Department of Radiology, First Affiliated Hospital of Wanan Medical College, NO.2 Zheshanxi Road, Wuhu City, Anhui Province, 241000, China.
Department of Radiology, First Affiliated Hospital of Soochow University, NO.899 Pinghai Road, Suzhou City, Jiangsu Province, 215004, China.
BMC Cancer. 2022 Aug 25;22(1):920. doi: 10.1186/s12885-022-10022-7.
The incidence and mortality rate of rectal cancer are still high, the metastasis of rectal cancer are main causes of death. The control of the distant metastasis is one of the main concerns in the treatment of locally advanced rectal cancer, but there are few studies on predicting synchronous distant metastasis (SDM) of rectal cancer.
The data of patients with rectal adenocarcinoma confirmed by endoscopic biopsy or postoperative pathology from September 2015 to May 2020 in hospital A (center 1) and hospital B (center 2) were analyzed retrospectively, including age, sex, carcinoembryonic antigen, carbohydrate antigen 19-9, tumor location, tumor length, image staging and characteristics. The average age of the 169 patients consisting of 105 males and 64 females in study is 61.2 years. All patients underwent rectal routine rectal MRI, DKI and IVIM examinations on a 3.0-T scanner. Two radiologists sketched regions of interest (ROIs) on b = 1000 s/mm DKI and IVIM images to obtain quantitative parameters with FireVoxel manually. We evaluated the difference of histogram analysis, clinical and image data between SDM group and non-SDM group, and evaluated the efficacy of each index in predicting SDM of rectal cancer.
The 90th percentile of f values in the SDM group is lower than that in the non-SDM group (29.4 ± 8.4% vs. 35 ± 17.8%, P = 0.005). CA19-9 in the SDM group is higher than that in the non-SDM group (P = 0.003). Low and high rectal cancer are more likely to develop SDM than middle rectal cancer (P = 0.05 and P = 0.047). The combination of these three indexes has a greater area under the curve (AUC) than any one index (0.801 vs. 0.685 (f (90th percentile)) and 0.627 (CA19-9), P = 0.0075 and 0.0058, respectively), and its specificity and sensitivity are 80.0% and 71.6%, respectively. When this combination is incorporated into the predictive nomogram model, the c-index is 0.801 (95% confidence interval (CI): 0.730-0.871).
IVIM quantitative parameters combine with CA19-9 and tumor location can better predict the risk of SDM of rectal cancer.
直肠癌的发病率和死亡率仍然很高，直肠癌的转移是死亡的主要原因。控制远处转移是局部晚期直肠癌治疗的主要关注点之一，但目前关于预测直肠癌同步远处转移（SDM）的研究较少。
回顾性分析 2015 年 9 月至 2020 年 5 月在医院 A（中心 1）和医院 B（中心 2）经内镜活检或术后病理证实为直肠腺癌的患者资料，包括年龄、性别、癌胚抗原、糖类抗原 19-9、肿瘤部位、肿瘤长度、影像学分期和特征。研究共纳入 169 例患者，其中男性 105 例，女性 64 例，平均年龄 61.2 岁。所有患者均在 3.0T 扫描仪上进行直肠常规直肠 MRI、DKI 和 IVIM 检查。两名放射科医生在 b=1000s/mm DKI 和 IVIM 图像上手动勾画感兴趣区（ROI）以获得定量参数。我们评估了 SDM 组和非 SDM 组之间直方图分析、临床和图像数据的差异，并评估了每个指标预测直肠癌 SDM 的疗效。
SDM 组的 f 值 90 百分位数低于非 SDM 组（29.4±8.4%比 35±17.8%，P=0.005）。SDM 组的 CA19-9 高于非 SDM 组（P=0.003）。低位和高位直肠癌比中位直肠癌更易发生 SDM（P=0.05 和 P=0.047）。这三个指标的联合比任何一个指标的 AUC 都更大（0.801 比 0.685（f（90 百分位数））和 0.627（CA19-9），P=0.0075 和 0.0058），其特异性和敏感性分别为 80.0%和 71.6%。当将这种组合纳入预测列线图模型时，c 指数为 0.801（95%置信区间（CI）：0.730-0.871）。
IVIM 定量参数结合 CA19-9 和肿瘤位置可以更好地预测直肠癌 SDM 的风险。
