Department of Radiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, Province, PR China; College of Medical Imaging, Xuzhou Medical University, Xuzhou, Jiangsu, Province, PR China.
Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuannanli, Chaoyang District, Beijing 100021, PR China.
Acad Radiol. 2020 Sep;27(9):e233-e243. doi: 10.1016/j.acra.2019.10.021. Epub 2019 Nov 25.
This study aimed to investigate the predictive value of pre-/postneoadjuvant chemoradiotherapy (nCRT) magnetic resonance imaging (MRI) characteristics for the long-term survival outcomes in patients with locally advanced rectal cancer (LARC).
We retrospectively evaluated pre- and post-nCRT MRI and clinicopathologic characteristics of LARC patients. The 3-year disease-free survival (DFS) was estimated using the Kaplan-Meier product-limit method. Associations between MRI variabilities and survival outcomes were assessed using Cox proportional hazards model.
In total, 171 LARC patients (112 men and 59 women) with a median age of 55 years (range, 27-82 years) treated with nCRT were evaluated. The median follow-up was 47.6 months, and the 3-, 4-, and 5-year DFS in the overall cohort was 76.6%, 74.5%, and 73.7%, respectively. MRI assessment of extramural venous invasion (mrEMVI) positivity was a significant independent adverse factor of long-term survival (hazard ratio [HR] = 2.589, 95% confidence interval [CI] = 1.398-4.794, p = 0.002) on multivariate analysis. Patients with positive mrEMVI had significantly lower 3-year DFS than those with negative mrEMVI (52.6 months vs 65.1 months; p = 0.003). Moreover, the tumor regression grade on MRI (mrTRG) also significantly correlated with survival outcomes in patients with LARC. Patients with partial response on post-nCRT MRI (mrPR) showed short DFS than those with complete response (mrCR; HR = 4.914, 95% CI = 1.176-20.533, p = 0.029). The 3-year DFS of mrCR and mrPR patients were 74.3 months and 58.9 months, respectively (p = 0.011).
The pre-/post-nCRT MRI characteristics may be used to long-term survival stratification in LARC patients. mrEMVI positivity was an independent adverse prognostic indicator for 3-year DFS. Further, mrTRG may also be a predictive factor for the prognosis of LARC patients. The pre-/post-nCRT MR imaging may offer more information for providing individualized treatment.
本研究旨在探讨新辅助放化疗（nCRT）前后磁共振成像（MRI）特征对局部进展期直肠癌（LARC）患者长期生存结局的预测价值。
我们回顾性评估了 LARC 患者的 nCRT 前后 MRI 及临床病理特征。采用 Kaplan-Meier 乘积限法估计 3 年无病生存率（DFS）。采用 Cox 比例风险模型评估 MRI 变量与生存结局之间的关系。
共评估了 171 例接受 nCRT 治疗的中位年龄为 55 岁（范围：27-82 岁）的 LARC 患者（男性 112 例，女性 59 例）。中位随访时间为 47.6 个月，全组患者的 3 年、4 年和 5 年 DFS 分别为 76.6%、74.5%和 73.7%。多因素分析显示，MRI 评估的外膜静脉侵犯（mrEMVI）阳性是影响长期生存的显著独立不良因素（风险比[HR] = 2.589，95%置信区间[CI] = 1.398-4.794，p = 0.002）。mrEMVI 阳性患者的 3 年 DFS 明显低于 mrEMVI 阴性患者（52.6 个月 vs 65.1 个月；p = 0.003）。此外，MRI 上的肿瘤退缩分级（mrTRG）也与 LARC 患者的生存结局显著相关。nCRT 后 MRI 上出现部分缓解（mrPR）的患者的 DFS 短于完全缓解（mrCR）患者（HR = 4.914，95%CI = 1.176-20.533，p = 0.029）。mrCR 和 mrPR 患者的 3 年 DFS 分别为 74.3 个月和 58.9 个月（p = 0.011）。
新辅助放化疗前后 MRI 特征可用于 LARC 患者的长期生存分层。mrEMVI 阳性是 3 年 DFS 的独立不良预后指标。此外，mrTRG 也可能是预测 LARC 患者预后的一个因素。nCRT 前后 MRI 可为提供个体化治疗提供更多信息。
