Yeung Trevor M, Rosen Roni Y, Bercz Aron, Williams Hannah, Omer Dana, Verheij Floris S, Behman Ramy, Marcadis Andrea, Shia Jinru, Cercek Andrea, Segal Neil H, Yaeger Rona, Kim Tae-Hyung, Horvat Natally, Gollub Marc J, Smith J Joshua, Saltz Leonard, Garcia-Aguilar Julio
Department of Colorectal Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Division of Colorectal Surgery, Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong.
Surg Endosc. 2025 Jul 14. doi: 10.1007/s00464-025-11982-0.
Patients with locally advanced rectal cancer may avoid surgery if they develop a clinical complete response (cCR) to total neoadjuvant therapy (TNT). During surveillance, detection of local regrowth can be challenging. The ability of MRI to predict local regrowth is uncertain, especially when it differs from endoscopic findings. This study evaluates the ability of MRI and endoscopy to predict local regrowth in patients under surveillance for cCR after TNT.
All rectal cancer patients in our institution from 2006 to 2020 who achieved cCR following TNT, and entered watch and wait (WW), with findings suspicious for local regrowth during surveillance and subsequently underwent surgery were assessed. The main outcomes were the ability of MRI to correctly identify the local regrowths and its correlation with endoscopy and pathology.
1426 patients were diagnosed with locally advanced rectal cancer. 388 patients achieved cCR after TNT and underwent surveillance. 112 patients developed clinical and/or radiological findings suspicious of local regrowth. Of 99 patients who proceeded to surgery, 12 (12%) had a pathological complete response (pCR). For patients with an abnormal MRI only and normal endoscopy, pCR rate was 4/9 (44%). For patients with an abnormal endoscopy, pCR rates in those with a normal MRI and those with an abnormal MRI were 6/34 (18%) and 2/56 (4%), respectively (χ-test, p = 0.001). Normal endoscopy was significantly associated with higher odds of pCR (OR 8.2, p = 0.012) whereas normal MRI showed a non-significant association (OR 2.11, p = 0.33).
In rectal cancer patients achieving cCR after TNT, local regrowth without detectable endoscopic findings is rare. When isolated abnormal MRI findings occur, repeat radiologic surveillance prior to deciding on surgery may minimize unnecessary surgical interventions.
局部晚期直肠癌患者若对全新辅助治疗（TNT）产生临床完全缓解（cCR），则可避免手术。在监测期间，检测局部复发可能具有挑战性。MRI预测局部复发的能力尚不确定，尤其是当它与内镜检查结果不同时。本研究评估了MRI和内镜检查在TNT后接受cCR监测的患者中预测局部复发的能力。
评估了2006年至2020年在本机构接受TNT后达到cCR并进入观察等待（WW）阶段、在监测期间发现局部复发可疑并随后接受手术的所有直肠癌患者。主要结局是MRI正确识别局部复发的能力及其与内镜检查和病理学的相关性。
1426例患者被诊断为局部晚期直肠癌。388例患者在TNT后达到cCR并接受监测。112例患者出现临床和/或影像学表现可疑局部复发。在99例接受手术的患者中，12例（12%）有病理完全缓解（pCR）。仅MRI异常而内镜检查正常的患者，pCR率为4/9（44%）。内镜检查异常的患者中，MRI正常者和MRI异常者的pCR率分别为6/34（18%）和2/56（4%）（χ检验，p = 0.001）。内镜检查正常与pCR几率较高显著相关（OR 8.2，p = 0.012），而MRI正常则显示无显著相关性（OR 2.11，p = 0.33）。
在TNT后达到cCR的直肠癌患者中，未发现内镜检查结果的局部复发很少见。当出现孤立的MRI异常发现时，在决定手术前重复进行影像学监测可减少不必要的手术干预。
