shanghai Medical College, Fudan University , Shanghai Medical College, Fudan University , Shanghai , China.

出版信息

Br J Radiol. 2018 Jan;91(1081):20170617. doi: 10.1259/bjr.20170617. Epub 2017 Nov 21.

DOI:10.1259/bjr.20170617

PMID:29072488

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5966220/

Abstract

OBJECTIVE

To evaluate the feasibility of the EMD (extramural depth)/mesorectum ratio as a marker for T3 rectal cancer and its ability to predict tumour response to neoadjuvant chemoradiation and survival.

METHODS

From 2010 to 2016, 284 T3 rectal cancer patients who underwent high resolution MRI before neoadjuvant chemoradiation were enrolled. The EMD was defined as the distance from the outer edge of the muscularis propria to the outermost edge of the tumour. The measurement of the tumour EMD and mesorectum was in the same layer and their ratio was calculated. Receiver operating characteristic analysis and relative area under the curve statistics were used to choose the cut-off value. The association of the EMD/mesorectum ratio and other MRI or clinical factors with the tumour regression grade (TRG) was analysed. Cox regression analysis was used to estimate independent risk factors for disease-free survival (DFS) and overall survival (OS).

RESULTS

The mean EMD/mesorectum ratio was 0.47 ± 0.3. We chose an EMD/mesorectum ratio of 0.5 in further analyses after receiver operating characteristic analysis. Of 284 patients, 177 (62.3%) had an EMD/mesorectum ratio ≤ 0.5. Patients with an EMD/mesorectum ratio ≤ 0.5 had a higher TRG 0-1 rate than patients with a ratio >0.5 (53.1% vs 36.4%, p = 0.006). A multivariate analysis identified that an EMD/mesorectum ratio >0.5 [hazard ratio (HR) 2.020; p = 0.028] and ypTNM II-III (HR 3.550; p = 0.017) were independent prognostic factors to indicate decreased DFS. For OS, only patients with TRG 2-3 had decreased OS compared with patients with TRG 0-1 (HR 2.959; p = 0.035).

CONCLUSION

When the EMD/mesorectum ratio was applied to categorize T3 rectal cancer patients, the ratio of 0.5 can be used as a cut-off value for T3 rectal cancer. Patients with a ratio ≤ 0.5 had a higher response rate and better DFS. However, further validation is needed in a larger sample of patients. Advances in knowledge: The EMD/mesorectum ratio may serve to predict tumour response to neoadjuvant chemoradiation and survival in T3 rectal cancer patients.

摘要

目的

评估壁外深度（EMD）/直肠系膜比值作为T3期直肠癌标志物的可行性及其预测肿瘤对新辅助放化疗反应和生存情况的能力。

方法

纳入2010年至2016年期间284例在新辅助放化疗前行高分辨率MRI检查的T3期直肠癌患者。EMD定义为固有肌层外边缘至肿瘤最外边缘的距离。肿瘤EMD和直肠系膜的测量在同一层面，并计算其比值。采用受试者工作特征分析和曲线下相对面积统计来选择临界值。分析EMD/直肠系膜比值及其他MRI或临床因素与肿瘤退缩分级（TRG）的相关性。采用Cox回归分析评估无病生存（DFS）和总生存（OS）的独立危险因素。

结果

EMD/直肠系膜比值的平均值为0.47±0.3。经受试者工作特征分析后，我们在进一步分析中选择EMD/直肠系膜比值为0.5。在284例患者中，177例（62.3%）的EMD/直肠系膜比值≤0.5。EMD/直肠系膜比值≤0.5的患者TRG 0-1级的比例高于比值>0.5的患者（53.1%对36.4%，p = 0.006）。多因素分析确定，EMD/直肠系膜比值>0.5[风险比（HR）2.020；p = 0.028]和ypTNM II-III期（HR 3.550；p = 0.017）是提示DFS降低的独立预后因素。对于OS，仅TRG 2-3级的患者与TRG 0-1级的患者相比OS降低（HR 2.959；p = 0.035）。