磁共振肿瘤退缩分级与直肠癌患者的病理相关性。
Magnetic resonance tumour regression grade and pathological correlates in patients with rectal cancer.
机构信息
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea.
Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea.
出版信息
Br J Surg. 2018 Nov;105(12):1671-1679. doi: 10.1002/bjs.10898. Epub 2018 Jun 12.
BACKGROUND
Evidence to support the specific use of magnetic resonance tumour regression grade (mrTRG) is inadequate. The aim of this study was to investigate the pathological characteristics of mrTRG after chemoradiotherapy (CRT) for rectal cancer and the implications for surgery.
METHODS
Patients undergoing long-course CRT (45-50 Gy plus a booster dose of 4-6 Gy) for mid or low rectal cancer (cT3-4 or cN+ without metastasis) between 2011 and 2015 who had post-CRT rectal MRI before surgery were included retrospectively. Three board-certified experienced radiologists assessed mrTRG. mrTRG was correlated with pathological tumour regression grade (pTRG), ypT and ypN. In a subgroup of patients with mrTRG1-2 and no tumour spread (such as nodal metastasis) on MRI, the projected rate of completion total mesorectal excision (TME) if they underwent transanal excision (TAE) and had a ypT status of ypT2 or higher was estimated, and recurrence-free survival was calculated according to the operation (TME or TAE) that patients had actually received.
RESULTS
Some 439 patients (290 men and 149 women of mean(s.d.) age 62·2(11·4) years) were analysed. The accuracy of mrTRG1 for predicting pTRG1 was 61 per cent (40 of 66), and that for ypT1 or less was 74 per cent (49 of 66). For mrTRG2, these values were 22·3 per cent (25 of 112) and 36·6 per cent (41 of 112) respectively. Patients with mrTRG1 and mrTRG2 without tumour spread were ypN+ in 3 per cent (1 of 29) and 16 per cent (8 of 50) respectively. Assuming mrTRG1 or mrTRG1-2 with no tumour spread on post-CRT MRI as the criteria for TAE, the projected completion TME rate was 26 per cent (11 of 43) and 41·0 per cent (41 of 100) respectively. For the 100 patients with mrTRG1-2 and no tumour spread, recurrence-free survival did not differ significantly between TME (79 patients) and TAE (21) (adjusted hazard ratio 1·86, 95 per cent c.i. 0·42 to 8·18).
CONCLUSION
Patients with mrTRG1 without tumour spread may be suitable for TAE.
背景
支持磁共振肿瘤消退分级（mrTRG）具体应用的证据不足。本研究旨在探讨直肠癌放化疗后（CRT）mrTRG 的病理特征及其对手术的影响。
方法
回顾性分析 2011 年至 2015 年间接受长程 CRT（45-50Gy 加 4-6Gy 增敏剂量）治疗的中低位直肠癌（cT3-4 或 cN+无转移）患者的资料。所有患者在术前均行 CRT 后直肠 MRI 检查。3 名有资质的经验丰富的放射科医生对 mrTRG 进行评估。mrTRG 与病理肿瘤消退分级（pTRG）、ypT 和 ypN 相关。在一组 mrTRG1-2 且 MRI 未见肿瘤扩散（如淋巴结转移）的患者中，如果他们接受经肛门内镜微创手术（TAE）且 ypT 状态为 ypT2 或更高，则估计可完成全直肠系膜切除术（TME）的比例，并根据患者实际接受的手术（TME 或 TAE）计算无复发生存率。
结果
共分析了 439 例患者（290 例男性，149 例女性，平均年龄 62.2±11.4 岁）。mrTRG1 预测 pTRG1 的准确率为 61%（66 例中 40 例），预测 ypT1 或更低的准确率为 74%（66 例中 49 例）。对于 mrTRG2，这些值分别为 22.3%（112 例中 25 例）和 36.6%（112 例中 41 例）。mrTRG1 和 mrTRG2 且无肿瘤扩散的患者中，ypN+的比例分别为 3%（29 例中 1 例）和 16%（50 例中 8 例）。假设 CRT 后 MRI 上 mrTRG1 或 mrTRG1-2 无肿瘤扩散作为 TAE 的标准，预计可完成 TME 的比例分别为 26%（43 例中 11 例）和 41.0%（100 例中 41 例）。在 100 例 mrTRG1-2 且无肿瘤扩散的患者中，TME（79 例）与 TAE（21 例）的无复发生存率无显著差异（调整后的危险比 1.86，95%可信区间 0.42 至 8.18）。
结论
无肿瘤扩散的 mrTRG1 患者可能适合 TAE。
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