Natout Mustafa, Machmouchi Ahmad, Hussain Hero, Chehade Laudy, Abbas Noura, Turfa Rim, Kattan Joseph, Temraz Sally, Tawil Ayman, Elkhaldi Mousa, Jaber Omar, Amarin Rula, Alawabdeh Tala, Charafeddine Maya, Al Darazi Monita, Shamseddine Ali
Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon.
Department of Internal Medicine, Division of Hematology/Oncology, Naef K. Basile Cancer Institute-NKBCI, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon.
Diagnostics (Basel). 2025 Apr 2;15(7):913. doi: 10.3390/diagnostics15070913.
: Predictive tools are needed to assess the response to treatment and guide treatment decisions for locally advanced rectal cancer (LARC). This study explores the value of combining the immunoscore (IS) and magnetic resonance imaging tumor regression grade (mrTRG) with pathologic and radiologic neoadjuvant rectal (NAR) scores in predicting pathologic complete response (pCRs). : The scores were assessed for patients with LARC enrolled in the Averectal study (NCT03503630), who received five fractions of short-course radiotherapy, followed by six cycles of mFOLFOX-6 plus avelumab, and total mesorectal excision. The IS was calculated using the mean density percentiles of CD3- and CD8-positive T-cells on baseline biopsy samples. Baseline and post-treatment MRIs were reviewed to measure the mrTRG. NAR scores were calculated using the pre-treatment T stage and post-treatment pathologic and radiologic N and T stages. : Fifteen out of thirty-five patients whose data were available achieved pCR (42.8%), and seven out of fourteen patients with mrTRG = 1 (complete response) attained pCR. In patients with both a mrTRG = 1 and high IS, the pCR rate was 66.7% (6/9). All of the patients who achieved pCR had a low or intermediate pathologic NAR score with a significant correlation between pCR and pathologic NAR scores ( < 0.0001). Both pathologic and radiologic NAR scores were correlated with overall survival and disease-free survival. : The IS can supplement the mrTRG to better predict TNT outcomes, along with the use of the NAR score. This combination could potentially help with patient selection for non-operative management and guide treatment strategies for those with different recurrence risks.
需要预测工具来评估局部晚期直肠癌（LARC）的治疗反应并指导治疗决策。本研究探讨了将免疫评分（IS）、磁共振成像肿瘤退缩分级（mrTRG）与病理和放射学新辅助直肠（NAR）评分相结合在预测病理完全缓解（pCR）方面的价值。：对参加Averectal研究（NCT03503630）的LARC患者的评分进行了评估，这些患者接受了五分割的短程放疗，随后进行六个周期的mFOLFOX - 6加阿维鲁单抗治疗，然后行全直肠系膜切除术。IS通过基线活检样本上CD3和CD8阳性T细胞的平均密度百分位数计算得出。回顾基线和治疗后的MRI以测量mrTRG。NAR评分使用治疗前T分期以及治疗后病理和放射学N和T分期计算得出。：在有可用数据的35例患者中，15例实现了pCR（42.8%），在14例mrTRG = 1（完全缓解）的患者中，7例实现了pCR。在mrTRG = 1且IS高的患者中，pCR率为66.7%（6/9）。所有实现pCR的患者病理NAR评分低或中等，pCR与病理NAR评分之间存在显著相关性（<0.0001）。病理和放射学NAR评分均与总生存期和无病生存期相关。：IS可以补充mrTRG以更好地预测TNT结果，同时使用NAR评分。这种组合可能有助于非手术治疗的患者选择，并指导具有不同复发风险患者的治疗策略。
