Ouyang Ganlu, Yang Xibiao, Deng Xiangbing, Meng Wenjian, Yu Yongyang, Wu Bing, Jiang Dan, Shu Pei, Wang Ziqiang, Yao Jin, Wang Xin
Department of Radiation Oncology/Abdominal Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
Cancer Manag Res. 2021 Jul 13;13:5657-5669. doi: 10.2147/CMAR.S311501. eCollection 2021.
To investigate the potential value of magnetic resonance imaging (MRI) in predicting response relevance to total neoadjuvant treatment (TNT) in locally advanced rectal cancer.
We analyzed MRI of 71 patients underwent TNT from 2015 to 2017 retrospectively. We categorized the response of TNT as CR (complete response) vs non-CR, and high vs moderate vs low sensitivity. Logistic regression analysis was used to identify the best predictors of response. Diagnostic performance was assessed using receiver operating characteristic curve analysis.
Post-ICT (induction chemotherapy) ∆TL (tumor length), post-CRT (concurrent chemoradiotherapy) ∆LNN (the numbers of lymph node metastases), post-CCT (consolidation chemotherapy) ∆S (maximum cross-sectional area of tumor on diffusion-weighted imaging), post-CCT ADC (the mean apparent diffusion coefficient values of tumor) and post-CCT ∆LNV (volume of lymph node) were the best CR predictors. Post-ICT ∆TL, post-CRT EMVI (extramural vascular invasion) and post-CCT ∆S (S on T2-weight) were the best significant factors for high sensitivity.
Post-ICT ∆TL may be an early predictor of CR and high sensitivity to TNT. Dynamic analysis based on MRI between baseline and post-CCT could provide the most valuable prediction of CR. The grouping modality of CR vs non-CR may be more suitable for treatment response prediction than high vs moderate vs low sensitivity.
探讨磁共振成像（MRI）在预测局部晚期直肠癌对全新辅助治疗（TNT）反应相关性方面的潜在价值。
我们回顾性分析了2015年至2017年接受TNT的71例患者的MRI。我们将TNT的反应分为完全缓解（CR）与非CR，以及高敏感性、中等敏感性与低敏感性。采用逻辑回归分析来确定反应的最佳预测指标。使用受试者工作特征曲线分析评估诊断性能。
诱导化疗（ICT）后肿瘤长度变化（∆TL）、同步放化疗（CRT）后淋巴结转移数量变化（∆LNN）、巩固化疗（CCT）后扩散加权成像上肿瘤最大横截面积变化（∆S）、CCT后表观扩散系数均值（ADC）以及CCT后淋巴结体积变化（∆LNV）是CR的最佳预测指标。ICT后∆TL、CRT后壁外血管侵犯（EMVI）以及CCT后∆S（T2加权像上的S）是高敏感性的最佳显著因素。
ICT后∆TL可能是CR以及对TNT高敏感性的早期预测指标。基于基线与CCT后MRI的动态分析可为CR提供最有价值的预测。CR与非CR的分组方式可能比高敏感性、中等敏感性与低敏感性更适合治疗反应预测。
