Sorbonne Université, Service d'Oncologie Médicale, Hôpital Saint Antoine, AP-HP, INSERM UMRS 938, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe labellisée par la Ligue Nationale contre le Cancer, SIRIC CURAMUS, Paris.
Sorbonne Université, Service de Radiologie, Hôpital Saint Antoine, APHP, Laboratoire d'Imagerie Biomédicale, UMR 7371, UMR S 1146, Paris.
ESMO Open. 2024 Aug;9(8):103678. doi: 10.1016/j.esmoop.2024.103678. Epub 2024 Aug 14.
Neoadjuvant immunotherapy emerges as a promising strategy for patients with localized colon cancer (CC) harboring microsatellite instability/mismatch repair deficiency (MSI/dMMR). The aim of this study is to evaluate the concordance between clinical cTN stage assessed by preoperative computed tomography (CT) scan and pTN stage of MSI/dMMR CC.
Consecutive patients diagnosed for localized MSI/dMMR CC and treated with upfront surgery between 2013 and 2022 in two French centers were eligible. Two independent radiologists, blinded to pathological findings, reviewed all preoperative CT scans and assessed cTN stage, with a third radiologist reviewing discordant cases. Radiological predictive diagnostic accuracy for pT4 and pN+ (N+ = N1 or N2) were calculated.
One hundred and thirteen patients were included (right CCs = 79%). CT scan diagnostic performances for pT4 were sensitivity (Se) = 33.3%; specificity (Sp) = 94.0%; positive predictive value (PPV) = 66.7%; and negative predictive value (NPV) = 79.6% and for pN+ were Se = 70.3%; Sp = 59.2%; PPV = 45.6%; and NPV = 80.4%. When pT-pN were combined, 37.5% of tumors identified as cT4 and/or cN+ were actually pT1-3 and pN0, and 23.1% of the pT4 and pN+ population was not identified as such radiologically.
The ability of preoperative CT scan to predict pT and pN stages is limited for localized MSI/dMMR CCs. Reassessing neoadjuvant strategies' benefit-risk balance in this population is needed.
新辅助免疫疗法为微卫星不稳定/错配修复缺陷（MSI/dMMR）的局部结肠癌（CC）患者提供了一种有前途的治疗策略。本研究旨在评估术前计算机断层扫描（CT）评估的临床 cTN 分期与 MSI/dMMR CC 的 pTN 分期之间的一致性。
连续入选 2013 年至 2022 年在法国两个中心接受新辅助治疗的局部 MSI/dMMR CC 患者。两名独立的放射科医生在不了解病理结果的情况下对所有术前 CT 扫描进行评估，并评估 cTN 分期，对有分歧的病例由第三名放射科医生进行评估。计算 CT 扫描对 pT4 和 pN+（N+ = N1 或 N2）的预测诊断准确性。
共纳入 113 例患者（右 CCs = 79%）。CT 扫描对 pT4 的诊断性能为敏感性（Se）= 33.3%；特异性（Sp）= 94.0%；阳性预测值（PPV）= 66.7%；阴性预测值（NPV）= 79.6%；对 pN+的 Se = 70.3%；Sp = 59.2%；PPV = 45.6%；NPV = 80.4%。当 pT-pN 联合时，37.5%的肿瘤被确定为 cT4 和/或 cN+，实际上为 pT1-3 和 pN0，23.1%的 pT4 和 pN+人群未被影像学识别。
术前 CT 扫描预测局部 MSI/dMMR CC 的 pT 和 pN 分期的能力有限。需要重新评估新辅助策略在该人群中的获益风险平衡。
