磁共振成像识别的包膜外血管浸润、肿瘤结节、直肠系膜淋巴结及盆腔侧壁病变在局部晚期直肠癌中的预后意义

Prognostic significance of MR identified EMVI, tumour deposits, mesorectal nodes and pelvic side wall disease in locally advanced rectal cancer.

作者信息

Chandramohan Anuradha, Mittal Rohin, Dsouza Romina, Yezzaji Harish, Eapen Anu, Simon Betty, John Reetu, Singh Ashish, Ram Thomas S, Jesudason Mark R, Masih Dipti, Karuppusami Reka

机构信息

Department of Radiology, Christian Medical College, Vellore, India.

Department of Colorectal Surgery, Christian Medical College, Vellore, India.

出版信息

Colorectal Dis. 2022 Apr;24(4):428-438. doi: 10.1111/codi.16032. Epub 2022 Jan 7.

DOI:10.1111/codi.16032

PMID:34954863

Abstract

AIM

To study the prognostic significance of MRI identified tumour deposits (TD), extramural vascular invasion (EMVI), lymph node metastases (LNM) and pelvic sidewall (PSW) disease in rectal cancer.

METHODS

This IRB approved study was conducted on patients with stage IIA-IIIC rectal adenocarcinoma treated with neoadjuvant long course chemoradiotherapy (LCCRT) and total mesorectal excision (TME) type of surgery between 2012-2018. A radiologist blinded to outcome reviewed staging and restaging magnetic resonance imaging (MRI) for TD, EMVI, LNM and PSW. The agreement between four radiologists was studied and we obtained outcome data from a prospectively maintained database. The prognostic significance of imaging findings was assessed.

RESULTS

A total of 297 (186 males) patients with a mean age of 47.3 (SD14.4) years were included in the study. The majority had T3 (n = 206) or T4 (n = 59) stage disease. The mean duration of follow-up was 49.3 ± 25 months (6.6-101 months). 5-year overall (OS) and disease-free survival (DFS) was 84% and 74%, respectively. Staging and restaging MRI had EMVI in 49.5% and 31.3%; TD in 47.5% and 31.6%; LNM in 61.1% and 38.1% and PSW in 11.4% and 6.1%. OS was adversely affected by EMVI, TD and PSW with the adjusted HR (aHR) of 3.32, 3.31, 3.27 for staging MRI and 2.99, 3.1, 2.81 for restaging MRI, respectively, p < 0.05. DFS was affected by EMVI (aHR = 1.85, 2.33) and TD (aHR = 1.83, 2.19), p < 0.05. Persistence of these findings after LCCRT led to worst outcome. Intra- and interobserver agreement for EMVI, TD and LN was 0.789, 0.734, 0.406 and 0.449, 0.354, 0.376, respectively, p < 0.001.

CONCLUSIONS

MRI identified that TD, EMVI and PSW disease are independent poor prognostic indicators in rectal cancer patients. Interobserver agreement for these findings was moderate to fair.

摘要

目的

研究磁共振成像（MRI）识别的肿瘤沉积物（TD）、壁外血管侵犯（EMVI）、淋巴结转移（LNM）及盆腔侧壁（PSW）病变在直肠癌中的预后意义。

方法

本研究经机构审查委员会（IRB）批准，纳入2012年至2018年间接受新辅助长程放化疗（LCCRT）及全直肠系膜切除术（TME）的IIA-IIIC期直肠腺癌患者。一名对结果不知情的放射科医生对分期及再分期的MRI进行TD、EMVI、LNM及PSW评估。研究了四位放射科医生之间的一致性，并从一个前瞻性维护的数据库中获取结果数据。评估影像学检查结果的预后意义。

结果

本研究共纳入297例患者（186例男性），平均年龄47.3（标准差14.4）岁。大多数患者为T3期（n = 206）或T4期（n = 59）疾病。平均随访时间为49.3±25个月（6.6 - 101个月）。5年总生存率（OS）和无病生存率（DFS）分别为84%和74%。分期及再分期MRI显示EMVI分别为49.5%和31.3%；TD分别为47.5%和31.6%；LNM分别为61.1%和38.1%；PSW分别为11.4%和6.1%。EMVI、TD及PSW对OS有不利影响，分期MRI的调整后风险比（aHR）分别为3.32、3.31、3.27，再分期MRI分别为2.99、3.1、2.81，p < 0.05。DFS受EMVI（aHR = 1.85，2.33）和TD（aHR = 1.83，2.19）影响，p < 0.05。LCCRT后这些表现持续存在导致预后更差。EMVI、TD及LNM的观察者内及观察者间一致性分别为0.789、0.734、0.406及0.449、0.354、0.376，p < 0.001。