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Saqib HWU, Abdullah A, Majid A. "Unveiling controversies: The role of HIPEC in colorectal cancer peritoneal metastasis". EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108345. [PMID: 38644060 DOI: 10.1016/j.ejso.2024.108345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/12/2024] [Indexed: 04/23/2024]
Affiliation(s)
- Hasnain Wajeeh Us Saqib
- Islamic International Medical College, Riphah International University, Rawalpindi, Pakistan.
| | - Ali Abdullah
- Islamic International Medical College, Riphah International University, Rawalpindi, Pakistan.
| | - Abdul Majid
- Islamic International Medical College, Riphah International University, Rawalpindi, Pakistan.
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Geffen EGMV, Nederend J, Sluckin TC, Hazen SMJA, Horsthuis K, Beets-Tan RGH, Marijnen CAM, Tanis PJ, Kusters M. Prognostic significance of MRI-detected extramural venous invasion according to grade and response to neo-adjuvant treatment in locally advanced rectal cancer A national cohort study after radiologic training and reassessment. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108307. [PMID: 38581757 DOI: 10.1016/j.ejso.2024.108307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/20/2024] [Accepted: 03/23/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Detection of grade 3-4 extra mural venous invasion (mrEMVI) on magnetic resonance imaging (MRI) is associated with an increased distant metastases (DM)-rate. This study aimed to determine the impact of different grades of mrEMVI and their disappearance after neoadjuvant therapy. METHODS A Dutch national retrospective cross-sectional study was conducted, including patients who underwent resection for rectal cancer in 2016 from 60/69 hospitals performing rectal surgery. Patients with a cT3-4 tumour ≤8 cm from the anorectal junction were selected and their MRI-scans were reassessed by trained abdominal radiologists. Positive mrEMVI grades (3 and 4) were analyzed in regard to 4-year local recurrence (LR), DM, disease-free survival (DFS) and overall survival (OS). RESULTS The 1213 included patients had a median follow-up of 48 months (IQR 30-54). Positive mrEMVI was present in 324 patients (27%); 161 had grade 3 and 163 had grade 4. A higher mrEMVI stage (grade 4 vs grade 3 vs no mrEMVI) increased LR-risk (21% vs 18% vs 7%, <0.001) and DM-risk (49% vs 30% vs 21%, p < 0.001) and decreased DFS (42% vs 55% vs 69%, p < 0.001) and OS (62% vs 76% vs 81%, p < 0.001), which remained independently associated in multivariable analysis. When mrEMVI had disappeared on restaging MRI, DM-rate was comparable to initial absence of mrEMVI (both 26%), whereas LR-rate remained high (22% vs 9%, p = 0.006). CONCLUSION The negative oncological impact of mrEMVI on recurrence and survival rates was dependent on grading. Disappearance of mrEMVI on restaging MRI decreased the risk of DM, but not of LR.
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Affiliation(s)
- Eline G M van Geffen
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, De Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Treatment and Quality of Life and Imaging and Biomarkers, Amsterdam, the Netherlands
| | - Joost Nederend
- Catharina Hospital, Department of Radiology, Michelangelolaan 2, Eindhoven, the Netherlands
| | - Tania C Sluckin
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, De Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Treatment and Quality of Life and Imaging and Biomarkers, Amsterdam, the Netherlands
| | - Sanne-Marije J A Hazen
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, De Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Treatment and Quality of Life and Imaging and Biomarkers, Amsterdam, the Netherlands
| | - Karin Horsthuis
- Cancer Center Amsterdam, Treatment and Quality of Life and Imaging and Biomarkers, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Regina G H Beets-Tan
- The Netherlands Cancer Institute, Department of Radiology, Plesmanlaan 121, Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology, University of Maastricht, Universiteitssingel 40, Maastricht, the Netherlands; Department of Radiology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Campusvej 55, DK-5230, Odense, Denmark
| | - Corrie A M Marijnen
- LUMC, Department of Radiation Oncology, Albinusdreef 2, Leiden, the Netherlands; The Netherlands Cancer Institute, Department of Radiation Oncology, Plesmanlaan 121, Amsterdam, the Netherlands
| | - Pieter J Tanis
- Cancer Center Amsterdam, Treatment and Quality of Life and Imaging and Biomarkers, Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Surgery, Meibergdreef 9, Amsterdam, the Netherlands; Erasmus MC, Department of Surgical Oncology and Gastrointestinal Surgery, Rotterdam, the Netherlands
| | - Miranda Kusters
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, De Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Treatment and Quality of Life and Imaging and Biomarkers, Amsterdam, the Netherlands.
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Roef MJ, van den Berg K, Rutten HJT, Burger J, Nederend J. The Additional Role of F18-FDG PET/CT in Characterizing MRI-Diagnosed Tumor Deposits in Locally Advanced Rectal Cancer. Tomography 2024; 10:632-642. [PMID: 38668405 PMCID: PMC11054900 DOI: 10.3390/tomography10040048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/12/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024] Open
Abstract
Rationale: F18-FDG PET/CT may be helpful in baseline staging of patients with high-risk LARC presenting with vascular tumor deposits (TDs), in addition to standard pelvic MRI and CT staging. Methods: All patients with locally advanced rectal cancer that had TDs on their baseline MRI of the pelvis and had a baseline F18-FDG PET/CT between May 2016 and December 2020 were included in this retrospective study. TDs as well as lymph nodes identified on pelvic MRI were correlated to the corresponding nodular structures on a standard F18-FDG PET/CT, including measurements of nodular SUVmax and SUVmean. In addition, the effects of partial volume and spill-in on SUV measurements were studied. Results: A total number of 62 patients were included, in which 198 TDs were identified as well as 106 lymph nodes (both normal and metastatic). After ruling out partial volume effects and spill-in, 23 nodular structures remained that allowed for reliable measurement of SUVmax: 19 TDs and 4 LNs. The median SUVmax between TDs and LNs was not significantly different (p = 0.096): 4.6 (range 0.8 to 11.3) versus 2.8 (range 1.9 to 3.9). For the median SUVmean, there was a trend towards a significant difference (p = 0.08): 3.9 (range 0.7 to 7.8) versus 2.3 (range 1.5 to 3.4). Most nodular structures showing either an SUVmax or SUVmean ≥ 4 were characterized as TDs on MRI, while only two were characterized as LNs. Conclusions: SUV measurements may help in separating TDs from lymph node metastases or normal lymph nodes in patients with high-risk LARC.
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Affiliation(s)
- Mark J. Roef
- Department of Radiology and Nuclear Medicine, Catharina Hospital Eindhoven, 5623 EJ Eindhoven, The Netherlands;
| | - Kim van den Berg
- Catharina Cancer Institute, Catharina Hospital Eindhoven, 5623 EJ Eindhoven, The Netherlands;
| | - Harm J. T. Rutten
- Department of Surgery, Catharina Hospital Eindhoven, 5623 EJ Eindhoven, The Netherlands; (H.J.T.R.); (J.B.)
| | - Jacobus Burger
- Department of Surgery, Catharina Hospital Eindhoven, 5623 EJ Eindhoven, The Netherlands; (H.J.T.R.); (J.B.)
| | - Joost Nederend
- Department of Radiology and Nuclear Medicine, Catharina Hospital Eindhoven, 5623 EJ Eindhoven, The Netherlands;
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van den Berg K, Wang S, Willems JMWE, Creemers GJ, Roodhart JML, Shkurti J, Burger JWA, Rutten HJT, Beets-Tan RGH, Nederend J. The diagnostic accuracy of local staging in colon cancer based on computed tomography (CT): evaluating the role of extramural venous invasion and tumour deposits. Abdom Radiol (NY) 2024; 49:365-374. [PMID: 38019283 DOI: 10.1007/s00261-023-04094-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/04/2023] [Accepted: 10/09/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE The shift from adjuvant to neoadjuvant treatment in colon cancer demands the radiological selection of patients for systemic therapy. The aim of this study was to evaluate the accuracy of the CT-based TNM stage and high-risk features, including extramural venous invasion (EMVI) and tumour deposits, in the identification of patients with histopathological advanced disease, currently considered for neoadjuvant treatment (T3-4 disease). METHODS All consecutive patients surgically treated for non-metastatic colon cancer between January 2018 and January 2020 in a referral centre for colorectal cancer were identified retrospectively. All tumours were staged on CT according to the TNM classification system. Additionally, the presence of EMVI and tumour deposits on CT was evaluated. The histopathological TNM classification was used as reference standard. RESULTS A total of 176 patients were included. Histopathological T3-4 colon cancer was present in 85.0% of the patients with CT-detected T3-4 disease. Histopathological T3-4 colon cancer was present in 96.4% of the patients with CT-detected T3-4 colon cancer in the presence of both CT-detected EMVI and CT-detected tumour deposits. Histopathological T0-2 colon cancer was present in 50.8% of the patients with CT-detected T0-2 disease, and in 32.4% of the patients without CT-detected EMVI and tumour deposits. CONCLUSION The diagnostic accuracy of CT-based staging was comparable with previous studies. The presence of high-risk features on CT increased the probability of histopathological T3-4 colon cancer. However, a substantial part of the patients without CT-detected EMVI and tumour deposits was diagnosed with histopathological T3-4 disease. Hence, more accurate selection criteria are required to correctly identify patients with locally advanced disease.
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Affiliation(s)
- K van den Berg
- Department of Medical Oncology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
| | - S Wang
- Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands
| | - J M W E Willems
- Department of Medical Oncology, Anna Hospital, Geldrop, The Netherlands
| | - G J Creemers
- Department of Medical Oncology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - J M L Roodhart
- Department of Medical Oncology, University Medical Centre, Utrecht, The Netherlands
| | - J Shkurti
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J W A Burger
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - H J T Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - R G H Beets-Tan
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J Nederend
- Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands
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Di Fabio F, Allievi N, Lord A, Bhagwanani A, Venkatasubramaniam A, Arnold S, Moran B. MRI-predicted extramural vascular invasion and tumour deposit are main predictors of disease-free survival in patients undergoing surgical resection for rectal cancer. BJS Open 2024; 8:zrad139. [PMID: 38170894 PMCID: PMC10763995 DOI: 10.1093/bjsopen/zrad139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/27/2023] [Accepted: 10/23/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND MRI is crucial in staging patients with rectal cancer and planning treatment. The aim was to analyse the prognostic role of MRI-predicted tumour deposits and/or extramural vascular invasion (mrTD/EMVI) in a cohort of patients with rectal cancer undergoing surgical resection, with selective neoadjuvant chemoradiotherapy (nCRT). METHOD Retrospective analysis of a single-centre cohort of consecutive patients with rectal cancer undergoing low anterior resection or abdominoperineal excision between 2008 and 2020. Unit policy was selective nCRT for MRI-predicted threatened or involved circumferential resection margin (mrCRM), or radiologically involved pelvic sidewall nodes. The primary outcome was disease-free survival. Secondary outcomes were rates of local recurrence, distant recurrence and overall survival. RESULTS A total of 314 patients were analysed. Median age was 65 years (female/male: 114/200). A total of 54/314 (17%) had nCRT and 35 patients (11%) underwent abdominoperineal excision. Median follow-up was 64 months. Overall, local recurrence was detected in 18/314 (5.7%) and distant recurrence in 45/314 (14.3%). In patients not receiving nCRT (n = 260), local recurrence was detected in 11/260 (4.2%) and distant recurrence in 35/260 (13.5%). Disease-free survival was 80.5% at 5 years. Specifically, disease-free survival was 89% in mrTD/EMVI-negative and mrCRM-negative, 67% in mrTD/EMVI-positive and mrCRM-negative, and 64% in the mrCRM-positive rectal cancer (log-rank, P < 0.001). On multivariable Cox-regression analysis mrTD/EMVI was the only MRI variable associated with disease-free survival (hazard ratio 2.95; P < 0.001). CONCLUSION mrTD/EMVI is a major prognostic indicator. Rectal cancer patients with mrCRM-negative and mrTD/EMVI-negative have excellent long-term outcomes with surgery alone. Patients with mrTD/EMVI-positive should be selectively stratified for neoadjuvant treatments in future clinical trials.
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Affiliation(s)
- Francesco Di Fabio
- Rectal Cancer Unit, Colorectal Surgery, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Niccolo Allievi
- Rectal Cancer Unit, Colorectal Surgery, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Amy Lord
- Rectal Cancer Unit, Colorectal Surgery, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Anisha Bhagwanani
- Radiology, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Arcot Venkatasubramaniam
- Rectal Cancer Unit, Colorectal Surgery, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Steve Arnold
- Rectal Cancer Unit, Colorectal Surgery, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Brendan Moran
- Rectal Cancer Unit, Colorectal Surgery, Basingstoke and North Hampshire Hospital, Basingstoke, UK
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Jin Y, Yin H, Zhang H, Wang Y, Liu S, Yang L, Song B. Predicting tumor deposits in rectal cancer: a combined deep learning model using T2-MR imaging and clinical features. Insights Imaging 2023; 14:221. [PMID: 38117396 PMCID: PMC10733230 DOI: 10.1186/s13244-023-01564-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/05/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Tumor deposits (TDs) are associated with poor prognosis in rectal cancer (RC). This study aims to develop and validate a deep learning (DL) model incorporating T2-MR image and clinical factors for the preoperative prediction of TDs in RC patients. METHODS AND METHODS A total of 327 RC patients with pathologically confirmed TDs status from January 2016 to December 2019 were retrospectively recruited, and the T2-MR images and clinical variables were collected. Patients were randomly split into a development dataset (n = 246) and an independent testing dataset (n = 81). A single-channel DL model, a multi-channel DL model, a hybrid DL model, and a clinical model were constructed. The performance of these predictive models was assessed by using receiver operating characteristics (ROC) analysis and decision curve analysis (DCA). RESULTS The areas under the curves (AUCs) of the clinical, single-DL, multi-DL, and hybrid-DL models were 0.734 (95% CI, 0.674-0.788), 0.710 (95% CI, 0.649-0.766), 0.767 (95% CI, 0.710-0.819), and 0.857 (95% CI, 0.807-0.898) in the development dataset. The AUC of the hybrid-DL model was significantly higher than the single-DL and multi-DL models (both p < 0.001) in the development dataset, and the single-DL model (p = 0.028) in the testing dataset. Decision curve analysis demonstrated the hybrid-DL model had higher net benefit than other models across the majority range of threshold probabilities. CONCLUSIONS The proposed hybrid-DL model achieved good predictive efficacy and could be used to predict tumor deposits in rectal cancer. CRITICAL RELEVANCE STATEMENT The proposed hybrid-DL model achieved good predictive efficacy and could be used to predict tumor deposits in rectal cancer. KEY POINTS • Preoperative non-invasive identification of TDs is of great clinical significance. • The combined hybrid-DL model achieved good predictive efficacy and could be used to predict tumor deposits in rectal cancer. • A preoperative nomogram provides gastroenterologist with an accurate and effective tool.
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Affiliation(s)
- Yumei Jin
- Department of Medical Imaging Center, Qujing First People's Hospital, Qujing, 655000, Yunnan Province, China.
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China.
| | - Hongkun Yin
- Beijing Infervision Technology Co.Ltd, Beijing, China
| | - Huiling Zhang
- Beijing Infervision Technology Co.Ltd, Beijing, China
| | - Yewu Wang
- Department of Joint and Sports Medicine, Qujing First People's Hospital, Qujing, 655000, Yunnan Province, China
| | - Shengmei Liu
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Ling Yang
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Bin Song
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China.
- Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China.
- Department of Radiology, Sanya People's Hospital, Sanya, Hainan Province, 572000, China.
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Chen M, Ma Y, Song Y, Huang J, Gao Y, Zheng J, He F. Survival outcomes of different neoadjuvant treatment regimens in patients with locally advanced rectal cancer and MRI-detected extramural venous invasion. Cancer Med 2023; 12:20523-20537. [PMID: 37864414 PMCID: PMC10660615 DOI: 10.1002/cam4.6625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/13/2023] [Accepted: 09/25/2023] [Indexed: 10/22/2023] Open
Abstract
PURPOSE MRI-detected extramural venous invasion (mrEMVI) is associated with poor survival outcomes in patients with locally advanced rectal cancer (LARC). An mrEMVI-positive status is considered a strong indication for neoadjuvant treatment, but the optimal regimen is unknown. PATIENTS AND METHODS We retrospectively compared pathological and survival outcomes of 584 patients diagnosed with mrEMVI-positive rectal cancer between January 2013 and October 2021, and receiving either neoadjuvant chemotherapy (NCT) alone, neoadjuvant chemoradiotherapy (nCRT) alone, or nCRT plus NCT, prior to total mesorectal excision. Propensity score matching (PSM) was used to balance clinical bias between groups, which were compared using chi-square testing and Kaplan-Meier curves. RESULTS Median follow-up was 33.9 (range, 10.2-100.4) months. The 3-year overall survival (OS), disease-free survival (DFS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRFS) rates for all patients were 90.4%, 57.5%, 61.1%, and 85.7%, respectively. Of 584 mrEMVI-positive patients at the time of diagnosis, 457 (78.3%) were EMVI-negative on surgical pathology, and they had significantly better 3-year OS, DMFS, DFS, and LRFS rates (all p < 0.001) than patients who remained EMVI-positive. After PSM was applied, patients receiving nCRT alone had significantly better 3-year OS (96.8% vs. 86.5%, p = 0.005) and DMFS (67.1% vs. 53.5%, p = 0.03) rates than those receiving NCT alone. Patients receiving NCT plus nCRT had higher pathological complete response (PCR) (10.8% vs. 2.7%, p = 0.04) and downstaging (33.8% vs. 5.3%, p < 0.001) rates than those receiving nCRT alone, but survival rates did not differ (all p > 0.05). CONCLUSION Most EMVI-positive patients with LARC converted to EMVI-negative after neoadjuvant treatment, resulting in improved OS and DFS. Patients receiving nCRT had more favorable survival outcomes than those receiving NCT, suggesting the importance of including neoadjuvant radiotherapy. Patients receiving NCT in addition to nCRT had higher rates of PCR and downstaging, but their survival rates were not better.
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Affiliation(s)
- Mo Chen
- Department of Genitourinary OncologyThe First People's Hospital of FoshanFoshanGuangdongChina
| | - Yan Ma
- Department of Radiation Oncology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor DiseasesThe Sixth Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouGuangdongChina
- Biomedical Innovation Center, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouGuangdongChina
| | - Yi‐wen Song
- Department of Radiation Oncology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor DiseasesThe Sixth Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouGuangdongChina
- Biomedical Innovation Center, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouGuangdongChina
| | - Jinhua Huang
- Department of Minimal Invasive Interventional TherapySun Yat‐sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer MedicineGuangzhouGuangdongChina
| | - Yuan‐hong Gao
- Department of Radiation OncologySun Yat‐sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer MedicineGuangzhouGuangdongChina
| | - Jian Zheng
- Department of Radiation Oncology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor DiseasesThe Sixth Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouGuangdongChina
- Biomedical Innovation Center, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouGuangdongChina
| | - Fang He
- Department of Radiation Oncology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor DiseasesThe Sixth Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouGuangdongChina
- Biomedical Innovation Center, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouGuangdongChina
- Department of Radiation OncologySun Yat‐sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer MedicineGuangzhouGuangdongChina
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Lv B, Yuan L, Li J, Kong X, Cheng Y, Shang K, Jin E. Predictive value of infiltrating tumor border configuration of rectal cancer on MRI. BMC Med Imaging 2023; 23:155. [PMID: 37828450 PMCID: PMC10571450 DOI: 10.1186/s12880-023-01118-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Infiltrating tumor border configuration (iTBC) is assessed by postoperative pathological examination, thus, is not helpful for preoperative treatment strategies. The study aimed to detect iTBC by magnetic resonance imaging (MRI) and evaluate its predictive value. MATERIALS AND METHODS A total of 153 patients with rectal cancer were retrospectively analyzed. Clinicopathological and MRI data mainly including tumor border configuration (TBC) on MRI, MRI-detected extramural vascular invasion (MEMVI), tumor length, tumor growth pattern, maximal extramural depth, pathology-proven lymph node metastasis (PLN) and pathology-proven extramural vascular invasion (PEMVI) were analyzed. The correlation of MRI factors with PEMVI and PLN was analyzed by univariate and multivariate logistic regression analyses. The nomograms were established based on multivariate logistic regression analysis and were confirmed by Bootstrap self-sampling. The receiver operating characteristic (ROC) curve analysis and area under the curve (AUC) were used to evaluate the diagnostic efficiency. RESULTS Fifty cases of PEMVI and 48 cases of PLN were found. Forty cases of PEMVI and 34 cases of PLN in 62 cases of iTBC were also found. iTBC, MEMVI and maximal extramural depth were significantly associated with PEMVI and PLN (P < 0.05). iTBC (odds ratio = 3.84 and 3.02) and MEMVI (odds ratio = 7.27 and 3.22) were independent risk factors for PEMVI and PLN. The C-indices of the two nomograms for predicting PEMVI and PLN were 0.863 and 0.752, respectively. The calibration curves and ROC curves of the two nomograms showed that the correlation between the predicted and the actual incidence of PEMVI and PLN was good. The AUCs of iTBC for predicting PEMVI and PLN were 0.793 (95% CI: 0.714-0.872) and 0.721 (95% CI: 0.632-0.810), respectively. The DeLong test showed that the predictive efficiency of the nomogram in predicting PEMVI was better than that of iTBC (P = 0.0009) and MEMVI (P = 0.0095). CONCLUSION iTBC and MEMVI are risk factors for PEMVI and pelvic lymph node metastasis. The nomograms based on iTBC show a good performance in predicting PEMVI and pelvic lymph node metastasis, possessing a certain clinical reference value. TRIAL REGISTRATION This study was approved by the Ethics Committee of Beijing Friendship Hospital, and individual consent was waived for this retrospective analysis.
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Affiliation(s)
- Baohua Lv
- Department of Radiology, Taian City Central Hospital, Qingdao University, Tai’an, 271099 China
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong-an Road, Beijing, 100050 China
| | - Leilei Yuan
- Department of Radiology, Taian City Central Hospital, Qingdao University, Tai’an, 271099 China
| | - Jizheng Li
- Department of Radiology, Taian City Central Hospital, Qingdao University, Tai’an, 271099 China
| | - Xue Kong
- Department of Radiology, Taian City Central Hospital, Qingdao University, Tai’an, 271099 China
| | - Yanling Cheng
- Respiratory department of Shandong Second Rehabilitation Hospital, Tai’an, 271000 China
| | - Kai Shang
- Department of Orthopedic, Taian City Central Hospital, Qingdao University, Tai’an, 271099 China
| | - Erhu Jin
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong-an Road, Beijing, 100050 China
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9
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Zhao M, Feng L, Zhao K, Cui Y, Li Z, Ke C, Yang X, Qiu Q, Lu W, Liang Y, Xie C, Wan X, Liu Z. An MRI-based scoring system for pretreatment risk stratification in locally advanced rectal cancer. Br J Cancer 2023; 129:1095-1104. [PMID: 37558922 PMCID: PMC10539304 DOI: 10.1038/s41416-023-02384-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Accurately assessing the risk of recurrence in patients with locally advanced rectal cancer (LARC) before treatment is important for the development of treatment strategies. The purpose of this study is to develop an MRI-based scoring system to predict the risk of recurrence in patients with LARC. METHODS This was a multicenter observational study that enrolled participants who underwent neoadjuvant chemoradiotherapy. To evaluate the risk of recurrence in these patients, we developed the mrDEC scoring system and assessed inter-reader agreement. Additionally, we plotted Kaplan-Meier curves to compare the 3-year disease-free survival (DFS) and 5-year overall survival (OS) rates among patients with different mrDEC scores. RESULTS A total of 1287 patients with LARC were included in this study. We observed substantial inter-reader agreement for mrDEC. Based on the mrDEC scores ranging from 0 to 3, the patients were categorized into four groups. The 3-year DFS rates for the groups were 91.0%, 79.5%, 65.5%, and 44.0% (P < 0.0001), respectively, and the 5-year OS rates were 92.9%, 87.1%, 74.8%, and 44.5%, respectively (P < 0.0001). CONCLUSIONS The mrDEC scoring system proved to be an effective tool for predicting the prognosis of patients with LARC and can assist clinicians in clinical decision-making.
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Affiliation(s)
- Minning Zhao
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Lili Feng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Ke Zhao
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China.
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Yanfen Cui
- Department of Radiology, Shanxi Cancer Hospital, Shanxi Medical University, Taiyuan, China
| | - Zhenhui Li
- Department of Radiology, the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Chenglu Ke
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Xinyue Yang
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Qing Qiu
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Weirong Lu
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanting Liang
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - ChuanMiao Xie
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
- Department of Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, China.
| | - Xiangbo Wan
- Provincial Key Laboratory of Radiation Medicine in Henan (Under construction), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
- Department of Radiation Oncology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
- Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Zaiyi Liu
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China.
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10
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Kim TH, Firat C, Thompson HM, Gangai N, Zheng J, Capanu M, Bates DDB, Paroder V, García-Aguilar J, Shia J, Gollub MJ, Horvat N. Extramural Venous Invasion and Tumor Deposit at Diffusion-weighted MRI in Patients after Neoadjuvant Treatment for Rectal Cancer. Radiology 2023; 308:e230079. [PMID: 37581503 PMCID: PMC10478788 DOI: 10.1148/radiol.230079] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/10/2023] [Accepted: 06/14/2023] [Indexed: 08/16/2023]
Abstract
Background Diffusion-weighted (DW) imaging is useful in detecting tumor in the primary tumor bed in locally advanced rectal cancer (LARC) after neoadjuvant therapy, but its value in detecting extramural venous invasion (EMVI) and tumor deposit is not well validated. Purpose To evaluate diagnostic accuracy and association with patient prognosis of viable EMVI and tumor deposit on DW images in patients with LARC after neoadjuvant therapy using whole-mount pathology specimens. Materials and Methods This retrospective study included patients who underwent neoadjuvant therapy and surgery from 2018 to 2021. Innovative five-point Likert scale was used by two radiologists to independently evaluate the likelihood of viable EMVI and tumor deposit on restaging DW MRI scans in four axial quadrants (12 to 3 o'clock, 3 to 6 o'clock, 6 to 9 o'clock, and 9 to 12 o'clock). Diagnostic accuracy was assessed at both the per-quadrant and per-patient level, with whole-mount pathology as the reference standard. Weighted κ values for interreader agreement and Cox regression models for disease-free survival and overall survival analyses were used. Results A total of 117 patients (mean age, 56 years ± 12 [SD]; 70 male, 47 female) were included. Pathologically proven viable EMVI and tumor deposit was detected in 29 of 117 patients (25%) and in 44 of 468 quadrants (9.4%). Per-quadrant analyses showed an area under the receiver operating characteristics curve of 0.75 (95% CI: 0.68, 0.83), with sensitivity and specificity of 55% and 96%, respectively. Good interreader agreement was observed between the radiologists (κ = 0.62). Per-patient analysis showed sensitivity and specificity of 62% and 93%, respectively. The presence of EMVI and tumor deposit on restaging DW MRI scans was associated with worse disease-free survival (hazard ratio [HR], 5.6; 95% CI: 2.4, 13.3) and overall survival (HR, 8.9; 95% CI: 1.6, 48.5). Conclusion DW imaging using the five-point Likert scale showed high specificity and moderate sensitivity in the detection of viable extramural venous invasion and tumor deposits in LARC after neoadjuvant therapy, and its presence on restaging DW MRI scans is associated with worse prognosis. Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Méndez and Ayuso in this issue.
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Affiliation(s)
| | | | - Hannah M. Thompson
- From the Departments of Radiology (T.H.K., N.G., D.D.B.B., V.P.,
M.J.G., N.H.), Pathology (C.F., J.S.), Surgery (H.M.T., J.G.A.), and
Epidemiology and Biostatistics (J.Z., M.C.), Memorial Sloan-Kettering Cancer
Center, 1275 York Ave, Box 29, New York, NY 10065
| | - Natalie Gangai
- From the Departments of Radiology (T.H.K., N.G., D.D.B.B., V.P.,
M.J.G., N.H.), Pathology (C.F., J.S.), Surgery (H.M.T., J.G.A.), and
Epidemiology and Biostatistics (J.Z., M.C.), Memorial Sloan-Kettering Cancer
Center, 1275 York Ave, Box 29, New York, NY 10065
| | - Junting Zheng
- From the Departments of Radiology (T.H.K., N.G., D.D.B.B., V.P.,
M.J.G., N.H.), Pathology (C.F., J.S.), Surgery (H.M.T., J.G.A.), and
Epidemiology and Biostatistics (J.Z., M.C.), Memorial Sloan-Kettering Cancer
Center, 1275 York Ave, Box 29, New York, NY 10065
| | - Marinela Capanu
- From the Departments of Radiology (T.H.K., N.G., D.D.B.B., V.P.,
M.J.G., N.H.), Pathology (C.F., J.S.), Surgery (H.M.T., J.G.A.), and
Epidemiology and Biostatistics (J.Z., M.C.), Memorial Sloan-Kettering Cancer
Center, 1275 York Ave, Box 29, New York, NY 10065
| | - David D. B. Bates
- From the Departments of Radiology (T.H.K., N.G., D.D.B.B., V.P.,
M.J.G., N.H.), Pathology (C.F., J.S.), Surgery (H.M.T., J.G.A.), and
Epidemiology and Biostatistics (J.Z., M.C.), Memorial Sloan-Kettering Cancer
Center, 1275 York Ave, Box 29, New York, NY 10065
| | - Viktoriya Paroder
- From the Departments of Radiology (T.H.K., N.G., D.D.B.B., V.P.,
M.J.G., N.H.), Pathology (C.F., J.S.), Surgery (H.M.T., J.G.A.), and
Epidemiology and Biostatistics (J.Z., M.C.), Memorial Sloan-Kettering Cancer
Center, 1275 York Ave, Box 29, New York, NY 10065
| | - Julio García-Aguilar
- From the Departments of Radiology (T.H.K., N.G., D.D.B.B., V.P.,
M.J.G., N.H.), Pathology (C.F., J.S.), Surgery (H.M.T., J.G.A.), and
Epidemiology and Biostatistics (J.Z., M.C.), Memorial Sloan-Kettering Cancer
Center, 1275 York Ave, Box 29, New York, NY 10065
| | - Jinru Shia
- From the Departments of Radiology (T.H.K., N.G., D.D.B.B., V.P.,
M.J.G., N.H.), Pathology (C.F., J.S.), Surgery (H.M.T., J.G.A.), and
Epidemiology and Biostatistics (J.Z., M.C.), Memorial Sloan-Kettering Cancer
Center, 1275 York Ave, Box 29, New York, NY 10065
| | - Marc J. Gollub
- From the Departments of Radiology (T.H.K., N.G., D.D.B.B., V.P.,
M.J.G., N.H.), Pathology (C.F., J.S.), Surgery (H.M.T., J.G.A.), and
Epidemiology and Biostatistics (J.Z., M.C.), Memorial Sloan-Kettering Cancer
Center, 1275 York Ave, Box 29, New York, NY 10065
| | - Natally Horvat
- From the Departments of Radiology (T.H.K., N.G., D.D.B.B., V.P.,
M.J.G., N.H.), Pathology (C.F., J.S.), Surgery (H.M.T., J.G.A.), and
Epidemiology and Biostatistics (J.Z., M.C.), Memorial Sloan-Kettering Cancer
Center, 1275 York Ave, Box 29, New York, NY 10065
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11
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Lin Z, Plukker JTM, Tian DP, Chen SB, Kats-Ugurlu G, Su M. Identification and Prognostic Effect of Extramural Venous Invasion in Locally Advanced Esophageal Squamous Cell Carcinoma. Am J Surg Pathol 2023; 47:766-773. [PMID: 37199448 DOI: 10.1097/pas.0000000000002048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The role of extramural venous invasion (EMVI) in esophageal cancer is still unclear. This study aimed to identify EMVI and assess its impact on survival and recurrences in esophageal squamous cell carcinoma (ESCC). Retrospectively, we reviewed resection specimens of 147 locally advanced ESCC (pT3-T4aN0-3M0) patients who had a curative intended surgery alone at the Cancer Hospital of Shantou University from March 2009 to December 2013. After confirming pT≥3 in hematoxylin-eosin tumor slides, EMVI was evaluated by Verhoeff and Caldesmon staining. The impact of EMVI with other clinicopathological characteristics and survival were analyzed using the χ 2 test, Cox regression, and Kaplan-Meier method. EMVI was present in 30.6% (45/147) of the P ≥T3 ESCCs and associated with lymph-vascular invasion and poor differentiation grade ( P <0.05). Disease-free survival and overall survival in patients with EMVI-absent tumors were about 2.0 times longer than in those with EMVI-present tumors. In pN0 patients, EMVI-presence was associated with poor overall survival (HR 4.829, 95% CI 1.434-16.26, P =0.003) and Disease-free Survival (HR 4.026, 95% CI 0.685-23.32, P =0.018). In pN1-3 patients, EMVI had no additional effect on survival. Conclusions EMVI has an independent adverse prognostic effect on survival in ESCC patients after surgery alone. EMVI should be included in pathology reports as it might contribute to identify high-risk patients for potential additional treatment.
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Affiliation(s)
- Zhen Lin
- Institute of Clinical Pathology, Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College
- Department of Pathology
| | - John T M Plukker
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Dong-Ping Tian
- Institute of Clinical Pathology, Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College
| | - Shao-Bin Chen
- Department of Thoracic Surgery, Cancer Hospital of Shantou University Medical College, Shantou, China
| | | | - Min Su
- Institute of Clinical Pathology, Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College
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12
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Tian L, Li N, Xie D, Li Q, Zhou C, Zhang S, Liu L, Huang C, Liu L, Lai S, Wang Z. Extramural vascular invasion nomogram before radical resection of rectal cancer based on magnetic resonance imaging. Front Oncol 2023; 12:1006377. [PMID: 36968215 PMCID: PMC10034136 DOI: 10.3389/fonc.2022.1006377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/28/2022] [Indexed: 03/11/2023] Open
Abstract
PurposeThis study verified the value of magnetic resonance imaging (MRI) to construct a nomogram to preoperatively predict extramural vascular invasion (EMVI) in rectal cancer using MRI characteristics.Materials and methodsThere were 55 rectal cancer patients with EMVI and 49 without EMVI in the internal training group. The external validation group consisted of 54 rectal cancer patients with EMVI and 55 without EMVI. High-resolution rectal T2WI, pelvic diffusion-weighted imaging (DWI) sequences, and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) were used. We collected the following data: distance between the lower tumor margin and the anal margin, distance between the lower tumor margin and the anorectal ring, tumor proportion of intestinal wall, mrT stage, maximum tumor diameter, circumferential resection margin, superior rectal vein width, apparent diffusion coefficient (ADC), T2WI EMVI score, DWI and DCE-MRI EMVI scores, demographic information, and preoperative serum tumor marker data. Logistic regression analyses were used to identify independent risk factors of EMVI. A nomogram prediction model was constructed. Receiver operating characteristic curve analysis verified the predictive ability of the nomogram. P < 0.05 was considered significant.ResultTumor proportion of intestinal wall, superior rectal vein width, T2WI EMVI score, and carbohydrate antigen 19-9 were significant independent predictors of EMVI in rectal cancer and were used to create the model. The areas under the receiver operating characteristic curve, sensitivities, and specificities of the nomogram were 0.746, 65.45%, and 83.67% for the internal training group, respectively, and 0.780, 77.1%, and 71.3% for the external validation group, respectively.Data conclusionA nomogram including MRI characteristics can predict EMVI in rectal cancer preoperatively and provides a valuable reference to formulate individualized treatment plans and predict prognosis.
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Affiliation(s)
- Lianfen Tian
- Department of Radiology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Ningqin Li
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Dong Xie
- Department of Radiology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Qiang Li
- Department of Radiology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Chuanji Zhou
- Department of Radiology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Shilai Zhang
- Department of Radiology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Lijuan Liu
- Department of Radiology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Caiyun Huang
- Department of Radiology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Lu Liu
- Department of Radiology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Shaolu Lai
- Department of Radiology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
- *Correspondence: Zheng Wang, ; Shaolu Lai,
| | - Zheng Wang
- Department of Radiology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
- *Correspondence: Zheng Wang, ; Shaolu Lai,
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13
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Chiloiro G, Romano A, Mariani S, Macchia G, Giannarelli D, Caravatta L, Franco P, Boldrini L, Arcelli A, Bacigalupo A, Belgioia L, Fontana A, Meldolesi E, Montesi G, Niespolo RM, Palazzari E, Piva C, Valentini V, Gambacorta MA. Predictive and prognostic value of inflammatory markers in locally advanced rectal cancer (PILLAR) - A multicentric analysis by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) Gastrointestinal Study Group. Clin Transl Radiat Oncol 2023; 39:100579. [PMID: 36935859 PMCID: PMC10014327 DOI: 10.1016/j.ctro.2023.100579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
Background Patients (pts) affected with locally advanced rectal cancer (LARC) may respond differently to neoadjuvant chemoradiotherapy (nCRT). The identification of reliable biomarkers able to predict oncological outcomes could help in the development of risk-adapted treatment strategies. It has been suggested that inflammation parameters may have a role in predicting tumor response to nCRT and survival outcomes and in rectal cancer, but no definitive conclusion can be drawn at present. The aim of the current study is to evaluate the role of baseline inflammatory markers as prognostic and predictive factors in a large multicentric Italian cohort of LARC pts. Methods Patients diagnosed with LARC from January 2002 to December 2019 in 9 Italian centers were retrospectively collected. Patients underwent long-course RT with chemotherapy based on fluoropyrimidine ± oxaliplatin followed by surgery. Inflammatory markers were retrieved based on a pre-treatment blood sample including HEI (hemo-eosinophils inflammation index), SII (systemic index of inflammation), NLR (neutrophil-to-lymphocyte ratio), PLR (platelet-to-lymphocyte ratio) and MLR (monocyte-to-lymphocyte ratio). Outcomes of interest were pathological complete response (pCR), disease-free survival (DFS), and overall survival (OS). Results 808 pts were analyzed. pCR rate was 22 %, 5yOS and 5yDFS were 84.0% and 63.1% respectively. Multivariate analysis identified that a NLR cut-off value >1.2 and SII cut-off value >500 could predict pCR (p = 0.05 and 0.009 respectively). In addition to age, extramesorectal nodes and RT dose, MLR >0.18 (p = 0.03) and HEI = 3 (p = 0.05) were independent prognostic factors for DFS. Finally, age, RT dose, MLR with a cut-off >0.35 (p = 0.028) and HEI = 3 (p = 0.045) were independent predictors of OS. Conclusions Higher values of baseline composite inflammatory markers can serve as predictors of lower pCR rates and worse survival outcomes in LARC patients undergoing nCRT. More reliable data from prospective studies could lead to the integration of these inexpensive and easy-to-derive tools into clinical practice.
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Affiliation(s)
- Giuditta Chiloiro
- Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Angela Romano
- Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Silvia Mariani
- Catholic University of Sacred Heart, Rome, Italy
- Corresponding author.
| | - Gabriella Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Diana Giannarelli
- Facility of Epidemiology and Biostatistics, G-STEP Generator, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Luciana Caravatta
- Radiation Oncology Unit, “SS Annunziata” Hospital, “G. d'Annunzio” University, Chieti, Italy
| | - Pierfrancesco Franco
- Division of Radiation Oncology, Department of Translational Medicine, University of Eastern Piedmont, and University Hospital “Maggiore della Carità”, Novara, Italy
| | - Luca Boldrini
- Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Alessandra Arcelli
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine – DIMES, University of Bologna S. Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Liliana Belgioia
- Department of Health Science (DISSAL), University of Genoa, Genoa, Italy
| | - Antonella Fontana
- Radiation Oncology Division, Santa Maria Goretti Hospital, Latina, Italy
| | - Elisa Meldolesi
- Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Giampaolo Montesi
- Radiation Oncology Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | | | - Elisa Palazzari
- Radiation Oncology Department, Oncological Referral Center, Aviano, Italy
| | - Cristina Piva
- Department of Radiation Oncology, A.S.L. TO4, Ivrea Community Hospital, Ivrea, Italy
| | - Vincenzo Valentini
- Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Maria Antonietta Gambacorta
- Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
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14
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Yang R, Zhao H, Wang X, Ding Z, Tao Y, Zhang C, Zhou Y. Magnetic resonance imaging radiomics modeling predicts tumor deposits and prognosis in stage T3 lymph node positive rectal cancer. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:1268-1279. [PMID: 36750477 DOI: 10.1007/s00261-023-03825-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 02/09/2023]
Abstract
PURPOSE To develop a magnetic resonance imaging radiomics model to predict tumor deposits (TDs) and prognosis in stage T3 lymph node positive (T3N+) rectal cancer (RC). METHODS This retrospective study included 163 patients with pathologically confirmed T3N + RC from December 2013 to December 2015. The patients were divided into two groups for training and testing. Extracting radiomic features from MR images and selecting features using principal component analysis (PCA), then radiomic scores (rad-scores) were obtained by logistic regression analysis. Finally, a combined TDs prediction model containing rad-scores and clinical features was developed. A receiver operating characteristic (ROC) curve was used to assess the prediction performance. The overall survival (OS) rate in patients with high-risk and low-risk TDs predicted by rad-scores was validated by Kaplan-Meier survival curves. RESULTS Of the 163 patients included, histological TDs was diagnosed in 45 patients. The area under the curve (AUC) of the final model was 0.833 (training) and 0.844 (testing). The patients with rad-scores predicted high-risk were associated with OS. In addition, postoperative adjuvant therapy improved the OS of the high-risk TDs group (P < 0.05). CONCLUSION MRI-based radiomics modeling helps in the preoperative prediction of patients with TDs+ in T3N + RC and provides risk stratification for neoadjuvant therapy. In addition, the rad-scores of TDs could suggest different survival benefits of postoperative adjuvant therapy for T3N + RC patients and guide clinical treatment.
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Affiliation(s)
- Rui Yang
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin, 150081, Heilongjiang, China
| | - Hongxin Zhao
- Department of Radiology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin, 150010, Heilongjiang, China
| | - Xinxin Wang
- Department of Radiology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin, 150010, Heilongjiang, China
| | - Zhipeng Ding
- Department of Radiology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin, 150010, Heilongjiang, China
| | - Yuqing Tao
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin, 150081, Heilongjiang, China
| | - Chunhui Zhang
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin, 150081, Heilongjiang, China.
| | - Yang Zhou
- Department of Radiology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin, 150010, Heilongjiang, China.
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15
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Peparini N. Oncological outcome after lateral pelvic lymphadenectomy for low rectal carcinoma: not only an N-status matter. ANZ J Surg 2023; 93:54-58. [PMID: 36190012 DOI: 10.1111/ans.18067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/06/2022] [Accepted: 09/11/2022] [Indexed: 11/27/2022]
Abstract
Tumour deposits (TDs), novel pathological entities, should be considered when estimating the regional and systemic spread of rectal carcinoma and formulating treatment strategies. In fact, TDs may have more severe prognostic impact than lymph node positivity or the lymph node ratio. The assessment of the presence of TDs can be performed only through accurate postoperative pathological examination; however, the detection of TDs is not part of any of the procedures currently used to assess preoperative or intraoperative staging. This review aims to analyse and discuss the impact of TDs on the oncological outcome of patients who undergo surgery for advanced low rectal carcinoma. No prospective study has evaluated the impact of lateral pelvic TDs on oncological outcomes following total mesorectal excision with lateral pelvic lymphadenectomy. Although adequate total mesorectal excision allows for the excision of intramesorectal TDs, lateral pelvic lymph node dissection cannot guarantee the removal of lateral pelvic TDs; moreover, it remains to be determined whether surgical excision of lateral pelvic TDs can impact long-term outcomes. However, the identification of lateral pelvic TDs strengthens the 'staging effect' and limits the 'therapeutic effect' of lateral pelvic lymphadenectomy, supporting the rationale for the use of neoadjuvant chemoradiotherapy for rectal cancer. When evaluating the oncological outcomes after total mesorectal excision with lateral pelvic lymphadenectomy, the impact of lateral pelvic TDs should be considered.
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Affiliation(s)
- Nadia Peparini
- Distretto 3, Azienda Sanitaria Locale Roma 6, Ciampino (Rome), Italy
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16
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Distinguishing mesorectal tumor deposits from metastatic lymph nodes by using diffusion-weighted and dynamic contrast-enhanced magnetic resonance imaging in rectal cancer. Eur Radiol 2022; 33:4127-4137. [PMID: 36520180 DOI: 10.1007/s00330-022-09328-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 11/18/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES This study aimed to identify whether apparent diffusion coefficient (ADC) values and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters are helpful in distinguishing mesorectal tumor deposits (TD) from metastatic lymph nodes (MLN) in rectal cancer (RC). METHODS Thirty patients (59 lesions, including 30 TD and 29 MLN) with RC who underwent pretreatment-MRI between February 2016 and August 2018 were enrolled. The morphological features, ADC values, and semi-quantitative parameters of DCE-MRI, including relative enhancement (RE), maximum enhancement (ME), maximum relative enhancement (MRE), time to peak (TTP), wash-in rates (WIR), wash-out rates (WOR), brevity of enhancement (BRE), and area under the curve (AUC) were measured on lesions (TD or MLN) and RC. The parameters were compared between TD and MLN, tumor with and without TD group by using Fisher's exact test, independent-samples t-test, and Mann-Whitney U test. The ratio (lesion-to-tumor) of the parameters was compared between TD and MLN. Receiver operating characteristic curve analysis and binary logistic regression analysis were used to assess the diagnostic ability of single and combined metrics for distinguishing TD from MLN. RESULTS The morphological features, including size, shape, and border, were significantly different between TD and MLN. TD exhibited significantly lower RE, MRE, RE-ratio, MRE-ratio, ADCmin-ratio, and ADCmean-ratio than MLN. RE-ratio showed the highest AUC (0.749) and accuracy (77.97%) among single parameters. The combination of DCE-MRI and DWI parameters together showed higher diagnostic efficiency (AUC = 0.825). CONCLUSIONS Morphological features, ADC values, and DCE-MRI parameters can preoperatively help distinguish TD from MLN in RC. KEY POINTS • DWI and DCE-MRI can facilitate early detection and distinguishing mesorectal TD (tumor deposits) from MLN (metastatic lymph nodes) in rectal cancer preoperatively. • TD has some specific morphological features, including relatively larger size, lower short- to long-axis ratio, irregular shape, and ill-defined border on T2-weighted MR images in rectal cancer. • The combination of ADC values and semi-quantitative parameters of DCE-MRI (RE, MRE) can help to improve the diagnostic efficiency of TD in rectal cancer.
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van den Berg K, Schaap DP, Voogt ELK, Buffart TE, Verheul HMW, de Groot JWB, Verhoef C, Melenhorst J, Roodhart JML, de Wilt JHW, van Westreenen HL, Aalbers AGJ, van 't Veer M, Marijnen CAM, Vincent J, Simkens LHJ, Peters NAJB, Berbée M, Werter IM, Snaebjornsson P, Peulen HMU, van Lijnschoten IG, Roef MJ, Nieuwenhuijzen GAP, Bloemen JG, Willems JMWE, Creemers GJM, Nederend J, Rutten HJT, Burger JWA. Neoadjuvant FOLFOXIRI prior to chemoradiotherapy for high-risk ("ugly") locally advanced rectal cancer: study protocol of a single-arm, multicentre, open-label, phase II trial (MEND-IT). BMC Cancer 2022; 22:957. [PMID: 36068495 PMCID: PMC9446695 DOI: 10.1186/s12885-022-09947-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/29/2022] [Indexed: 11/14/2022] Open
Abstract
Background The presence of mesorectal fascia (MRF) invasion, grade 4 extramural venous invasion (EMVI), tumour deposits (TD) or extensive or bilateral extramesorectal (lateral) lymph nodes (LLN) on MRI has been suggested to identify patients with indisputable, extensive locally advanced rectal cancer (LARC), at high risk of treatment failure. The aim of this study is to evaluate whether or not intensified chemotherapy prior to neoadjuvant chemoradiotherapy improves the complete response (CR) rate in these patients. Methods This multicentre, single-arm, open-label, phase II trial will include 128 patients with non-metastatic high-risk LARC (hr-LARC), fit for triplet chemotherapy. To ensure a study population with indisputable, unfavourable prognostic characteristics, hr-LARC is defined as LARC with on baseline MRI at least one of the following characteristics; MRF invasion, EMVI grade 4, enlarged bilateral or extensive LLN at high risk of an incomplete resection, or TD. Exclusion criteria are the presence of a homozygous DPD deficiency, distant metastases, any chemotherapy within the past 6 months, previous radiotherapy within the pelvic area precluding standard chemoradiotherapy, and any contraindication for the planned treatment. All patients will be planned for six two-weekly cycles of FOLFOXIRI (5-fluorouracil, leucovorin, oxaliplatin and irinotecan) prior to chemoradiotherapy (25 × 2 Gy or 28 × 1.8 Gy with concomitant capecitabine). A resection will be performed following radiological confirmation of resectable disease after the completion of chemoradiotherapy. A watch and wait strategy is allowed in case of a clinical complete response. The primary endpoint is the CR rate, described as a pathological CR or a sustained clinical CR one year after chemoradiotherapy. The main secondary objectives are long-term oncological outcomes, radiological and pathological response, the number of resections with clear margins, treatment-related toxicity, perioperative complications, health-related costs, and quality of life. Discussion This trial protocol describes the MEND-IT study. The MEND-IT study aims to evaluate the CR rate after intensified chemotherapy prior to concomitant chemoradiotherapy in a homogeneous group of patients with locally advanced rectal cancer and indisputably unfavourable characteristics, defined as hr-LARC, in order to improve their prognosis. Trial registration Clinicaltrials.gov: NCT04838496, registered on 02–04-2021 Netherlands Trial Register: NL9790. Protocol version Version 3 dd 11–4-2022.
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Affiliation(s)
- K van den Berg
- Department of Medical Oncology, Catharina Hospital, Eindhoven, the Netherlands.,Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - D P Schaap
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - E L K Voogt
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - T E Buffart
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.,Department of Medical Oncology, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - H M W Verheul
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - J W B de Groot
- Department of Medical Oncology, Isala Oncology Centre, Zwolle, the Netherlands
| | - C Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - J Melenhorst
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - J M L Roodhart
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - J H W de Wilt
- Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | - A G J Aalbers
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M van 't Veer
- Department of Research and Education, Catharina Hospital, Eindhoven, the Netherlands
| | - C A M Marijnen
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.,Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - J Vincent
- Department of Medical Oncology, Elkerliek Hospital, Helmond, the Netherlands
| | - L H J Simkens
- Department of Medical Oncology, Maxima Medical Centre, Veldhoven, the Netherlands
| | - N A J B Peters
- Department of Medical Oncology, St. Jans Hospital, Weert, the Netherlands
| | - M Berbée
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - I M Werter
- Department of Medical Oncology, Rijnstate Hospital, Arnhem, the Netherlands
| | - P Snaebjornsson
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - H M U Peulen
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - I G van Lijnschoten
- Department of Pathology, PAMM Laboratory for Pathology and Medical Microbiology, Eindhoven, the Netherlands
| | - M J Roef
- Department of Nuclear Medicine, Catharina Hospital, Eindhoven, the Netherlands
| | | | - J G Bloemen
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - J M W E Willems
- Department of Medical Oncology, Anna Hospital, Geldrop, the Netherlands
| | - G J M Creemers
- Department of Medical Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - J Nederend
- Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands
| | - H J T Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands.,GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - J W A Burger
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands.
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