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Yadav A, Kumar A. Artificial intelligence in rectal cancer: What is the future? Artif Intell Cancer 2023; 4:11-22. [DOI: 10.35713/aic.v4.i2.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 12/07/2023] Open
Abstract
Colorectal cancer (CRC) is the third most prevalent cancer in both men and women, and it is the second leading cause of cancer-related deaths globally. Around 60%-70% of CRC patients are diagnosed at advanced stages, with nearly 20% having liver metastases. It is noteworthy that the 5-year survival rates decline significantly from 80%-90% for localized disease to a mere 10%-15% for patients with metastasis at the time of diagnosis. Early diagnosis, appropriate therapeutic strategy, accurate assessment of treatment response, and prognostication is essential for better outcome. There has been significant technological development in the last couple of decades to improve the outcome of rectal cancer including Artificial intelligence (AI). AI is a broad term used to describe the study of machines that mimic human intelligence, such as perceiving the environment, drawing logical conclusions from observations, and performing complex tasks. At present AI has demonstrated a promising role in early diagnosis, prognosis, and treatment outcomes for patients with rectal cancer, a limited role in surgical decision making, and had a bright future.
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Affiliation(s)
- Alka Yadav
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, UP, India
| | - Ashok Kumar
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, UP, India
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Carbonara R, Surgo A, Ciliberti MP, Gregucci F, Bonaparte I, Nicosia L, Meldolesi E, Caliandro M, Ferraro V, Inchingolo R, Memeo R, Ludovico E, Calbi R, Lavalle M, Gambacorta MA, Alongi F, Fiorentino A. Impact of preoperative chemoradiation with higher dose intensity modulated radiotherapy on pathological complete response for locally advanced rectal cancer: a systematic review. Expert Rev Anticancer Ther 2022; 22:1249-1259. [PMID: 36174658 DOI: 10.1080/14737140.2022.2130895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Neoadjuvant chemoradiation (CRT) followed by total mesorectal excision is the current standard-of-care for locally advanced UICC II-III stage rectal cancer (LARC). A pathological complete response (pCR) correlates with survival. Improvements of pCR, including dose escalation, should be explored. The aim of this explorative analysis is to assess the impact on pCR of intensity-modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB). AREAS COVERED A literature search via PICO (Population, Intervention, Comparison, Outcome) in MEDLINE/PubMed and EMBASE and a systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Metanalysis) methodology were performed. Studies that reported pCR rate in patients with LARC in clinical stage T2N+M0 or cT3/4 N0/+M0 treated with preoperative CRT with SIB-IMRT/VMAT (Volumetric Modulated Arc Therapy) were included. Sixty-two studies were identified, but only eight clinical trials with a total of 311 patients were included . Median follow-up was 16-61 months. pCR reached the value of 38%. Good survival outcomes were observed with a mild toxicity profile. EXPERT OPINION Radiotherapy dose intensification in LARC showed a slight increase of pCR compared to historical studies. Prospective evaluations are necessary to define which patients would benefit most.
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Affiliation(s)
- Roberta Carbonara
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Alessia Surgo
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Maria Paola Ciliberti
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Fabiana Gregucci
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Ilaria Bonaparte
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Luca Nicosia
- IRCCS, Advanced Radiation Oncology Department, Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Elisa Meldolesi
- Radiation Oncology Department, Fondazione Policlinico Universitario A.Gemelli, IRCCS, Rome, Italy
| | - Morena Caliandro
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Valentina Ferraro
- Hepatobiliary and Pancreatic Surgery Unit, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Riccardo Inchingolo
- Hepatobiliary and Pancreatic Surgery Unit, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Riccardo Memeo
- Hepatobiliary and Pancreatic Surgery Unit, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Elena Ludovico
- Radiology Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti (BA), Bari, Italy
| | - Roberto Calbi
- Radiology Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti (BA), Bari, Italy
| | - Mariadea Lavalle
- Nuclear Medicine Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti (BA), Bari, Italy
| | | | - Filippo Alongi
- IRCCS, Advanced Radiation Oncology Department, Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy.,Medicine Faculty, University of Brescia, Brescia, Italy
| | - Alba Fiorentino
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
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Scheele J, Schmidt SA, Tenzer S, Henne-Bruns D, Kornmann M. Overstaging: A Challenge in Rectal Cancer Treatment. Visc Med 2018; 34:301-306. [PMID: 30345289 DOI: 10.1159/000488652] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Preoperative staging, including computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic ultrasound (EUS), is decisive to envisage the therapeutic concept for rectal cancer (RC). Overstaging may subject the patient to neoadjuvant therapy that does not improve survival but may lead to therapy-associated morbidity. Methods This study retrospectively compares and values EUS, CT, and MRI in Union Internationale Contre le Cancer (UICC) stage I-III RC with a focus on overstaging. RC patients receiving primary operation only at the University Clinic Ulm were analyzed. The therapeutic relevance of preoperative staging was determined by comparison with postoperative pathological workup. Results 244 examinations in 184 RC patients (EUS: n = 63, CT: n = 143, MRI: n = 38) revealed therapy-relevant overstaging into the T3/4 category in 10 (16%) EUS, 18 (13%) CT, and 10 (26%) MRI cases. Patients were upgraded to the N+ category in 13 (21%) EUS, 29 (20%) CT, and 11 (29%) MRI cases. As a result, UICC stages II and III turned out to be overstaged in 13 (21%) EUS, 18 (13%) CT, and 10 (26%) MRI cases. Conclusion More than 10% therapy-relevant overstaging by any method represents a major challenge for modern RC therapy. Physicians should scrupulously consider this fact in their treatment considerations to avoid overtreatment.
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Affiliation(s)
- Jan Scheele
- Clinic of General, Visceral, and Transplantion Surgery, University of Ulm, Ulm, Germany
| | | | - Sandra Tenzer
- Clinic of General, Visceral, and Transplantion Surgery, University of Ulm, Ulm, Germany
| | - Doris Henne-Bruns
- Clinic of General, Visceral, and Transplantion Surgery, University of Ulm, Ulm, Germany
| | - Marko Kornmann
- Clinic of General, Visceral, and Transplantion Surgery, University of Ulm, Ulm, Germany
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Matalon SA, Mamon HJ, Fuchs CS, Doyle LA, Tirumani SH, Ramaiya NH, Rosenthal MH. Anorectal Cancer: Critical Anatomic and Staging Distinctions That Affect Use of Radiation Therapy. Radiographics 2016; 35:2090-107. [PMID: 26562239 DOI: 10.1148/rg.2015150037] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Although rectal and anal cancers are anatomically close, they are distinct entities with different histologic features, risk factors, staging systems, and treatment pathways. Imaging is at the core of initial clinical staging of these cancers and most commonly includes magnetic resonance imaging for local-regional staging and computed tomography for evaluation of metastatic disease. The details of the primary tumor and involvement of regional lymph nodes are crucial in determining if and how radiation therapy should be used in treatment of these cancers. Unfortunately, available imaging modalities have been shown to have imperfect accuracy for identification of nodal metastases and imaging features other than size. Staging of nonmetastatic rectal cancers is dependent on the depth of invasion (T stage) and the number of involved regional lymph nodes (N stage). Staging of nonmetastatic anal cancers is determined according to the size of the primary mass and the combination of regional nodal sites involved; the number of positive nodes at each site is not a consideration for staging. Patients with T3 rectal tumors and/or involvement of perirectal, mesenteric, and internal iliac lymph nodes receive radiation therapy. Almost all anal cancers warrant use of radiation therapy, but the extent and dose of the radiation fields is altered on the basis of both the size of the primary lesion and the presence and extent of nodal involvement. The radiologist must recognize and report these critical anatomic and staging distinctions, which affect use of radiation therapy in patients with anal and rectal cancers.
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Affiliation(s)
- Shanna A Matalon
- From the Departments of Radiology (S.A.M., S.H.T., N.H.R., M.H.R.), Radiation Oncology (H.J.M.), and Pathology (L.A.D.), Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass (H.J.M., C.S.F., L.A.D., S.H.T., N.H.R., M.H.R.); and Departments of Medical Oncology (C.S.F.) and Imaging (S.H.T., N.H.R., M.H.R.), Dana-Farber Cancer Institute, Boston, Mass
| | - Harvey J Mamon
- From the Departments of Radiology (S.A.M., S.H.T., N.H.R., M.H.R.), Radiation Oncology (H.J.M.), and Pathology (L.A.D.), Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass (H.J.M., C.S.F., L.A.D., S.H.T., N.H.R., M.H.R.); and Departments of Medical Oncology (C.S.F.) and Imaging (S.H.T., N.H.R., M.H.R.), Dana-Farber Cancer Institute, Boston, Mass
| | - Charles S Fuchs
- From the Departments of Radiology (S.A.M., S.H.T., N.H.R., M.H.R.), Radiation Oncology (H.J.M.), and Pathology (L.A.D.), Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass (H.J.M., C.S.F., L.A.D., S.H.T., N.H.R., M.H.R.); and Departments of Medical Oncology (C.S.F.) and Imaging (S.H.T., N.H.R., M.H.R.), Dana-Farber Cancer Institute, Boston, Mass
| | - Leona A Doyle
- From the Departments of Radiology (S.A.M., S.H.T., N.H.R., M.H.R.), Radiation Oncology (H.J.M.), and Pathology (L.A.D.), Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass (H.J.M., C.S.F., L.A.D., S.H.T., N.H.R., M.H.R.); and Departments of Medical Oncology (C.S.F.) and Imaging (S.H.T., N.H.R., M.H.R.), Dana-Farber Cancer Institute, Boston, Mass
| | - Sree Harsha Tirumani
- From the Departments of Radiology (S.A.M., S.H.T., N.H.R., M.H.R.), Radiation Oncology (H.J.M.), and Pathology (L.A.D.), Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass (H.J.M., C.S.F., L.A.D., S.H.T., N.H.R., M.H.R.); and Departments of Medical Oncology (C.S.F.) and Imaging (S.H.T., N.H.R., M.H.R.), Dana-Farber Cancer Institute, Boston, Mass
| | - Nikhil H Ramaiya
- From the Departments of Radiology (S.A.M., S.H.T., N.H.R., M.H.R.), Radiation Oncology (H.J.M.), and Pathology (L.A.D.), Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass (H.J.M., C.S.F., L.A.D., S.H.T., N.H.R., M.H.R.); and Departments of Medical Oncology (C.S.F.) and Imaging (S.H.T., N.H.R., M.H.R.), Dana-Farber Cancer Institute, Boston, Mass
| | - Michael H Rosenthal
- From the Departments of Radiology (S.A.M., S.H.T., N.H.R., M.H.R.), Radiation Oncology (H.J.M.), and Pathology (L.A.D.), Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass (H.J.M., C.S.F., L.A.D., S.H.T., N.H.R., M.H.R.); and Departments of Medical Oncology (C.S.F.) and Imaging (S.H.T., N.H.R., M.H.R.), Dana-Farber Cancer Institute, Boston, Mass
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Kwon GH, Kim KA, Hwang SS, Park SY, Kim HA, Choi SY, Kim JW. Efficiency of Non-Contrast-Enhanced Liver Imaging Sequences Added to Initial Rectal MRI in Rectal Cancer Patients. PLoS One 2015; 10:e0137320. [PMID: 26348217 PMCID: PMC4562629 DOI: 10.1371/journal.pone.0137320] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 07/23/2015] [Indexed: 01/26/2023] Open
Abstract
Purpose The purpose of this study was to estimate the value of addition of liver imaging to initial rectal magnetic resonance imaging (MRI) for detection of liver metastasis and evaluate imaging predictors of a high risk of liver metastasis on rectal MRI. Methods We enrolled 144 patients who from October 2010 to May 2013 underwent rectal MRI with T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) (b values = 50, 500, and 900 s/mm2) of the liver and abdominopelvic computed tomography (APCT) for the initial staging of rectal cancer. Two reviewers scored the possibility of liver metastasis on different sets of liver images (T2WI, DWI, and combined T2WI and DWI) and APCT and reached a conclusion by consensus for different analytic results. Imaging features from rectal MRI were also analyzed. The diagnostic performances of CT and an additional liver scan to detect liver metastasis were compared. Multivariate logistic regression to determine independent predictors of liver metastasis among rectal MRI features and tumor markers was performed. This retrospective study was approved by the Institutional Review Board, and the requirement for informed consent was waived. Results All sets of liver images were more effective than APCT for detecting liver metastasis, and DWI was the most effective. Perivascular stranding and anal sphincter invasion were statistically significant for liver metastasis (p = 0.0077 and p = 0.0471), while extramural vascular invasion based on MRI (mrEMVI) was marginally significant (p = 0.0534). Conclusion The addition of non-contrast-enhanced liver imaging, particularly DWI, to initial rectal MRI in rectal cancer patients could facilitate detection of liver metastasis without APCT. Perivascular stranding, anal sphincter invasion, and mrEMVI detected on rectal MRI were important imaging predictors of liver metastasis.
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Affiliation(s)
- Gene-hyuk Kwon
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung Ah Kim
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- * E-mail:
| | - Seong Su Hwang
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo Youn Park
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun A. Kim
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun Young Choi
- Department of Radiology and Medical Research Institute, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Ji Woong Kim
- Department of Chiropractic, Graduate School of Health promotion, Hanseo University, Seosan-Si, Korea
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Marone P, Bellis MD, D’Angelo V, Delrio P, Passananti V, Girolamo ED, Rossi GB, Rega D, Tracey MC, Tempesta AM. Role of endoscopic ultrasonography in the loco-regional staging of patients with rectal cancer. World J Gastrointest Endosc 2015; 7:688-701. [PMID: 26140096 PMCID: PMC4482828 DOI: 10.4253/wjge.v7.i7.688] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 11/26/2014] [Accepted: 03/20/2015] [Indexed: 02/05/2023] Open
Abstract
The prognosis of rectal cancer (RC) is strictly related to both T and N stage of the disease at the time of diagnosis. RC staging is crucial for choosing the best multimodal therapy: patients with high risk locally advanced RC (LARC) undergo surgery after neoadjuvant chemotherapy and radiotherapy (NAT); those with low risk LARC are operated on after a preoperative short-course radiation therapy; finally, surgery alone is recommended only for early RC. Several imaging methods are used for staging patients with RC: computerized tomography, magnetic resonance imaging, positron emission tomography, and endoscopic ultrasound (EUS). EUS is highly accurate for the loco-regional staging of RC, since it is capable to evaluate precisely the mural infiltration of the tumor (T), especially in early RC. On the other hand, EUS is less accurate in restaging RC after NAT and before surgery. Finally, EUS is indicated for follow-up of patients operated on for RC, where there is a need for the surveillance of the anastomosis. The aim of this review is to highlight the impact of EUS on the management of patients with RC, evaluating its role in both preoperative staging and follow-up of patients after surgery.
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Ahuja NK, Sauer BG, Wang AY, White GE, Zabolotsky A, Koons A, Leung W, Sarkaria S, Kahaleh M, Waxman I, Siddiqui AA, Shami VM. Performance of endoscopic ultrasound in staging rectal adenocarcinoma appropriate for primary surgical resection. Clin Gastroenterol Hepatol 2015; 13:339-44. [PMID: 25019698 DOI: 10.1016/j.cgh.2014.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 07/03/2014] [Accepted: 07/03/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Endoscopic ultrasound (EUS) often is used to stage rectal cancer and thereby guide treatment. Prior assessments of its accuracy have been limited by small sets of data collected from tumors of varying stages. We aimed to characterize the diagnostic performance of EUS analysis of rectal cancer, paying particular attention to determining whether patients should undergo primary surgical resection. METHODS We performed a retrospective observational study using procedural databases and electronic medical records from 4 academic tertiary-care hospitals, collecting data on EUS analyses from 2000 through 2012. Data were analyzed from 86 patients with rectal cancer initially staged as T2N0 by EUS. The negative predictive value (NPV) was calculated by comparing initial stages determined by EUS with those determined by pathology analysis of surgical samples. Logistic regression models were used to assess variation in diagnostic performance with case attributes. RESULTS EUS excluded advanced tumor depth with an NPV of 0.837 (95% confidence interval [CI], 0.742-0.908), nodal metastasis with an NPV of 0.872 (95% CI, 0.783-0.934), and both together with an NPV of 0.767 (95% CI, 0.664-0.852) compared with pathology analysis. Incorrect staging by EUS affected treatment decision making for 20 of 86 patients (23.3%). Patient age at time of the procedure correlated with the NPV for metastasis to lymph node, but no other patient features were associated significantly with diagnostic performance. CONCLUSIONS Based on a multicenter retrospective study, EUS staging of rectal cancer as T2N0 excludes advanced tumor depth and nodal metastasis, respectively, with an approximate NPV of 85%, similar to that of other modalities. EUS has an error rate of approximately 23% in identifying disease appropriate for surgical resection, which is lower than previously reported.
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Affiliation(s)
- Nitin K Ahuja
- Department of Internal Medicine, University of Virginia, Charlottesville, Virginia.
| | - Bryan G Sauer
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia
| | - Andrew Y Wang
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia
| | - Grace E White
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia
| | - Andrew Zabolotsky
- Department of Internal Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ann Koons
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, Illinois
| | - Wesley Leung
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, Illinois
| | - Savreet Sarkaria
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York
| | - Michel Kahaleh
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York
| | - Irving Waxman
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, Illinois
| | - Ali A Siddiqui
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Vanessa M Shami
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia
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Yang Y, Tang T, Peng W, Xia L, Wang X, Duan B, Shu Y. The comparison of miR-155 with computed tomography and computed tomography plus serum amyloid A protein in staging rectal cancer. J Surg Res 2014; 193:764-71. [PMID: 25261908 DOI: 10.1016/j.jss.2014.08.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 08/17/2014] [Accepted: 08/22/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Recently identified class of microRNAs (miRNAs) provided a new insight in cancer research. As a member of miRNAs family, miR-155 expression demonstrated the correlation with tumor stage. Thus, its expression level can be potentially used for staging rectal tumors. The aim of this study was to systematically evaluate the potential abilities of miR-155 in preoperatively N staging. MATERIALS AND METHODS Expression of miR-155 was detected and quantitated in rectal cancer tissues and in adjacent nonmalignant tissues from 40 patients by TaqMan MicroRNA assays. Preoperative enhanced computed tomography (CT) scan, serum amyloid A protein (SAA), carcinoembryonic antigen (CEA), and postoperative pathologic biopsy were performed. RESULTS A significant overexpression of miR-155 was observed in rectal carcinoma tissues (0.137 ± 0.095 versus 0.093 ± 0.091, P = 0.043). High expression of miR-155 in N1-2 (0.09 ± 0.038 versus 0.183 ± 0.111, P = 0.001) and III and IV stages (0.091 ± 0.039 versus 0.178 ± 0.111, P = 0.002) presented its potential correlation with N and tumor-node-metastasis combined stages. Receiver operating characteristics curve analysis showed that miR-155 could discriminate N0 from N1-2 with 85.0% sensitivity and 85.0% specificity at the cutoff value of 0.125. miR-155 and CT had nearly equal performances in sensitivity (0.850 versus 0.700, P = 0.450) and specificity (0.850 versus 0.550, P = 0.077) in predicting N1-2 stage. Compared with CT + SAA, miR-155 had similar sensitivity (0.850 versus 0.950, P = 0.617) but higher specificity (0.750 versus 0.200, P = 0.015) for lymph node assessment. CONCLUSIONS Increase in the expression of miR-155 might represent a potential valuable marker for rectal carcinoma N and combined tumor-node-metastasis staging.
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Affiliation(s)
- Yun Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Tian Tang
- Department of Hepatic Surgery and Hepatic Transplantation Center, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China
| | - Wei Peng
- Department of Gynecology and Obstetrics, West China Women's and Children's Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China
| | - Lin Xia
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xiaodong Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Baofeng Duan
- Department of Oncology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Ye Shu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
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Abstract
The rectum and anus are two anatomically complex organs with diverse pathologies. This article reviews the basic anatomy of the rectum and anus. In addition, it addresses the current radiographic techniques used to evaluate these structures, specifically ultrasound, magnetic resonance imaging, and defecography.
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Affiliation(s)
- Patrick Solan
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH 45267-0558, USA
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