Department of Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuannanli, Chaoyang District, Beijing, 100021, People's Republic of China.
Department of Radiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, People's Republic of China.
Abdom Radiol (NY). 2019 Nov;44(11):3652-3663. doi: 10.1007/s00261-018-1828-1.
The aim of this study was to investigate the value of MRI morphologic and clinicopathologic factors for predicting 3-year disease-free survival (DFS) in patients with locally advanced rectal cancer (LARC).
In this retrospective study, pre- and post-neoadjuvant chemoradiotherapy (nCRT) MRI morphologic (e.g., pre-nCRT MRI-detected extramural venous invasion) and clinicopathologic variabilities (e.g., pathological complete response) were evaluated in all patients. Three-year DFS was estimated using Kaplan-Meier product-limit method, and Cox proportional hazards models were used to determine associations between morphologic or clinicopathologic variabilities and survival outcomes.
A total of 115 patients (39 females and 76 males; median age, 54 years; age range, 28-82 years) with LARC treated with nCRT were enrolled. With a median follow-up of 48.0 months, the 3-year DFS was 79.0% for all patients. During follow-up, 18 patients died, 28 patients experienced relapse (26 distant, one local, and one both), and 69 patients were censored. MRI-detected extramural venous invasion (mrEMVI) was the only significantly independent factor of long-term survival, while HR was 2.308 (95% CI 1.151-4.629, P = 0.018) on univariate and 2.495 (95% CI 1.243-5.012, P = 0.010) on multivariate analysis. The 3-year cumulative survival rate in patients with mrEMVI negativity compared with positivity were 86.6% versus 65.0% (P = 0.015), respectively.
In conclusion, pre-nCRT mrEMVI status was the independent significant risk factor for long-term outcomes in LARC patients treated with nCRT, while the other morphologic and clinicopathologic characteristics were not related to the patient survival.
本研究旨在探讨 MRI 形态学和临床病理因素在预测局部进展期直肠癌（LARC）患者 3 年无病生存（DFS）中的价值。
在这项回顾性研究中，对所有患者的新辅助放化疗（nCRT）前和后 MRI 形态学（例如，nCRT 前 MRI 检测到的外膜静脉侵犯）和临床病理变异性（例如，病理完全缓解）进行了评估。使用 Kaplan-Meier 乘积限法估计 3 年 DFS，并使用 Cox 比例风险模型确定形态学或临床病理变异性与生存结果之间的关联。
共纳入 115 例接受 nCRT 治疗的 LARC 患者（39 名女性和 76 名男性；中位年龄 54 岁；年龄范围 28-82 岁）。中位随访 48.0 个月后，所有患者的 3 年 DFS 为 79.0%。在随访期间，18 例患者死亡，28 例患者复发（26 例远处转移，1 例局部转移，1 例两者均有），69 例患者被删失。MRI 检测到的外膜静脉侵犯（mrEMVI）是唯一具有显著长期生存意义的独立因素，单因素分析时 HR 为 2.308（95%CI 1.151-4.629，P=0.018），多因素分析时 HR 为 2.495（95%CI 1.243-5.012，P=0.010）。mrEMVI 阴性患者的 3 年累积生存率与阳性患者相比分别为 86.6%和 65.0%（P=0.015）。
总之，nCRT 前 mrEMVI 状态是 nCRT 治疗 LARC 患者长期结局的独立显著危险因素，而其他形态学和临床病理特征与患者生存无关。
