Li Qing-Yang, Yang Ding, Guan Zhen, Yan Xin-Yue, Li Xiao-Ting, Sun Rui-Jia, Lu Qiao-Yuan, Zhang Xiao-Yan, Sun Ying-Shi
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China.
Eur Radiol. 2025 Jul 2. doi: 10.1007/s00330-025-11788-7.
Evaluation of extranodal extension (ENE) after neoadjuvant chemoradiotherapy (nCRT) might improve the currently suboptimal prognostic implication of preoperative nodal evaluation in rectal cancer, but evidence is lacking. The aim of this study was to evaluate diagnostic accuracy and prognostic value of MRI-determined ENE after nCRT in rectal cancer.
This single-center study included a prospective developing dataset and a retrospective validation cohort, which enrolled patients who underwent nCRT and surgery from 2021 to 2023 and 2018 to 2019, respectively. In the developing dataset, participants were chronologically divided into training and test sets in 3:1 ratio and multiparametric features were analyzed on MRI before and after nCRT (hereafter, post-nCRT) in nodes that achieved per-node matching with pathology. The diagnostic process was established with logistic analyses and evaluated with areas under the receiver operating characteristic curve (AUCs). In the validation cohort, potential risk factors were evaluated, and Cox analysis was used to explore their association with disease-free survival (DFS).
208 participants were included in the developing dataset. The post-nCRT process, which incorporated the tail sign and vessel interruption on post-nCRT MRI, yielded AUCs of 0.86 (95% CI: 0.82, 0.89) and 0.83 (95% CI: 0.76, 0.89) in the training and test sets, respectively. In the validation cohort of 123 patients, the presence of ENE on post-nCRT MRI was demonstrated to be an independent risk factor for DFS (p = 0.02).
The evaluation of ENE after nCRT better predicts prognosis, whose presence may serve as an indicator of intensified therapy in rectal cancer patients.
Question Evidence of evaluating the extranodal extension (ENE), a pathological prognostic indicator, on MRI after neoadjuvant chemoradiotherapy (nCRT) is lacking in rectal cancer. Findings ENE could be detected by only two features on post-nCRT MRI, and its presence was associated with poorer disease-free survival. Clinical relevance The preoperative evaluation of ENE after nCRT improved the currently suboptimal contribution of nodal evaluation to prognostication in rectal cancer patients.
评估新辅助放化疗（nCRT）后结外侵犯（ENE）情况，可能会改善目前直肠癌术前淋巴结评估对预后的欠佳预测价值，但相关证据尚缺。本研究旨在评估MRI判定的直肠癌nCRT后ENE的诊断准确性及预后价值。
本单中心研究包括一个前瞻性开发数据集和一个回顾性验证队列，分别纳入了在2021年至2023年以及2018年至2019年期间接受nCRT及手术的患者。在开发数据集中，参与者按时间顺序以3:1的比例分为训练集和测试集，并对nCRT前后（以下简称nCRT后）MRI上与病理实现逐个淋巴结匹配的淋巴结的多参数特征进行分析。通过逻辑分析建立诊断流程，并使用受试者操作特征曲线下面积（AUC）进行评估。在验证队列中评估潜在风险因素，并采用Cox分析探讨其与无病生存期（DFS）的关联。
208名参与者纳入开发数据集。nCRT后流程结合了nCRT后MRI上的尾征和血管中断情况，在训练集和测试集中的AUC分别为0.86（95%CI：0.82, 0.89）和0.83（95%CI：0.76, 0.89）。在123例患者的验证队列中，nCRT后MRI上存在ENE被证明是DFS的独立危险因素（p = 0.02）。
nCRT后对ENE的评估能更好地预测预后，ENE的存在可作为直肠癌患者强化治疗的指标。
问题 在直肠癌中，缺乏新辅助放化疗（nCRT）后通过MRI评估结外侵犯（ENE）这一病理预后指标的证据。发现 nCRT后MRI仅通过两个特征即可检测到ENE，其存在与较差的无病生存期相关。临床意义 nCRT后对ENE的术前评估改善了目前淋巴结评估对直肠癌患者预后预测欠佳的情况。
