Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, No.52 Fu Cheng Road, Beijing, 100142, Hai Dian District, China.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, No.52 Fu Cheng Road, Beijing, 100142, Hai Dian District, China.
Int J Colorectal Dis. 2022 Jun;37(6):1239-1249. doi: 10.1007/s00384-022-04169-9. Epub 2022 May 3.
Current low anterior resection syndrome (LARS) score is lagging behind and only based on clinical symptoms patient described. Preoperative imaging indicators which can be used to predict LARS is unknown. We proposed preoperative MRI parameters for identifying major LARS.
Patients receiving curative restorative anterior resection from Sept. 2007 to Sept. 2015 were collected to complete LARS score (median 75.7 months since surgery). MRI measurements associated with LARS were tested, and a multivariate logistic model was conducted for predicting LARS. Receiver operating characteristic curve was used to evaluate the model.
Two hundred fifty-five patients undergoing neoadjuvant chemoradiotherapy and 72 patients undergoing direct surgery were enrolled. The incidence of major LARS in NCRT group was significantly higher (53.3% vs.34.7%, P = 0.005). In patients with neoadjuvant chemoradiotherapy, the thickness of ARJ (TARJ), the distance between the tumor's lower edge and anal rectal joint (DTA), and sex were independent factors for predicting major LARS; ORs were 0.382 (95% CI, 0.198-0.740), 0.653 (95% CI, 0.565-0.756), and 0.935 (95% CI, 0.915-0.955). The AUC of the multivariable model was 0.842 (95% CI, 0.794-0.890). In patients with direct surgery, only DTA was the independent factor for predicting major LARS; OR was 0.958 (95% CI, 0.930-0.988). The AUC was 0.777 (95% CI: 0.630-0.925).
Baseline MRI measurements have the potential to predict major LARS in rectal cancer, which will benefit the decision-making and improve patients' life quality.
目前的低位前切除综合征（LARS）评分滞后，仅基于患者描述的临床症状。用于预测 LARS 的术前影像学指标尚不清楚。我们提出了术前 MRI 参数来识别主要的 LARS。
收集 2007 年 9 月至 2015 年 9 月接受根治性前切除术的患者，以完成 LARS 评分（手术中位时间 75.7 个月）。对与 LARS 相关的 MRI 测量进行了测试，并建立了多变量逻辑模型来预测 LARS。使用受试者工作特征曲线来评估该模型。
共纳入 255 例接受新辅助放化疗和 72 例直接手术的患者。NCRT 组中主要 LARS 的发生率明显更高（53.3%比 34.7%，P=0.005）。在接受新辅助放化疗的患者中，直肠前间隙厚度（TARJ）、肿瘤下缘至肛直肠结合部的距离（DTA）和性别是预测主要 LARS 的独立因素；OR 分别为 0.382（95%CI，0.198-0.740）、0.653（95%CI，0.565-0.756）和 0.935（95%CI，0.915-0.955）。多变量模型的 AUC 为 0.842（95%CI，0.794-0.890）。在直接手术的患者中，只有 DTA 是预测主要 LARS 的独立因素；OR 为 0.958（95%CI，0.930-0.988）。AUC 为 0.777（95%CI：0.630-0.925）。
基线 MRI 测量值有可能预测直肠癌的主要 LARS，这将有利于决策，并提高患者的生活质量。
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