de'Angelis Nicola, Pigneur Frederic, Martínez-Pérez Aleix, Vitali Giulio Cesare, Landi Filippo, Torres-Sánchez Teresa, Rodrigues Victor, Memeo Riccardo, Bianchi Giorgio, Brunetti Francesco, Espin Eloy, Ris Frederic, Luciani Alain
Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France.
Department of Radiology, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France.
Oncotarget. 2018 May 18;9(38):25315-25331. doi: 10.18632/oncotarget.25431.
Locally advanced rectal cancer (LARC) requires a multimodal therapy tailored to the patient and tumor characteristics. Pretreatment magnetic resonance imaging (MRI) is necessary to stage the primary tumor, while restaging MRI, which is not systematically performed, may be of interest to identify poor responders to neoadjuvant chemoradiation therapy (NCRT), and redefine therapeutic approach. The study group aimed to investigate the role and accuracy of pretreatment (including pelvimetry) and restaging MRIs in predicting surgical difficulties and surgical outcomes in LARC therapy.
Patients with mid or low LARC who were administered NCRT, who underwent laparoscopic total mesorectal excision, and for whom pretreatment and restaging MRIs were available, were included.
MRIs of 170 patients (median age: 61 years) were reanalyzed by the same radiologist. Pelvimetry differed significantly between males and females, but no gender difference was noted in the clinical and tumor characteristics. Tumor volume and tumor height assessed on the restaging MRI were associated, respectively, with operative time and estimated blood loss. Conversion was predicted by tumor volume, interischial distance and pubic tubercle height. The quality of the surgical resection was found to be a predictor of overall and disease-free survival. The sensitivity and specificity of tumor regression grade 1 to identify a pathologic complete response were 76.9% and 89.3%, respectively.
In LARC management, pelvimetry and restaging MRI may be useful to predict surgical difficulties and surgical outcomes. However, the main independent predictor of patient survival appears to be the achievement of a successful surgical resection.
局部晚期直肠癌（LARC）需要根据患者和肿瘤特征进行多模式治疗。治疗前的磁共振成像（MRI）对于原发性肿瘤分期是必要的，而未系统进行的再分期MRI可能有助于识别对新辅助放化疗（NCRT）反应不佳的患者，并重新定义治疗方法。该研究组旨在调查治疗前（包括骨盆测量）和再分期MRI在预测LARC治疗中的手术难度和手术结果方面的作用及准确性。
纳入接受NCRT、行腹腔镜全直肠系膜切除术且有治疗前和再分期MRI资料的中低位LARC患者。
同一位放射科医生对170例患者（中位年龄：61岁）的MRI进行了重新分析。男性和女性的骨盆测量结果有显著差异，但在临床和肿瘤特征方面未发现性别差异。再分期MRI评估的肿瘤体积和肿瘤高度分别与手术时间和估计失血量相关。肿瘤体积、坐骨棘间距离和耻骨结节高度可预测中转开腹。手术切除质量是总生存期和无病生存期的预测指标。肿瘤退缩分级1识别病理完全缓解的敏感性和特异性分别为76.9%和89.3%。
在LARC治疗中，骨盆测量和再分期MRI可能有助于预测手术难度和手术结果。然而，患者生存的主要独立预测因素似乎是成功的手术切除。
