Chandarana Mihir, Arya Supreeta, de Menezes Jean-Louis, Engineer Reena, Ostwal Vikas, Patil Prachi, Kumar Suman, Dusane Rohit, D'souza Ashwin, Saklani Avanish
1Department of General Surgery, Forth Valley Royal Hospital, Larbert, UK.
2Specialty Registrar, Forth Valley Royal Hospital, Larbert, UK.
Indian J Surg Oncol. 2019 Jun;10(2):364-371. doi: 10.1007/s13193-019-00894-w. Epub 2019 Feb 21.
To determine the role of MRI as a predictor of circumferential resection margin (CRM) involvement. To study the impact of CRM status on MRI on recurrence and survival, in correlation with pathology. Analysis of a prospective database was performed over a period of 1 year. All patients with adenocarcinoma of rectum were included in the study. The MRI at presentation for all patients irrespective of stage (MRIT), pre-NACTRT MRI (MRI) for patients with locally advanced tumours, and post-NACTRT MRI (MRI) of these patients were analysed separately. The status of CRM on MRI was compared to that on histopathology and as a predictor of recurrence and survival. Two hundred twenty-one patients were included with a median follow-up 30 months. Sensitivity, specificity, positive predictive value, negative predictive value (NPV) and accuracy were 50%, 65.46%, 5.63%, 96.95% and 64.85% for MRIT; 50%, 55.32%, 5.97%, 95.12% and 55.03% for MRI1; and 77.78%, 63.29%, 10.77%, 98.04% and 64.07% for MRI2, respectively. On multivariate analysis, pathological positive margin alone predicted a poor overall survival (OS) whereas involved CRM on pathology and MRIT predicted poorer disease-free survival (DFS) and local recurrence. Pre-treatment and post-treatment MRI scans have a moderate sensitivity, specificity and accuracy and a high negative predictive value to predict CRM status on pathology. Pathological CRM status is the only factor to impact OS, DFS and LR on multivariate analysis. CRM status on MRI at presentation (MRI) does impact DFS and local recurrence but not OS.
确定MRI作为环周切缘（CRM）受累预测指标的作用。研究MRI上CRM状态对复发和生存的影响，并与病理学进行相关性分析。对一个前瞻性数据库进行了为期1年的分析。所有直肠腺癌患者均纳入研究。分别分析了所有患者初诊时的MRI（MRIT）、局部晚期肿瘤患者新辅助化疗放疗前的MRI（MRI1）以及这些患者新辅助化疗放疗后的MRI（MRI2）。将MRI上的CRM状态与组织病理学上的状态进行比较，并作为复发和生存的预测指标。纳入221例患者，中位随访时间为30个月。MRIT的敏感性、特异性、阳性预测值、阴性预测值（NPV）和准确性分别为50%、65.46%、5.63%、96.95%和64.85%；MRI1的分别为50%、55.32%、5.97%、95.12%和55.03%；MRI2的分别为77.78%、63.29%、10.77%、98.04%和64.07%。多因素分析显示，仅病理切缘阳性预测总体生存（OS）较差，而病理上CRM受累和MRIT预测无病生存（DFS）较差及局部复发。治疗前和治疗后的MRI扫描在预测病理上的CRM状态方面具有中等的敏感性、特异性和准确性以及较高的阴性预测值。病理CRM状态是多因素分析中影响OS, DFS和局部复发的唯一因素。初诊时MRI上的CRM状态（MRI）确实影响DFS和局部复发，但不影响OS。
