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Jin Y, Wang Y, Zhu Y, Li W, Tang F, Liu S, Song B. A nomogram for preoperative differentiation of tumor deposits from lymph node metastasis in rectal cancer: A retrospective study. Medicine (Baltimore) 2023; 102:e34865. [PMID: 37832071 PMCID: PMC10578668 DOI: 10.1097/md.0000000000034865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/31/2023] [Indexed: 10/15/2023] Open
Abstract
The objective is to develop and validate a combined model for noninvasive preoperative differentiating tumor deposits (TDs) from lymph node metastasis (LNM) in patients with rectal cancer (RC). A total of 204 patients were enrolled and randomly divided into 2 sets (training and validation set) at a ratio of 8:2. Radiomics features of tumor and peritumor fat were extracted by using Pyradiomics software from the axial T2-weighted imaging of MRI. Rad-score based on extracted Radiomics features were calculated by combination of feature selection and the machine learning method. Factors (Rad-score, laboratory test factor, clinical factor, traditional characters of tumor on MRI) with statistical significance were integrated to build a combined model. The combined model was visualized by a nomogram, and its distinguish ability, diagnostic accuracy, and clinical utility were evaluated by the receiver operating characteristic curve (ROC) analysis, calibration curve, and clinical decision curve, respectively. Carbohydrate antigen (CA) 19-9, MRI reported node stage (MRI-N stage), tumor volume (cm3), and Rad-score were all included in the combined model (odds ratio = 3.881 for Rad-score, 2.859 for CA19-9, 0.411 for MRI-N stage, and 1.055 for tumor volume). The distinguish ability of the combined model in the training and validation cohorts was area under the summary receiver operating characteristic curve (AUC) = 0.863, 95% confidence interval (CI): 0.8-0.911 and 0.815, 95% CI: 0.663-0.919, respectively. And the combined model outperformed the clinical model in both training and validation cohorts (AUC = 0.863 vs 0.749, 0.815 vs 0.627, P = .0022, .0302), outperformed the Rad-score model only in training cohorts (AUC = 0.863 vs 0.819, P = .0283). The combined model had highest net benefit and showed good diagnostic accuracy. The combined model incorporating Rad-score and clinical factors could provide a preoperative differentiation of TD from LNM and guide clinicians in making individualized treatment strategy for patients with RC.
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Affiliation(s)
- Yumei Jin
- Department of Medicine Imaging Center, Kunming Medical University, Qujing First People’s Hospital, Yunnan, China
- Department of Radiology, Sichuan University, West China Hospital, Sichuan, China
- Department of Radiology, Sanya People’s Hospital, Sanya, Hainan, China
| | - Yewu Wang
- Department of Joint and Sports Medicine, Kunming Medical University, Qujing First People’s Hospital, Yunnan, China
| | - Yonghua Zhu
- Department of Medicine Imaging Center, Kunming Medical University, Qujing First People’s Hospital, Yunnan, China
| | - Wenzhi Li
- Department of Medicine Imaging Center, Kunming Medical University, Qujing First People’s Hospital, Yunnan, China
| | - Fengqiong Tang
- Department of Medicine Imaging Center, Kunming Medical University, Qujing First People’s Hospital, Yunnan, China
| | - Shengmei Liu
- Department of Radiology, Sichuan University, West China Hospital, Sichuan, China
| | - Bin Song
- Department of Radiology, Sichuan University, West China Hospital, Sichuan, China
- Department of Radiology, Sanya People’s Hospital, Sanya, Hainan, China
- Functional and Molecular Imaging Key Laboratory of Sichuan Province, Sichuan University, West China Hospital, Sichuan, China
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Peng W, Qiao H, Mo L, Guo Y. Progress in the diagnosis of lymph node metastasis in rectal cancer: a review. Front Oncol 2023; 13:1167289. [PMID: 37519802 PMCID: PMC10374255 DOI: 10.3389/fonc.2023.1167289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Historically, the chief focus of lymph node metastasis research has been molecular and clinical studies of a few essential pathways and genes. Recent years have seen a rapid accumulation of massive omics and imaging data catalyzed by the rapid development of advanced technologies. This rapid increase in data has driven improvements in the accuracy of diagnosis of lymph node metastasis, and its analysis further demands new methods and the opportunity to provide novel insights for basic research. In fact, the combination of omics data, imaging data, clinical medicine, and diagnostic methods has led to notable advances in our basic understanding and transformation of lymph node metastases in rectal cancer. Higher levels of integration will require a concerted effort among data scientists and clinicians. Herein, we review the current state and future challenges to advance the diagnosis of lymph node metastases in rectal cancer.
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Affiliation(s)
- Wei Peng
- Medical Big Data and Bioinformatics Research Centre, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Huimin Qiao
- Medical Big Data and Bioinformatics Research Centre, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Linfeng Mo
- School of Health and Medicine, Guangzhou Huashang Vocational College, Guangzhou, Guangdong, China
| | - You Guo
- Medical Big Data and Bioinformatics Research Centre, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
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Lee S, Surabhi VR, Kassam Z, Chang KJ, Kaur H. Imaging of colon and rectal cancer. Curr Probl Cancer 2023:100970. [PMID: 37330400 DOI: 10.1016/j.currproblcancer.2023.100970] [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: 01/31/2023] [Revised: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 06/19/2023]
Abstract
Colon and rectal cancer imaging has traditionally been performed to assess for distant disease (typically lung and liver metastases) and to assess the resectability of the primary tumor. With technological and scientific advances in imaging and the evolution of treatment options, the role of imaging has expanded. Radiologists are now expected to provide a precise description of primary tumor invasion extent, including adjacent organ invasion, involvement of the surgical resection plane, extramural vascular invasion, lymphadenopathy, and response to neoadjuvant treatment, and to monitor for recurrence after clinical complete response.
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Affiliation(s)
- Sonia Lee
- Department of Radiological Sciences, University of California, Irvine, CA.
| | - Venkateswar R Surabhi
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Zahra Kassam
- Department of Medical Imaging, Schulich School of Medicine, Western University, St Joseph's Hospital, London, Ontario, Canada
| | - Kevin J Chang
- Department of Radiology, Boston University Medical Center, Boston, MA
| | - Harmeet Kaur
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Hall WA, Smith JJ. Achieving a Cure Without Total Mesorectal Excision in Rectal Adenocarcinoma. J Clin Oncol 2023; 41:173-180. [PMID: 36332177 PMCID: PMC9839271 DOI: 10.1200/jco.22.01812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/08/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022] Open
Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.Rectal cancer is a curable disease, yet curing the disease can be associated with lifelong morbidity because of the nature of the curative-intent treatment strategies. A major focus of modern prospective trials has been to maintain current cure rates, while minimizing lifelong lifestyle alterations and maximizing quality of life. Navigating the complex landscape of therapeutic options for rectal adenocarcinoma with a focus to accomplish this quality-of-life improvement is a critical focus area for future clinical trials. Many challenges remain on the path to optimizing cure and minimizing morbidity, and include improving initial staging accuracy, more precise selection of neoadjuvant therapy used for each patient, choosing the optimal surgical management strategy, and ensuring modern radiation therapy approaches are being used. Finally, organ preservation strategies have moved to the forefront in the management of both early and locally advanced rectal cancers and hold the potential for significant changes to come for patients with rectal cancer. Herein, we highlight some of the challenges remaining in the field, progress made, and how the recent data from the Canadian Cancer Trials Group phase II trial can be put into context with the ACOSOG Z6041, CARTS, and GRECCAR2 trials.
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Affiliation(s)
- William A. Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - J. Joshua Smith
- Department of Surgery, Colorectal Service, Memorial Sloan Kettering, New York, NY
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Zhuang Z, Zhang Y, Wei M, Yang X, Wang Z. Magnetic Resonance Imaging Evaluation of the Accuracy of Various Lymph Node Staging Criteria in Rectal Cancer: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:709070. [PMID: 34327144 PMCID: PMC8315047 DOI: 10.3389/fonc.2021.709070] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/22/2021] [Indexed: 02/05/2023] Open
Abstract
Background Magnetic resonance imaging (MRI)-based lymph node staging remains a significant challenge in the treatment of rectal cancer. Pretreatment evaluation of lymph node metastasis guides the formulation of treatment plans. This systematic review aimed to evaluate the diagnostic performance of MRI in lymph node staging using various morphological criteria. Methods A systematic search of the EMBASE, Medline, and Cochrane databases was performed. Original articles published between 2000 and January 2021 that used MRI for lymph node staging in rectal cancer were eligible. The included studies were assessed using the QUADAS-2 tool. A bivariate random-effects model was used to conduct a meta-analysis of diagnostic test accuracy. Results Thirty-seven studies were eligible for this meta-analysis. The pooled sensitivity, specificity, and diagnostic odds ratio of preoperative MRI for the lymph node stage were 0.73 (95% confidence interval [CI], 0.68–0.77), 0.74 (95% CI, 0.68–0.80), and 7.85 (95% CI, 5.78–10.66), respectively. Criteria for positive mesorectal lymph node metastasis included (A) a short-axis diameter of 5 mm, (B) morphological standard, including an irregular border and mixed-signal intensity within the lymph node, (C) a short-axis diameter of 5 mm with the morphological standard, (D) a short-axis diameter of 8 mm with the morphological standard, and (E) a short-axis diameter of 10 mm with the morphological standard. The pooled sensitivity/specificity for these criteria were 75%/64%, 81%/67%, 74%/79%, 72%/66%, and 62%/91%, respectively. There was no significant difference among the criteria in sensitivity/specificity. The area under the receiver operating characteristic (ROC) curve values of the fitted summary ROC indicated a diagnostic accuracy rate of 0.75–0.81. Conclusion MRI scans have minimal accuracy as a reference index for pretreatment staging of various lymph node staging criteria in rectal cancer. Multiple types of evidence should be used in clinical decision-making.
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Affiliation(s)
- Zixuan Zhuang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Mingtian Wei
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xuyang Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
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