From the Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Rd, Hai Dian District, Beijing 100142, China.
Radiology. 2024 Mar;310(3):e232605. doi: 10.1148/radiol.232605.
Background Detection of extranodal extension (ENE) at pathology is a poor prognostic indicator for rectal cancer, but whether ENE can be identified at pretreatment MRI is, to the knowledge of the authors, unknown. Purpose To evaluate the performance of pretreatment MRI in detecting ENE using a matched pathologic reference standard and to assess its prognostic value in patients with rectal cancer. Materials and Methods This single-center study included a prospective development data set consisting of participants with rectal adenocarcinoma who underwent pretreatment MRI and radical surgery (December 2021 to January 2023). MRI characteristics were identified by their association with ENE-positive nodes (χ test and multivariable logistic regression) and the performance of these MRI features was assessed (area under the receiver operating characteristic curve [AUC]). Interobserver agreement was assessed by Cohen κ coefficient. The prognostic value of ENE detected with MRI for predicting 3-year disease-free survival was assessed by Cox regression analysis in a retrospective independent validation cohort of patients with locally advanced rectal cancer (December 2019 to July 2020). Results The development data set included 147 participants (mean age, 62 years ± 11 [SD]; 87 male participants). The retrospective cohort included 110 patients (mean age, 60 years ± 9; 79 male participants). Presence of vessel interruption and fusion (both < .001), heterogeneous internal structure, and the broken-ring and tail signs (odds ratio range, 4.10-23.20; value range, <.001 to .002) were predictors of ENE at MRI, and together achieved an AUC of 0.91 (95% CI: 0.88, 0.93) in detecting ENE. Interobserver agreement was moderate for the presence of vessel interruption and fusion (κ = 0.46 for both) and substantial for others (κ = 0.61-0.67). The presence of ENE at pretreatment MRI was independently associated with worse 3-year disease-free survival (hazard ratio, 3.00; = .02). Conclusion ENE can be detected at pretreatment MRI, and its presence was associated with worse prognosis for patients with rectal cancer. © RSNA, 2024 See also the editorial by Eberhardt in this issue.
背景 病理学上检测到结外延伸（ENE）是直肠癌的预后不良指标，但作者认为，术前 MRI 是否能识别出 ENE 尚不清楚。目的 用匹配的病理参考标准评估术前 MRI 在检测 ENE 中的性能，并评估其在直肠癌患者中的预后价值。材料与方法 这项单中心研究包括一组接受术前 MRI 和根治性手术的直肠腺癌患者的前瞻性开发数据集（2021 年 12 月至 2023 年 1 月）。通过与 ENE 阳性淋巴结相关的特征（χ检验和多变量逻辑回归）来确定 MRI 特征，并评估这些 MRI 特征的性能（受试者工作特征曲线下面积[AUC]）。采用 Cohen κ 系数评估观察者间一致性。在另一组局部进展期直肠癌患者（2019 年 12 月至 2020 年 7 月）的回顾性独立验证队列中，通过 Cox 回归分析评估 MRI 检测到的 ENE 对预测 3 年无病生存的预后价值。结果 开发数据集包括 147 名参与者（平均年龄，62 岁±11[标准差]；87 名男性参与者）。回顾性队列包括 110 名患者（平均年龄，60 岁±9；79 名男性参与者）。血管中断和融合（均<.001）、不均匀的内部结构以及破环和尾巴征（比值比范围，4.10-23.20；P 值范围，<.001 至.002）是 MRI 检测到的 ENE 的预测因素，联合检测的 AUC 为 0.91（95%CI：0.88，0.93）。血管中断和融合的观察者间一致性为中度（κ=0.46），其他特征的观察者间一致性为高度（κ=0.61-0.67）。术前 MRI 上存在 ENE 与直肠癌患者的 3 年无病生存率较差独立相关（风险比，3.00；P=.02）。结论 术前 MRI 可检测到 ENE，其存在与直肠癌患者的预后较差相关。
