Qin Jiaming, Dong Wenjin, Zhao Fengshu, Liu Tianqi, Chen Mengxin, Zhang Rui, Zhao Yumeng, Zhang Cheng, Wang Wenhong
The School of Medicine, Nankai University, Tianjin, China.
Tianjin Union Medical Center, Nankai University, Tianjin, China.
Magn Reson Imaging. 2025 May;118:110338. doi: 10.1016/j.mri.2025.110338. Epub 2025 Jan 29.
To investigate the relationship between perirectal fat content and metachronous liver metastasis (MLM) in patients with Mid-low rectal cancer (MLRC).
A retrospective analysis was conducted on 254 patients who underwent curative surgery for MLRC between December 2016 and December 2021. Preoperative MRI measurements of the rectal mesenteric fat area (MFA), rectal posterior mesorectal thickness (PMT), and rectal mesenteric fascia envelopment volume (MFEV) were performed, along with collection of relevant clinical, pathological, and imaging data. Patients were categorized into the MLM group (Group A), other recurrence or metastasis group (Group B), and no recurrence and metastasis group (Group C). Analyze the differences between Group A and the other groups, and independent risk factors for MLM were explored. Kaplan-Meier analysis and log-rank test were used to validate independent predictive biomarkers for MLM.
Patients with MLM from MLRC had later pathological and imaging T stages and lower perirectal fat content (all P < 0.05). Compared to patients with other types of recurrent metastasis, male gender, poorly differentiated tumors, and advanced tumor N stage were more likely to develop MLM (all P < 0.05). In Cox univariate and multivariate regression analysis, smaller rectal PMT (hazard ratio (HR) 0.361 [0.154-0.846], P = 0.019) and MFEV (HR 0.983 [0.968-0.998], P = 0.022) were independently associated with MLM in MLRC (HR 0.361;0.983). Kaplan-Meier analysis showed that patients with rectal PMT <1.43 cm and rectal MFEV <137.46 cm had a significantly higher risk of MLM compared to patients with rectal PMT ≥1.43 cm and rectal MFEV ≥137.46 cm (all P < 0.05).
Rectal PMT and rectal MFEV can serve as novel parameters for predicting MLM in patients with MLRC.
探讨中低位直肠癌（MLRC）患者直肠周围脂肪含量与异时性肝转移（MLM）之间的关系。
对2016年12月至2021年12月期间接受根治性手术的254例MLRC患者进行回顾性分析。术前通过MRI测量直肠系膜脂肪面积（MFA）、直肠后系膜厚度（PMT）和直肠系膜筋膜包绕体积（MFEV），并收集相关临床、病理和影像资料。将患者分为MLM组（A组）、其他复发或转移组（B组）和无复发转移组（C组）。分析A组与其他组之间的差异，探讨MLM的独立危险因素。采用Kaplan-Meier分析和对数秩检验验证MLM的独立预测生物标志物。
MLRC发生MLM的患者病理和影像T分期较晚，直肠周围脂肪含量较低（均P<0.05）。与其他类型复发转移患者相比，男性、肿瘤分化差、肿瘤N分期 advanced更易发生MLM（均P<0.05）。在Cox单因素和多因素回归分析中，较小的直肠PMT（风险比（HR）0.361[0.154-0.846]，P=0.019）和MFEV（HR 0.983[0.968-0.998]，P=0.022）与MLRC中的MLM独立相关（HR 0.361；0.983）。Kaplan-Meier分析显示，直肠PMT<1.43 cm和直肠MFEV<137.46 cm的患者与直肠PMT≥1.43 cm和直肠MFEV≥137.46 cm的患者相比，MLM风险显著更高（均P<0.05）。
直肠PMT和直肠MFEV可作为预测MLRC患者MLM的新参数。
