[an error occurred while processing this directive] | [an error occurred while processing this directive]
Correlation analysis between MRI parameters and prognosis in locally advanced rectal cancer patients receiving chemoradiotherapy
Chen Silin1, Li Shuai2, Li Ning1, Liu Wenyang1, Jiang Liming3, Jiang Jun3, Ren Hua1, Wang Shulian1, Song Yongwen1, Liu Yueping1, Fang Hui1, Lu Ningning1, Tang Yu1, Qi Shunan1, Chen Bo1, Lei Junqin1, Shi Jinming1, Li Yexiong1, Jin Jing1, Tang Yuan1
1Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; 2Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China; 3Department of Image, National Cancer Center/National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
AbstractObjective To investigate the relationship between MRI parameters and clinical prognosis before and after chemoradiotherapy in patients with locally advanced rectal cancer. Methods Clinical and follow-up data of 96 patients with locally advanced rectal cancer who were initially treated in the Cancer Hospital of Chinese Academy of Medical Sciences from 2015 to 2017 were retrospectively analyzed. All patients received preoperative chemoradiotherapy, followed by delayed radical surgery at 6-13 weeks after radiotherapy.MRI assessment was performed twice around radiotherapy which were within 4 weeks before the treatment and 4-8 weeks after it.Correlation analysis was utilized to determine the association between MRI assessment and 3-year disease-free survival (DFS). Results Of the all patients, 80 (83%) had T3 stage, 16(17%) had T4 stage, 14 (15%) had N0 stage, and 82 (86%) had N1-2 stage.Among them, 69(72%) and 58(60%) patients were positive for MRF and EMVI. The median dose of radiotherapy was 50Gy, and all patients were sensitized by simultaneous capecitabine. After chemoradiotherapy, T-downstage rate of the whole group was 24%, and 50% for the N-downstage rate. The MRF-and EMVI-positive rates were significantly decreased to 37% and 27% after chemoradiotherapy (both P<0.001). Univariate and multivariate analyses showed that N staging and EMVI status change were significantly correlated with the 3-year DFS. Conclusion MRI after concurrent chemoradiotherapy reveals that positive EMVI throughout the treatment and N1-N2 staing are poor prognostic factors of DFS, suggesting the need for improving the treatment.
Fund:Capital's Funds for Health Improvement and Research(2020-1-4021);The Fundamental Research Funds for the Central Universities(3332019055);National Natural Science Foundation of China (81871509)
Chen Silin,Li Shuai,Li Ning et al. Correlation analysis between MRI parameters and prognosis in locally advanced rectal cancer patients receiving chemoradiotherapy[J]. Chinese Journal of Radiation Oncology, 2020, 29(7): 529-534.
Chen Silin,Li Shuai,Li Ning et al. Correlation analysis between MRI parameters and prognosis in locally advanced rectal cancer patients receiving chemoradiotherapy[J]. Chinese Journal of Radiation Oncology, 2020, 29(7): 529-534.
[1] Glynne-Jones R, Wyrwicz L, Tiret E, et al. Rectal cancer:ESMO clinical practice guidelines for diagnosis, treatment and follow-up[J]. Ann Oncol, 2018, 29(Suppl 4):iv263. DOI:10.1093/annonc/mdy161. [2] Doescher J, Veit JA, Hoffmann TK. AJCC Cancer Staging Manual[M]. 8th ed. HNO, 2017:1-5. [3] Nougaret S, Reinhold C, Mikhael HW, et al. The use of MRI imaging in treatment planning for patients with rectal carcinoma:have you checked the"DISTANCE"?[J]. Radiology, 2013, 268(2):330-344. DOI:10.1148/radiol.13121361. [4] Smith NJ, Barbachano Y, Norman AR, et al. Prognostic significance of magnetic resonance imaging-detected extramural vascular invasion in rectal cancer[J]. Br J Surg, 2008, 95(2):229-236. DOI:10.1002/bjs.5917. [5] Nagtegaal ID, Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer?[J]. J Clin Oncol, 2008, 26(2):303-312. DOI:10.1200/jco.2007.12.7027. [6] Roels S, Duthoy W, Haustermans K, et al. Definition and delineation of the clinical target volume for rectal cancer[J]. Int J Radiat Oncol Biol Phys, 2006, 65(4):1129-1142. DOI:10.1016/j.ijrobp.2006.02.050. [7] Boyle KM, Sagar PM, Chalmers AG, et al. Surgery for locally recurrent rectal cancer[J]. Dis Colon Rectum, 2005, 48(5):929-937. DOI:10.1007/s10350-004-0909-0. [8] Kreis ME, Ruppert R, Ptok H, et al. Use of preoperative magnetic resonance imaging to select patients with rectal cancer for neoadjuvant chemoradiation—interim analysis of the German OCUM trial (NCT01325649)[J]. J Gastrointest Surg, 2016, 20(1):25-32;discussion 32-33. DOI:10.1007/s11605-015-3011-0. [9] Valentini V, van Stiphout RG, Lammering G, et al. Nomograms for predicting local recurrence, distant metastases, and overall survival for patients with locally advanced rectal cancer on the basis of European randomized clinical trials[J]. J Clin Oncol, 2011, 29(23):3163-3172. DOI:10.1200/jco.2010.33.1595. [10] de Jong EA, ten Berge JC, Dwarkasing RS, et al. The accuracy of MRI, endorectal ultrasonography, and computed tomography in predicting the response of locally advanced rectal cancer after preoperative therapy:a metaanalysis[J]. Surgery, 2016, 159(3):688-699. DOI:10.1016/j.surg.2015.10.019. [11] Kim H, Myoung S, Koom WS, et al. MRI risk stratification for tumor relapse in rectal cancer achieving pathological complete remission after neoadjuvant chemoradiation therapy and curative resection[J]. PLoS One, 2016, 11(1):e0146235. DOI:10.1371/journal.pone.0146235. [12] Koh DM, Smith NJ, Swift RI, et al. The relationship between MRI demonstration of extramural venous invasion and nodal disease in rectal cancer[J]. Clin Med Oncol, 2008, 2:267-273. DOI:10.4137/cmo.s370. [13] Siddiqui MRS, Simillis C, Hunter C, et al. A meta-analysis comparing the risk of metastases in patients with rectal cancer and MRI-detected extramural vascular invasion (mrEMVI) vs. mrEMVI-negative cases[J]. Br J Cancer, 2017, 116(12):1513-1519. DOI:10.1038/bjc.2017.99. [14] Bugg WG, Andreou AK, Biswas D, et al. The prognostic significance of MRI-detected extramural venous invasion in rectal carcinoma[J]. Clin Radiol, 2014, 69(6):619-23. DOI:10.1016/j.crad.2014.01.010. [15] Chand M, Evans J, Swift RI, et al. The prognostic significance of postchemoradiotherapy high-resolution MRI and histopathology detected extramural venous invasion in rectal cancer[J]. Annals of Surgery, 2015, 261(3):473-479. DOI:10.1097/sla.0000000000000848. [16] Patel UB, Brown G, Machado I, et al. MRI assessment and outcomes in patients receiving neoadjuvant chemotherapy only for primary rectal cancer:long-term results from the GEMCAD 0801 trial[J]. Ann Oncol, 2017, 28(2):344-353. DOI:10.1093/annonc/mdw616. [17] Kim SH, Lee JM, Park HS, et al. Accuracy of MRI for predicting the circumferential resection margin, mesorectal fascia invasion, and tumor response to neoadjuvant chemoradiotherapy for locally advanced rectal cancer[J]. J Magn Reson Imaging, 2009, 29(5):1093-1101. DOI:10.1002/jMRI.21742. [18] Taylor FG, Quirke P, Heald RJ, et al. Preoperative magnetic resonance imaging assessment of circumferential resection margin predicts disease-free survival and local recurrence:5-year follow-up results of the MERCURY study[J]. J Clin Oncol, 2014, 32(1):34-43. DOI:10.1200/jco.2012.45.3258. [19] de Campos-Lobato LF, Stocchi L, da Luz Moreira A, et al. Downstaging without complete pathologic response after neoadjuvant treatment improves cancer outcomes for cⅢ but not cⅡ rectal cancers[J]. Ann Surg Oncol, 2010, 17(7):1758-1766. DOI:10.1245/s10434-010-0924-4. [20] 李宁,金晶,余静,等. 术前同步放化疗后yp0-Ⅰ期直肠癌预后分析[J]. 中华放射肿瘤学杂志, 2017, 26(3):296-301. DOI:10.3760/cma.j.issn.1004?4221.2017.03.010. Li Ning, Jin Jing, Yu Jing, et al. Prognostic factors in patients with stage yp0-I rectal cancer after preoperative concurrent chemoradiotherapy[J]. Chin J Radiat Oncol, 2017, 26(3):296-301. DOI:10.3760/cma.j.issn.1004-4221.2017.03.010. [21] Lai CL, Lai MJ, Wu CC, et al. Rectal cancer with complete clinical response after neoadjuvant chemoradiotherapy, surgery, or"watch and wait"[J]. Int J Colorectal Dis, 2016, 31(2):413-419. DOI:10.1007/s00384-015-2460-y. [22] Li J, Liu H, Yin J, et al. Wait-and-see or radical surgery for rectal cancer patients with a clinical complete response after neoadjuvant chemoradiotherapy:a cohort study[J]. Oncotarget, 2015, 6(39):42354-42361. DOI:10.18632/oncotarget.6093. [23] Smith JJ, Chow OS, Gollub MJ, et al. Organ preservation in rectal adenocarcinoma:a phase Ⅱ randomized controlled trial evaluating 3-year disease-free survival in patients with locally advanced rectal cancer treated with chemoradiation plus induction or consolidation chemotherapy, and total mesorectal excision or nonoperative management[J]. BMC Cancer, 2015, 15:767. DOI:10.1186/s12885-015-1632-z.
2020, Vol. 29 
