Department of Radiology, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy.
Department of Oncology and Haematology, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy.
Abdom Radiol (NY). 2020 Oct;45(10):2941-2949. doi: 10.1007/s00261-018-1838-z.
To evaluate the role of magnetic resonance imaging (MRI) performed before and after neoadjuvant chemoradiotherapy (nCRT) in predicting risk of recurrence in rectal cancer and to investigate the prognostic significance of MR-detected extramural venous invasion (mr-EMVI) and of its regression after nCRT.
During 2005-2016, 87 patients with rectal cancer underwent pre- and post-nCRT MRI before surgery. Two radiologists independently reviewed MR examinations retrospectively, assessing T stage, nodal involvement, circumferential resection margin (CRM) status, and mr-EMVI. All four parameters assessed in pre- and post-nCRT MRI were correlated with the risk of recurrence. Correlation with disease-free survival (DFS) was investigated for significant predictive factors in pre-nCRT MRI and for mr-EMVI and its possible regression in post-nCRT MRI.
15 of 87 patients developed recurrence, with a relapse-rate of 17.2%. Statistical analysis showed a significant correlation between CRM involvement and mr-EMVI assessed in pre-nCRT MRI and the risk of recurrence; 3 years-DFS in patients positive for these two parameters was significantly shorter compared with negatives. In post-nCRT MRI, all four parameters correlated significantly with recurrence: mr-EMVI affected significantly 3 years-DFS and its regression after nCRT correlated with a trend toward improvement of survival outcomes, although not statistically significant.
CRM involvement and mr-EMVI assessed in pre-nCRT MRI should be considered early predictive factors of recurrence in rectal cancer. MRI performed after nCRT has a significant value in predicting risk of recurrence: mr-EMVI confirmed to be a poor prognosis predictor and its regression or persistence after nCRT could have influences on treatment and follow-up strategies.
评估新辅助放化疗（nCRT）前后磁共振成像（MRI）在预测直肠癌复发风险中的作用，并探讨 MRI 检测到的壁外静脉侵犯（mr-EMVI）及其在 nCRT 后的消退的预后意义。
在 2005 年至 2016 年间，87 例直肠癌患者在手术前接受了 nCRT 前后的 MRI 检查。两位放射科医生独立回顾性地评估了 MRI 检查，评估 T 分期、淋巴结受累、环周切缘（CRM）状态和 mr-EMVI。nCRT 前后 MRI 评估的所有四个参数均与复发风险相关。对 nCRT 前后 MRI 中具有显著预测意义的参数与无病生存（DFS）进行相关性分析，并对 nCRT 后 mr-EMVI 及其可能的消退进行分析。
87 例患者中有 15 例发生复发，复发率为 17.2%。统计分析显示，CRM 受累和 nCRT 前 MRI 评估的 mr-EMVI 与复发风险之间存在显著相关性；这两个参数阳性的患者 3 年 DFS 明显短于阴性患者。在 nCRT 后 MRI 中，所有四个参数均与复发显著相关：mr-EMVI 显著影响 3 年 DFS，nCRT 后的消退与生存结果的改善趋势相关，尽管无统计学意义。
nCRT 前 MRI 评估的 CRM 受累和 mr-EMVI 应被视为直肠癌复发的早期预测因素。nCRT 后 MRI 在预测复发风险方面具有重要价值：mr-EMVI 被证实是预后不良的预测指标，nCRT 后的消退或持续存在可能对治疗和随访策略产生影响。
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