Patra A, Baheti A D, Ankathi S K, Desouza A, Engineer R, Ostwal V, Ramaswamy A, Saklani A
Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India.
Department of Radiodiagnosis, Homi Bhabha National Institute, Mumbai, India.
Indian J Surg Oncol. 2020 Dec;11(4):720-725. doi: 10.1007/s13193-020-01218-z. Epub 2020 Sep 22.
The MERCURY II study demonstrated the use of MRI-based risk factors such as extramural venous invasion (EMVI), tumor location, and circumferential resection margin (CRM) involvement to preoperatively predict pCRM (pathological CRM) outcomes for lower rectal tumors in a mixed group of upfront operated patients and patients who received neoadjuvant treatment. We aim to study the applicability of results of MERCURY II study in a homogeneous cohort of patients who received neoadjuvant chemoradiation (NACTRT) prior to surgery. After Institutional Review Board approval, post NACTRT restaging MRI of 132 patients operated for low rectal cancer between 2014 and 2018 were retrospectively reviewed by two radiologists for site of tumor, EMVI status, distance from anal verge (< 4 or > 4 cm), and mrCRM positivity. Findings were compared with post surgery pCRM outcomes using Fisher's exact test. Only 9/132(7%) patients showed pCRM involvement on histopathology, 8 of them being CRM positive on MRI ( = 0.01). The positive predictive value (PPV) of mrCRM positive status and pCRM status was 12.7% (95% CI: 9.7-16.5%), while the negative predictive value was 98.5% (95% CI: 91.4-99.8%) ( = 0.01). EMVI positive and anteriorly located tumors showed higher incidence of pCRM positivity but were not found to be significant (15% vs 5.2% and = 0.13 and 8.6% vs 2.1% and = 0.28, respectively). Unsafe mrCRM was the only factor significantly associated with pCRM positivity on post neoadjuvant restaging MRI. Tumors less than 4 cm from anal verge, anterior tumor location, and mrEMVI positivity did not show statistically significant results to predict pCRM involvement.
MERCURY II研究表明,在一组接受 upfront 手术的患者和接受新辅助治疗的患者中,基于MRI的危险因素,如壁外静脉侵犯(EMVI)、肿瘤位置和环周切缘(CRM)受累情况,可用于术前预测低位直肠肿瘤的pCRM(病理CRM)结果。我们旨在研究MERCURY II研究结果在一组术前接受新辅助放化疗(NACTRT)的同质患者中的适用性。经机构审查委员会批准,对2014年至2018年间接受低位直肠癌手术的132例患者的NACTRT后分期MRI进行回顾性分析,由两名放射科医生评估肿瘤部位、EMVI状态、距肛缘距离(<4或>4 cm)和mrCRM阳性情况。使用Fisher精确检验将结果与术后pCRM结果进行比较。仅9/132(7%)例患者在组织病理学上显示pCRM受累,其中8例MRI上CRM阳性(P = 0.01)。mrCRM阳性状态与pCRM状态的阳性预测值(PPV)为12.7%(95%CI:9.7 - 16.5%),而阴性预测值为98.5%(95%CI:91.4 - 99.8%)(P = 0.01)。EMVI阳性和位于前方的肿瘤显示pCRM阳性的发生率较高,但差异无统计学意义(分别为15%对5.2%,P = 0.13;8.6%对2.1%,P = 0.28)。不安全的mrCRM是新辅助分期MRI上与pCRM阳性显著相关的唯一因素。距肛缘小于4 cm的肿瘤、前方肿瘤位置和mrEMVI阳性在预测pCRM受累方面未显示出统计学显著结果。
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