Hu Tingdan, Rong Zening, Cai Chongpeng, Feng Yaru, Zhang Zhen, Cai Guoxiang, Sun Yiqun, Tong Tong
Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China.
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China.
Eur J Radiol. 2025 Mar;184:111954. doi: 10.1016/j.ejrad.2025.111954. Epub 2025 Jan 28.
To investigate whether MRI risk factors can be used to predict clinical outcomes and whether MRI risk assessment can be used to select stage II-III rectal cancer patients who may benefit from neoadjuvant chemoradiotherapy (nCRT).
A total of 947 rectal cancer patients who underwent total mesorectal excision (TME) were retrospectively recruited. An MRI scoring system was established using the cumulative score of three risk factors (mesorectal fascia involvement, extramural venous invasion, and tumour deposits). Patients with mrT3c-T4 stage, N2 stage, or any risk factors were considered MRI high-risk cases of rectal cancer. Cox regression analysis was used to identify independent risk factors for overall survival (OS) and disease-free survival (DFS). Kaplan-Meier curves were generated to show the benefits of nCRT after propensity score matching (PSM).
OS and DFS were more favourable in the MRI low-risk group than in the MRI high-risk group, and the MRI scoring system facilitated prognostic stratification in stage II-III rectal cancer patients. NCRT significantly improved 3-year OS (89.1 % versus 78.8 %, p = 0.001) and 3-year DFS (73.4 % versus 68.0 %, p = 0.030) in the MRI high-risk group. After PSM, OS and DFS were improved in the MRI high-risk group with an MRI score of 1 (OS: HR = 0.432 [95 % CI: 0.214-0.871], p = 0.019; DFS: HR = 0.477 [95 % CI: 0.275-0.825], p = 0.008) and an MRI score of 2 (OS: HR = 0.276 [95 % CI: 0.130-0.586], p = 0.001; DFS: HR = 0.358 [95 % CI: 0.182-0.705], p = 0.003), whereas MRI low-risk patients did not obtain any survival benefit from nCRT.
MRI-defined high-risk patients with MRI scores of 1 or 2 may benefit from nCRT. Baseline MRI should be given more consideration in nCRT decision-making.
探讨MRI风险因素是否可用于预测临床结局，以及MRI风险评估是否可用于选择可能从新辅助放化疗（nCRT）中获益的II-III期直肠癌患者。
回顾性纳入947例行全直肠系膜切除术（TME）的直肠癌患者。使用三个风险因素（直肠系膜筋膜受累、壁外静脉侵犯和肿瘤结节）的累积评分建立MRI评分系统。mrT3c-T4期、N2期或有任何风险因素的患者被视为直肠癌的MRI高危病例。采用Cox回归分析确定总生存（OS）和无病生存（DFS）的独立危险因素。绘制Kaplan-Meier曲线以显示倾向评分匹配（PSM）后nCRT的益处。
MRI低风险组的OS和DFS比MRI高风险组更有利，并且MRI评分系统有助于II-III期直肠癌患者的预后分层。nCRT显著改善了MRI高风险组的3年OS（89.1%对78.8%，p = 0.001）和3年DFS（73.4%对68.0%，p = 0.030）。PSM后，MRI评分为1（OS：HR = 0.432 [95%CI：0.214-0.871]，p = 0.019；DFS：HR = 0.477 [95%CI：0.275-0.825]，p = 0.008）和MRI评分为2（OS：HR = 0.276 [95%CI：0.130-0.586]，p = 0.001；DFS：HR = 0.358 [95%CI：0.182-0.705]，p = 0.003）的MRI高风险组的OS和DFS得到改善，而MRI低风险患者未从nCRT中获得任何生存益处。
MRI评分1或2的MRI定义的高危患者可能从nCRT中获益。在nCRT决策中应更多考虑基线MRI。
