Colon and Rectum Surgery, Adventhealth, Orlando, FL, USA.
Surgical Health Outcomes Consortium (SHOC), AdventHealth Digestive Health Institute, Orlando, FL, USA.
Surg Endosc. 2024 Nov;38(11):6846-6853. doi: 10.1007/s00464-024-11084-3. Epub 2024 Aug 22.
Neoadjuvant therapy has become standard of care for locally advanced rectal cancer patients. It is correlated with improved clinical and pathological outcomes, including significant tumor downstaging and organ preservation in certain patients. Magnetic resonance imaging (MRI), which has become the standard for pre-operative staging, is also used for clinical and pre-operative restaging following pre-operative treatment. In this meta-analysis, we aimed to evaluate the concordance between restaging MRI (following the completion of neoadjuvant therapy) and postoperative pathology result.
We conducted a meta-analysis following the PRISMA 2020 guidelines. Two independent reviewers searched PubMed and Google Scholar for studies reporting restaging MRI results compared to pathological outcomes. Outcomes included tumor and nodal staging, circumferential resection margin (CRM) and pathological complete response (pCR).
Out of 25,000 studies found on the initial search; 33 studies were included. The studies were published between 2005 and 2023 and included 4100 patients (57.14% males). The median age was 62.45 years. The median interval between the conclusion of neoadjuvant treatment and the subsequent restaging MRI was 6 weeks (range 4.14-8.8 weeks). The pooled concordance rates between the restaging MRI and the pathological outcomes for ypT stage and ypN stage were 63.9% (54.5%-73.3%, I = 96.02%) and 60.9% (42.9%-78.9%, I = 98.96%), respectively. The pooled concordance for predicting pathological complete response was 70.4% (53.6%-87.1%, I = 98.21%). As for the circumferential resection margin (CRM), the pooled concordance was 78.2.% (71.6%-84.8%, I = 83.76%).
Our findings suggest that the concordance rates between restaging MRI and pathological outcomes in rectal cancer patients following neoadjuvant therapy are limited. Caregivers should take these results into consideration when making clinical decisions about these patients. More data should be gathered about the predictive value of MRI after total neoadjuvant therapy as well as immunotherapy in rectal cancer patients.
新辅助治疗已成为局部晚期直肠癌患者的标准治疗方法。它与改善的临床和病理结果相关，包括在某些患者中显著的肿瘤降期和器官保留。磁共振成像（MRI）已成为术前分期的标准，也用于新辅助治疗后的临床和术前再分期。在这项荟萃分析中，我们旨在评估新辅助治疗完成后再分期 MRI 与术后病理结果之间的一致性。
我们按照 PRISMA 2020 指南进行了荟萃分析。两名独立的审查员搜索了 PubMed 和 Google Scholar，以查找报告再分期 MRI 结果与病理结果的研究。结果包括肿瘤和淋巴结分期、环周切缘（CRM）和病理完全缓解（pCR）。
在最初的搜索中发现了 25000 项研究；纳入了 33 项研究。这些研究发表于 2005 年至 2023 年，共纳入 4100 名患者（57.14%为男性）。中位年龄为 62.45 岁。新辅助治疗结束与随后的再分期 MRI 之间的中位间隔为 6 周（范围 4.14-8.8 周）。再分期 MRI 与病理结果在 ypT 分期和 ypN 分期方面的总体一致性率分别为 63.9%（54.5%-73.3%，I = 96.02%）和 60.9%（42.9%-78.9%，I = 98.96%）。预测病理完全缓解的总体一致性为 70.4%（53.6%-87.1%，I = 98.21%）。至于环周切缘（CRM），总体一致性为 78.2.%（71.6%-84.8%，I = 83.76%）。
我们的研究结果表明，新辅助治疗后直肠癌患者再分期 MRI 与病理结果之间的一致性率有限。护理人员在为这些患者做出临床决策时应考虑到这些结果。应该收集更多关于新辅助治疗后以及免疫治疗在直肠癌患者中 MRI 的预测价值的数据。
