Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
Eur J Surg Oncol. 2018 Dec;44(12):1858-1864. doi: 10.1016/j.ejso.2018.07.063. Epub 2018 Aug 18.
Pre-operative radiotherapy (RT) or chemo-radiotherapy (CRT) are sometimes recommended prior to rectal cancer surgery, but guideline recommendations vary. The aim was to describe stage distribution and other important characteristics required for the treatment decision of patients with primary rectal cancers utilizing magnetic resonance imaging (MRI) in an unselected population.
All 796 histopathologically verified rectal adenocarcinomas diagnosed 2010-2015 in two counties in Sweden (population 630,000 in 2015) were identified. Staging with pelvic MRI unless contraindications were present, treatment and pathology followed Swedish guidelines.
Twenty-three % of cases (n = 186) had distant metastases at diagnosis, demonstrating more advanced tumor and nodal stages when compared with non-metastatic patients (p < 0.001), and they more often displayed MRI-identified mucinous features and extramural vascular invasion (EMVI) than non-metastatic tumors (p < 0.001 for both). In non-metastatic patients, 8% displayed clinical stage T1 (cT1), 21% cT2, and 53% cT3; one-third of the latter threatened or involved the mesorectal fascia (MRF+). Almost 20% had stage cT4 (4% cT4a, 14% cT4b) of which 50% were considered "non-resectable". EMVI was seen in 33% of cT3M0 tumors and in 48% of cT4M0 tumors.
In an unselected population, approximately 80% of primary rectal cancers are referred to as "locally advanced" (stage II-III, or cT3-4 or N+), meaning that they, according to many international guidelines, are recommended neo-adjuvant treatment. This study provides a detailed description of the clinical stages and presence of characteristics identifiable on MRI which are of importance when assessing the needs for RT/CRT, when using different guidelines.
术前放疗（RT）或放化疗（CRT）有时被推荐用于直肠癌手术前，但指南建议存在差异。本研究旨在描述利用磁共振成像（MRI）对未经选择的人群中原发性直肠癌患者进行治疗决策所需的分期分布和其他重要特征。
在瑞典两个县（2015 年人口为 63 万），共确定了 796 例经组织病理学证实的直肠腺癌病例，所有病例均进行了盆腔 MRI 分期，除非存在禁忌证，然后按照瑞典指南进行治疗和病理检查。
23%（n=186）的病例在诊断时发生远处转移，与非转移性患者相比，这些患者的肿瘤和淋巴结分期更为晚期（p<0.001），且更常表现出 MRI 识别的黏液特征和外膜血管侵犯（EMVI）（均p<0.001）。在非转移性患者中，8%为临床分期 T1（cT1），21%为 cT2，53%为 cT3；后者的三分之一威胁或累及直肠系膜筋膜（MRF+）。近 20%的患者为 cT4（4%为 cT4a，14%为 cT4b），其中 50%被认为“不可切除”。EMVI 见于 33%的 cT3M0 肿瘤和 48%的 cT4M0 肿瘤中。
在未经选择的人群中，约 80%的原发性直肠癌被归类为“局部晚期”（II-III 期，或 cT3-4 或 N+），这意味着根据许多国际指南，建议对其进行新辅助治疗。本研究详细描述了在评估 RT/CRT 需求时使用不同指南时，MRI 上可识别的临床分期和特征的重要性。
