Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, VU University, Amsterdam, the Netherlands.
Br J Surg. 2020 Sep;107(10):1372-1382. doi: 10.1002/bjs.11590. Epub 2020 Apr 16.
Adequate MRI-based staging of early rectal cancers is essential for decision-making in an era of organ-conserving treatment approaches. The aim of this population-based study was to determine the accuracy of routine daily MRI staging of early rectal cancer, whether or not combined with endorectal ultrasonography (ERUS).
Patients with cT1-2 rectal cancer who underwent local excision or total mesorectal excision (TME) without downsizing (chemo)radiotherapy between 1 January 2011 and 31 December 2018 were selected from the Dutch ColoRectal Audit. The accuracy of imaging was expressed as sensitivity, specificity, and positive predictive value (PPV) and negative predictive value.
Of 7382 registered patients with cT1-2 rectal cancer, 5539 were included (5288 MRI alone, 251 MRI and ERUS; 1059 cT1 and 4480 cT2). Among patients with pT1 tumours, 54·7 per cent (792 of 1448) were overstaged by MRI alone, and 31·0 per cent (36 of 116) by MRI and ERUS. Understaging of pT2 disease occurred in 8·2 per cent (197 of 2388) and 27·9 per cent (31 of 111) respectively. MRI alone overstaged pN0 in 17·3 per cent (570 of 3303) and the PPV for assignment of cN0 category was 76·3 per cent (2733 of 3583). Of 834 patients with pT1 N0 disease, potentially suitable for local excision, tumours in 253 patients (30·3 per cent) were staged correctly as cT1 N0, whereas 484 (58·0 per cent) and 97 (11·6 per cent) were overstaged as cT2 N0 and cT1-2 N1 respectively.
This Dutch population-based analysis of patients who underwent local excision or TME surgery for cT1-2 rectal cancer based on preoperative MRI staging revealed substantial overstaging, indicating the weaknesses of MRI and missed opportunities for organ preservation strategies.
在器官保留治疗方法的时代，充分的 MRI 分期对于早期直肠癌的决策至关重要。本基于人群的研究旨在确定常规日常 MRI 分期早期直肠癌的准确性，无论是否结合直肠内超声（ERUS）。
从荷兰 ColoRectal Audit 中选择了 2011 年 1 月 1 日至 2018 年 12 月 31 日期间接受局部切除或全直肠系膜切除术（TME）且未进行缩小（化疗）放疗的 cT1-2 直肠癌患者。影像学的准确性表示为敏感性、特异性和阳性预测值（PPV）和阴性预测值。
在注册的 7382 例 cT1-2 直肠癌患者中，有 5539 例被纳入研究（5288 例仅行 MRI，251 例 MRI 和 ERUS；1059 例 cT1，4480 例 cT2）。在 pT1 肿瘤患者中，MRI 单独分期过高的占 54.7%（792/1448），MRI 和 ERUS 分别为 31.0%（36/116）。pT2 疾病分期过低的比例分别为 8.2%（197/2388）和 27.9%（31/111）。MRI 单独分期过高的 pN0 占 17.3%（570/3303），cN0 分类的 PPV 为 76.3%（2733/3583）。在 834 例 pT1N0 疾病患者中，有 80.3%（253/3157）的患者肿瘤被正确分期为 cT1N0，而 58.0%（484/834）和 11.6%（97/834）的患者被过度分期为 cT2N0 和 cT1-2N1。
本基于人群的分析对接受术前 MRI 分期的 cT1-2 直肠癌局部切除或 TME 手术患者进行了研究，结果显示 MRI 分期过高，表明 MRI 的局限性和错失器官保留策略的机会。
