Zhao Qing, Zhong Hongxia, Guan Xu, Wan Lijuan, Zhao Xinming, Zou Shuangmei, Zhang Hongmei
Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.
Department of Radiology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, People's Republic of China.
Int J Surg. 2025 Jan 1;111(1):200-209. doi: 10.1097/JS9.0000000000001916.
To compare the value of tumor stroma ratio (TSR) and radiomic signature from baseline MRI for stratifying the risk of distant metastases (DM) in patients with locally advanced rectal cancer (LARC).
Data from 302 patients with LARC who underwent neoadjuvant chemoradiotherapy and total mesorectal excision in our hospital between 2015 and 2018 were retrospectively reviewed, and the patients were randomly allocated into the training and validation cohorts in a ratio of 7:3. Patients were followed-up for more than 3 years postoperatively with metachronous DM as the endpoint. Independent risk factors for DM-free survival (DMFS) were analyzed using Cox regression. The TSR of endoscopic biopsy specimens was scored automatically. Totally 1229 radiomic features of each tumor were extracted from baseline MRI, and the Radscore was calculated.
The median follow-up time was 54.3 (51.6-57.1) months, and the 3-year DMFS was 83.8%. The best cutoff value of the TSR to distinguish a patient's DM risk was 0.477 (Sen=70.8%, Sep=78%, P <0.001). Increased TSR (HR=3.072, P =0.006) and Radscore (HR=719.231, P =0.023), advanced MR-evaluated T stage (HR=2.660, P =0.023) and ypN (HR=2.362, P =0.028) stage were independent risk factors for DMFS. The area under the curve of the combined model was significantly higher than that of the radiomic model ( P =0.013) but without a significant advantage over the TSR model ( P =0.086).
TSR of colonoscopic biopsies can independently stratify DM risk in patients with LARC. The TSR model is the most convenient and efficient method for DM risk stratification in LARC.
比较肿瘤基质比（TSR）和基线MRI的放射组学特征对局部晚期直肠癌（LARC）患者远处转移（DM）风险分层的价值。
回顾性分析2015年至2018年间在我院接受新辅助放化疗及全直肠系膜切除术的302例LARC患者的数据，并按7:3的比例将患者随机分为训练组和验证组。术后对患者进行超过3年的随访，以异时性DM为终点。采用Cox回归分析无远处转移生存（DMFS）的独立危险因素。对内镜活检标本的TSR进行自动评分。从基线MRI中提取每个肿瘤的1229个放射组学特征，并计算Radscore。
中位随访时间为54.3（51.6 - 57.1）个月，3年DMFS为83.8%。区分患者DM风险的TSR最佳截断值为0.477（灵敏度=70.8%，特异度=78%，P <0.001）。TSR升高（HR = 3.072，P = 0.006）、Radscore升高（HR = 719.231，P = 0.023）、MR评估的T分期进展（HR = 2.660，P = 0.023）和ypN分期（HR = 2.362，P = 0.028）是DMFS的独立危险因素。联合模型的曲线下面积显著高于放射组学模型（P = 0.013），但与TSR模型相比无显著优势（P = 0.086）。
结肠镜活检的TSR可独立对LARC患者的DM风险进行分层。TSR模型是LARC患者DM风险分层最方便、有效的方法。
