Discipline of Surgery, Galway University Hospitals, Galway, Ireland.
Colorectal Dis. 2021 Dec;23(12):3065-3072. doi: 10.1111/codi.15919. Epub 2021 Oct 1.
Estimating prognosis in rectal carcinoma (RC) is challenging, with distant recurrence (DR) occurring in up to 30% of cases. Radiomics is a novel field using diagnostic imaging to investigate the tumour heterogeneity of cancers and may have the potential to predict DR. The aim of the study was to perform a systematic review of the current literature evaluating the use of radiomics in predicting DR in patients with resected RC.
A systematic review was performed as per PRISMA guidelines to identify studies reporting radiomic analysis of magnetic resonance imaging (MRI) to predict DR in patients diagnosed with RC. Sensitivity and specificity of radiomic analyses were included for meta-analysis.
A total of seven studies including 1497 patients (998 males) were included, seven, five and one of whom reported radiomics, respectively. The overall pooled rate of DR from all included studies was 17.1% (256/1497), with 15.6% (236/1497), 1.3% (19/1497) and 0.2% (3/1497) of patients having hepatic, pulmonary and peritoneal metastases. Meta-analysis demonstrated that radiomics correctly predicted DR with pooled sensitivities and specificities of MRI 0.76 (95% CI: 0.73, 0.78) and 0.85 (95% CI: 0.83, 0.88), respectively.
This systematic review suggests the benefit of radiomic analysis of preoperative MRI in identifying patients with resected RC at an increased risk of DR. Our findings warrant validation in larger prospective studies as modalities to predict DR is a significant unmet need in RC. Radiomics may allow for tailored therapeutic strategies for high-risk groups.
直肠癌（RC）的预后评估具有挑战性，多达 30%的病例会发生远处复发（DR）。放射组学是一种利用诊断成像来研究癌症肿瘤异质性的新领域，可能有预测 DR 的潜力。本研究旨在对评估 MRI 放射组学预测 RC 患者 DR 的现有文献进行系统评价。
根据 PRISMA 指南进行系统评价，以确定报告磁共振成像（MRI）放射组学分析以预测 RC 患者 DR 的研究。纳入了放射组学分析的敏感性和特异性进行荟萃分析。
共纳入了 7 项研究，包括 1497 名患者（998 名男性），其中 7 项、5 项和 1 项分别报告了放射组学。所有纳入研究的 DR 总发生率为 17.1%（256/1497），其中 15.6%（236/1497）、1.3%（19/1497）和 0.2%（3/1497）的患者有肝、肺和腹膜转移。荟萃分析表明，放射组学正确预测了 DR，MRI 的 pooled 敏感性和特异性分别为 0.76（95%CI：0.73，0.78）和 0.85（95%CI：0.83，0.88）。
本系统评价表明，术前 MRI 放射组学分析有助于识别 RC 术后 DR 风险增加的患者。我们的研究结果需要在更大的前瞻性研究中进行验证，因为预测 DR 是 RC 的一个重大未满足的需求。放射组学可能为高危人群提供量身定制的治疗策略。
