Wada Yuma, Nishi Masaaki, Tokunaga Takuya, Kashihara Hideya, Takasu Chie, Yoshimoto Toshiaki, Shimada Mitsuo
Department of Surgery, Tokushima University, Tokushima, Japan.
Department of Surgery, Tokushima University, Tokushima, Japan
In Vivo. 2025 Mar-Apr;39(2):927-935. doi: 10.21873/invivo.13897.
BACKGROUND/AIM: Neoadjuvant chemoradiation therapy (nCRT) followed by surgery is recommended for patients with locally advanced rectal cancer (LARC). However, because 30%-40% of patients with LARC do not respond to nCRT, better prediction of treatment responses and survival outcomes is required. Therefore, this study aimed to identify apparent diffusion coefficient (ADC) values that predict survival outcomes after nCRT in patients with LARC.
We analyzed data from 66 patients with LARC who underwent nCRT and evaluated the ADC values pre- and post-nCRT. Cox proportional hazard regression analyses were conducted to assess survival outcomes.
There were no significant differences in disease-free survival (DFS) and overall survival (OS) between low and high ADC values pre-nCRT. However, patients classified as low ADC in post-nCRT had a significantly worse prognosis in OS and DFS (OS: =0.01; DFS: <0.01) than patients classified as high ADC. Moreover, an alteration in ADC values between pre- and post-nCRT was associated with poor OS [univariate, <0.01; multivariate: =0.01]. Finally, we identified ADC values that were significantly superior in predicting tumor regression grade, demonstrating remarkable diagnostic accuracy [post-nCRT: area under the curve (AUC)=0.79; alteration-nCRT: AUC=0.85].
We identified the clinical importance of changes in ADC values as a predictor of survival outcomes in patients with LARC. These results highlight the clinical importance of ADC values on improving the treatment strategies of patients.
背景/目的：对于局部晚期直肠癌（LARC）患者，推荐先进行新辅助放化疗（nCRT），然后进行手术。然而，由于30%-40%的LARC患者对nCRT无反应，因此需要更好地预测治疗反应和生存结果。因此，本研究旨在确定可预测LARC患者nCRT后生存结果的表观扩散系数（ADC）值。
我们分析了66例接受nCRT的LARC患者的数据，并评估了nCRT前后的ADC值。进行Cox比例风险回归分析以评估生存结果。
nCRT前ADC值低和高的患者之间无病生存期（DFS）和总生存期（OS）无显著差异。然而，nCRT后ADC值分类为低的患者在OS和DFS方面的预后明显比分类为高的患者差（OS：=0.01；DFS：<0.01）。此外，nCRT前后ADC值的改变与较差的OS相关[单因素，<0.01；多因素：=0.01]。最后，我们确定了在预测肿瘤退缩分级方面显著更优的ADC值，显示出显著的诊断准确性[nCRT后：曲线下面积（AUC）=0.79；nCRT改变：AUC=0.85]。
我们确定了ADC值变化作为LARC患者生存结果预测指标的临床重要性。这些结果突出了ADC值在改善患者治疗策略方面的临床重要性。
