Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Yuexiu District, No. 58, Zhongshan Second Road, Guangzhou, 510080, China.
Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-Sen University, Guangming District, No. 628, Zhenyuan Road, Shenzhen, 518107, China.
Eur Radiol. 2024 May;34(5):2963-2973. doi: 10.1007/s00330-023-10261-7. Epub 2023 Oct 16.
To evaluate the identification of tumor deposits (TDs) and the prognostic significance of an MRI tumor regression grade for TDs in patients with rectal cancer treated with neoadjuvant chemoradiotherapy (nCRT).
Ninety-one patients with cT3 or cT4 rectal cancer who underwent surgery following nCRT between August 2014 and June 2020 were retrospectively analyzed. Changes in pre-nCRT MRI-detected TDs (mrTDs) were described as mrTD regression grade. The diagnostic performance of post-nCRT MRI-detected TDs (ymrTDs) was compared with histopathological reference standard. The correlation between ymrTDs, mrTD regression grade, and disease-free survival (DFS) was assessed.
The sensitivity and specificity of ymrTDs were 88.00% and 89.39%, respectively. The area under the receiver operating characteristic curve was 0.887 (95% confidence interval [CI]: 0.803-0.944). The 3-year DFS of patients with positive ymrTDs was significantly lower than of the negative group (44.83% vs 82.73%, p < 0.001). The 3-year DFS was 33.33% for patients with poor regression of mrTDs following nCRT and 55.56% for those with moderate regression, compared to 69.23% in good responders and 83.97% in patients without mrTDs (p < 0.001). On multivariable Cox regression, mrTD regression grade was the only independent MRI factor associated with DFS (p = 0.042).
Diagnostic performance of ymrTDs was moderate. The mrTD regression grade was independently correlated with DFS, which may have a prognostic implication for treatment and follow-up.
Patients with poor regression of MRI-detected tumor deposits may benefit from more aggressive treatments, such as chemoradiation therapy plus induction or consolidation chemotherapy.
• MRI provides a preoperative and noninvasive way to visualize tumor deposits (TDs) after neoadjuvant chemoradiotherapy (nCRT). • Post-nCRT MRI-detected TDs are a poor prognostic marker in cT3 and cT4 rectal cancer patients. • The regression of MRI-detected TDs after nCRT is associated with an improved disease-free survival.
评估新辅助放化疗（nCRT）后直肠癌患者肿瘤沉积（TDs）的 MRI 肿瘤消退分级的识别和预后意义。
回顾性分析 2014 年 8 月至 2020 年 6 月期间接受 nCRT 后手术的 91 例 cT3 或 cT4 直肠癌患者。描述术前 nCRT MRI 检测到的 TD（mrTDs）的变化为 mrTD 消退分级。比较 post-nCRT MRI 检测到的 TD（ymrTDs）与组织病理学参考标准的诊断性能。评估 ymrTDs、mrTD 消退分级与无病生存（DFS）之间的相关性。
ymrTDs 的灵敏度和特异性分别为 88.00%和 89.39%。受试者工作特征曲线下面积为 0.887（95%置信区间[CI]：0.803-0.944）。阳性 ymrTDs 患者的 3 年 DFS 明显低于阴性组（44.83% vs 82.73%，p<0.001）。nCRT 后 mrTD 消退不良的患者 3 年 DFS 为 33.33%，消退中度的患者为 55.56%，而消退良好的患者为 69.23%，无 mrTDs 的患者为 83.97%（p<0.001）。多变量 Cox 回归分析显示，mrTD 消退分级是与 DFS 相关的唯一独立 MRI 因素（p=0.042）。
ymrTDs 的诊断性能为中等。mrTD 消退分级与 DFS 独立相关，可能对治疗和随访具有预后意义。
MRI 检测到的肿瘤沉积消退不良的患者可能受益于更积极的治疗，如放化疗联合诱导或巩固化疗。
MRI 提供了一种术前和非侵入性的方法来可视化新辅助放化疗（nCRT）后的肿瘤沉积（TDs）。
nCRT 后 MRI 检测到的 TDs 是 cT3 和 cT4 直肠癌患者预后不良的标志物。
nCRT 后 MRI 检测到的 TD 消退与无病生存改善相关。
