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Milanzi E, Pelly RM, Hayes IP, Gibbs P, Faragher I, Reece JC. Accuracy of Baseline Magnetic Resonance Imaging for Staging Rectal Cancer Patients Proceeding Directly to Surgery. J Surg Oncol 2024. [PMID: 39233560 DOI: 10.1002/jso.27852] [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: 05/24/2024] [Revised: 08/08/2024] [Accepted: 08/19/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND AND OBJECTIVES High-resolution magnetic resonance imaging (MRI) accuracy for staging preoperative rectal cancer varies across studies. We examined MRI accuracy for T- and N-staging of rectal cancer compared with final histopathology of the resected specimen in a large Australian cohort who did not receive neoadjuvant therapy or radiation. METHODS Retrospective analysis of prospectively-collected clinical data from 153 rectal adenocarcinomas locally staged by high-resolution MRI between January 2012 and December 2019 that did not undergo chemoradiotherapy or radiation before surgery. T- and N-stage agreement between MRI and final histopathology was assessed using Kappa statistic. Agreement at each T-stage was evaluated using log-linear modeling. N-staging accuracy was examined using positive and negative predictive values. RESULTS Overall agreement between MRI and final histopathology for T-stage and N-stage was 55% and 65%, respectively. Kappa statistic found higher agreement between MRI and final histopathology for T-staging (κ = 0.33) versus N-staging (κ = 0.18). MRI correctly assessed 91% of T1 tumors, 43% of T2 tumors, 65% of T3 tumors, and 80% of T4 tumors. MRI accuracy was higher for N-negative tumors (74.1%) than for N-positive tumors (44.4%). CONCLUSION MRI is moderately accurate at staging T1, T3, and T4 rectal tumors but caution when staging tumors as T2 is advised. Greater accuracy for staging N-negative versus N-positive tumors is indicated.
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Affiliation(s)
- Elasma Milanzi
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Rachel M Pelly
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Ian P Hayes
- Colorectal Surgery Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
| | - Peter Gibbs
- Personalised Oncology Division, Walter and Eliza Hall Institute, Parkville, Victoria, Australia
| | - Ian Faragher
- Colorectal Surgery Unit, Western Health, Melbourne, Victoria, Australia
| | - Jeanette C Reece
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
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Zager Y, Horesh N, Abdelmasseh M, Aquina CT, Alfonso BLL, Soliman MK, Albert MR, Monson JRT. The predicting value of post neoadjuvant treatment magnetic resonance imaging: a meta-analysis. Surg Endosc 2024:10.1007/s00464-024-11084-3. [PMID: 39174708 DOI: 10.1007/s00464-024-11084-3] [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: 05/06/2024] [Accepted: 07/13/2024] [Indexed: 08/24/2024]
Abstract
INTRODUCTION Neoadjuvant therapy has become standard of care for locally advanced rectal cancer patients. It is correlated with improved clinical and pathological outcomes, including significant tumor downstaging and organ preservation in certain patients. Magnetic resonance imaging (MRI), which has become the standard for pre-operative staging, is also used for clinical and pre-operative restaging following pre-operative treatment. In this meta-analysis, we aimed to evaluate the concordance between restaging MRI (following the completion of neoadjuvant therapy) and postoperative pathology result. METHODS We conducted a meta-analysis following the PRISMA 2020 guidelines. Two independent reviewers searched PubMed and Google Scholar for studies reporting restaging MRI results compared to pathological outcomes. Outcomes included tumor and nodal staging, circumferential resection margin (CRM) and pathological complete response (pCR). RESULTS Out of 25,000 studies found on the initial search; 33 studies were included. The studies were published between 2005 and 2023 and included 4100 patients (57.14% males). The median age was 62.45 years. The median interval between the conclusion of neoadjuvant treatment and the subsequent restaging MRI was 6 weeks (range 4.14-8.8 weeks). The pooled concordance rates between the restaging MRI and the pathological outcomes for ypT stage and ypN stage were 63.9% (54.5%-73.3%, I2 = 96.02%) and 60.9% (42.9%-78.9%, I2 = 98.96%), respectively. The pooled concordance for predicting pathological complete response was 70.4% (53.6%-87.1%, I2 = 98.21%). As for the circumferential resection margin (CRM), the pooled concordance was 78.2.% (71.6%-84.8%, I2 = 83.76%). CONCLUSIONS Our findings suggest that the concordance rates between restaging MRI and pathological outcomes in rectal cancer patients following neoadjuvant therapy are limited. Caregivers should take these results into consideration when making clinical decisions about these patients. More data should be gathered about the predictive value of MRI after total neoadjuvant therapy as well as immunotherapy in rectal cancer patients.
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Affiliation(s)
- Yaniv Zager
- Colon and Rectum Surgery, Adventhealth, Orlando, FL, USA.
- Surgical Health Outcomes Consortium (SHOC), AdventHealth Digestive Health Institute, Orlando, FL, USA.
| | - Nir Horesh
- Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Michael Abdelmasseh
- Colon and Rectum Surgery, Adventhealth, Orlando, FL, USA
- Surgical Health Outcomes Consortium (SHOC), AdventHealth Digestive Health Institute, Orlando, FL, USA
| | - Christopher T Aquina
- Colon and Rectum Surgery, Adventhealth, Orlando, FL, USA
- Surgical Health Outcomes Consortium (SHOC), AdventHealth Digestive Health Institute, Orlando, FL, USA
| | - Bustamante Lopez Leonardo Alfonso
- Colon and Rectum Surgery, Adventhealth, Orlando, FL, USA
- Surgical Health Outcomes Consortium (SHOC), AdventHealth Digestive Health Institute, Orlando, FL, USA
| | - Mark K Soliman
- Colon and Rectum Surgery, Adventhealth, Orlando, FL, USA
- Surgical Health Outcomes Consortium (SHOC), AdventHealth Digestive Health Institute, Orlando, FL, USA
| | - Matthew R Albert
- Colon and Rectum Surgery, Adventhealth, Orlando, FL, USA
- Surgical Health Outcomes Consortium (SHOC), AdventHealth Digestive Health Institute, Orlando, FL, USA
| | - John R T Monson
- Department of Colorectal Surgery, Northwell Health, Northshore University Hospital, New York, USA
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Peng W, Wan L, Tong X, Yang F, Zhao R, Chen S, Wang S, Li Y, Hu M, Li M, Li L, Zhang H. Prospective and multi-reader evaluation of deep learning reconstruction-based accelerated rectal MRI: image quality, diagnostic performance, and reading time. Eur Radiol 2024:10.1007/s00330-024-10882-6. [PMID: 39017934 DOI: 10.1007/s00330-024-10882-6] [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: 04/08/2024] [Revised: 04/08/2024] [Accepted: 05/02/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVES To evaluate deep learning reconstruction (DLR)-based accelerated rectal magnetic resonance imaging (MRI) compared with standard MRI. MATERIALS AND METHODS Patients with biopsy-confirmed rectal adenocarcinoma between November/2022 and May/2023 in a single centre were prospectively enrolled for an intra-individual comparison between standard fast spin-echo (FSEstandard) and DLR-based FSE (FSEDL) sequences. Quantitative and qualitative image quality metrics of the pre-therapeutic MRIs were evaluated in all patients; diagnostic performance and evaluating time for T-staging, N-staging, extramural vascular invasion (EMVI), and mesorectal fascia (MRF) status was further analysed in patients undergoing curative surgery, with histopathologic results as the diagnostic gold standard. RESULTS A total of 117 patients were enrolled, with 60 patients undergoing curative surgery. FSEDL reduced the acquisition time by 65% than FSEstandard. FSEDL exhibited higher signal-to-noise ratios, contrast-to-noise ratio, and subjective scores (noise, tumour margin clarity, visualisation of bowel wall layering and MRF, overall image quality, and diagnostic confidence) than FSEstandard (p < 0.001). Reduced artefacts were observed in FSEDL for patients without spasmolytics (p < 0.05). FSEDL provided higher T-staging accuracy by junior readers than FSEstandard (reader 1, 58.33% vs 70.00%, p = 0.016; reader 3, 60.00% vs 76.67%, p = 0.021), with similar N-staging, EMVI, and MRF performance. No significant difference was observed for senior readers. FSEDL exhibited shorter diagnostic time in all readers' T-staging and overall evaluation, and junior readers' EMVI and MRF (p < 0.05). CONCLUSION FSEDL provided improved image quality, reading time, and junior radiologists' T-staging accuracy than FSEstandard, while reducing the acquisition time by 65%. CLINICAL RELEVANCE STATEMENT DLR is clinically applicable for rectal MRI, providing improved image quality with shorter scanning time, which may ease the examination burden. It is beneficial for diagnostic optimisation in improving junior radiologists' T-staging accuracy and reading time. KEY POINTS The rising incidence of rectal cancer has demanded enhanced efficiency and quality in imaging examinations. FSEDL demonstrated superior image quality and had a 65% reduced acquisition time. FSEDL can improve the diagnostic accuracy of T-staging and reduce the reading time for assessing rectal cancer.
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Affiliation(s)
- Wenjing Peng
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lijuan Wan
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaowan Tong
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fan Yang
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rui Zhao
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuang Chen
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | | | - Mancang Hu
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Li
- GE Healthcare, Beijing, China
| | - Lin Li
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Hongmei Zhang
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Maoxi L, Haiyi L. Impact on CD4+ CD25 High -CD127 low regulatory T (Treg) cells of neoadjuvant therapy for rectal cancer patients. INDIAN J PATHOL MICR 2024; 67:10-14. [PMID: 38358182 DOI: 10.4103/ijpm.ijpm_433_22] [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] [Indexed: 02/16/2024] Open
Abstract
Background The efficacy of neoadjuvant therapy for rectal cancer has not been assessed. Objective To evaluate proportional changes in peripheral blood immune cells in rectal cancer patients after neoadjuvant therapy and assess the relationship between tumor regression and regulatory T (Treg) cells. Materials and Methods Rectal cancer patients who had received neoadjuvant therapy prior to surgery at Shanxi Cancer Hospital between January and September 2018 were enrolled in the study. Treg, CD4+ T, CD8+ T, NK, B cells, and CD4+/CD8+ ratio in peripheral blood before and after neoadjuvant therapy were measured by flow cytometry. Patients were divided into down-staging and control groups, depending on their responses to neoadjuvant therapy. Results A total of 108 patients were enrolled. The proportion of Treg cells was significantly lower after neoadjuvant therapy (P < 0.05) but no changes were seen in CD4+ T, CD8+ T, NK, B cells, or CD4+/CD8+ ratio (all P > 0.05). There were 76 patients in the down-staging and 32 in the control groups. There were no significant differences in clinical parameters between down-staging and control groups (all P > 0.05). There were no significant differences in immune cell proportions between the two groups prior to neoadjuvant therapy (all P > 0.05). Treg, CD4+ T, and B cells were all significantly lower in the down-staging group after neoadjuvant therapy than before (P < 0.05). CD4+/CD8+ ratios were lower (P < 0.05) while proportions of Treg and natural killer (NK) cells did not change after neoadjuvant therapy in the control group. Following neoadjuvant therapy, Treg and B cells were lower while CD4+ and CD4+/CD8+ ratios were higher in the down-staging group compared to the control group (P < 0.01). Conclusion Treg cells may constitute a reference for judging the effect of neoadjuvant therapy in rectal cancer patients.
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Affiliation(s)
- Liu Maoxi
- Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Liu Haiyi
- Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China
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Kikano EG, Matalon SA, Eskian M, Lee L, Melnitchouk N, Bleday R, Khorasani R. Concordance of MRI With Pathology for Primary Staging of Rectal Cancer in Routine Clinical Practice: A Single Institution Experience. Curr Probl Diagn Radiol 2024; 53:68-72. [PMID: 37704486 DOI: 10.1067/j.cpradiol.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/01/2023] [Accepted: 08/23/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE MRI is the preferred imaging modality for primary staging of rectal cancer, used to guide treatment. Patients identified with clinical stage I disease receive upfront surgical resection; those with clinical stage II or greater undergo upfront neoadjuvant therapy. Although clinical under-/over-staging may have consequences for patients and presents opportunities for organ preservation, the correlation between clinical and pathologic staging in routine clinical practice within a single institute has not been fully established. METHODS This retrospective, Institutional Review Board-approved study, conducted at a National Cancer Institute-Designated Comprehensive Cancer Center with a multi-disciplinary rectal cancer disease center, included patients undergoing rectal MRI for primary staging January 1, 2018-August 30, 2020. Data collection included patient demographics, initial clinical stage via MRI report, pathologic diagnosis, pathologic stage, and treatment. The primary outcome was concordance of overall clinical and pathologic staging. Secondary outcomes included reasons for mismatched staging. RESULTS A total 105 rectal adenocarcinoma patients (64 males, mean age 57 ± 12.7 years) had staging MRI followed by surgical resection. A total of 28 patients (27%) had mismatched under-/over- staging. Ten patients (10%) were understaged with mismatched T stage group (clinical stage I, pathologic stage II), five (5%) were understaged with mismatched N stage group (clinical stage I, pathologic stage III), and 13 (12%) were overstaged (clinical stage II-III, pathologic stage 0-I). Treatment matched concordance between clinical and pathologic stages was 86%. CONCLUSION MRI for primary rectal cancer staging has high concordance with pathology. Future studies to assess strategies for reducing clinically relevant understaging would be beneficial.
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Affiliation(s)
- Elias G Kikano
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA.
| | - Shanna A Matalon
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Mahsa Eskian
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Leslie Lee
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | - Ron Bleday
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Ramin Khorasani
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
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Xia Q, Cheng W, Bi J, Ren AP, Chen X, Li T. Value of biplane transrectal ultrasonography plus micro-flow imaging in preoperative T staging and rectal cancer diagnosis in combination with CEA/CA199 and MRI. BMC Cancer 2023; 23:860. [PMID: 37700269 PMCID: PMC10496222 DOI: 10.1186/s12885-023-11370-8] [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: 12/02/2022] [Accepted: 09/04/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Rectal cancer is one of the most common malignant tumors and has a high incidence rate and fatality rate. Accurate preoperative T staging of rectal cancer is critical for the selection of appropriate rectal cancer treatment. Various pre-operative imaging methods are available, and the identification of the most accurate method for clinical use is essential for patient care. We investigated the value of biplane transrectal ultrasonography (TRUS) combined with MFI in preoperative staging of rectal cancer and explored the value of combining TRUS plus MFI with CEA/CA199 and MRI. METHODS A total of 87 patients from Daping Hospital with rectal cancer who underwent TRUS examination plus MFI were included. Grades of MFI were determined by Alder classification. Among the total patients, 64 underwent MRI and serum CEA/CA199 tests additionally within one week of TRUS. Pathological results were used as the gold standard for cancer staging. Concordance rates between TRUS, MRI, and CEA/CA199 for tumors at different stages were compared. RESULTS There were no significant differences between the Alder classification and pathological T staging. The concordance rate of TRUS and MFI for rectal cancer T staging was 72.4% (K = 0.615, p < 0.001). Serum CEA and CA199 levels were significantly different in tumors at different stages and increased progressively by pathological stage (p < 0.001); the accuracy rate was 71.88% (K = 0.599, p < 0.001), while that of MRI was 51.56% (K = 0.303, p < 0.001), indicating that TRUS had higher consistency in the preoperative T staging of rectal cancer. The combination of TRUS, MRI, and CEA/CA199 yielded an accuracy rate of 90.6%, which was higher than that of any method alone. CONCLUSIONS Preoperative T staging of rectal cancer from biplane TRUS plus MFI was highly consistent with postoperative pathological T staging. TRUS combined with MRI and serum CEA/CA199 had a greater value in the diagnosis of rectal cancer and a higher diagnostic rate than any examination alone.
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Affiliation(s)
- Qin Xia
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, 400000, China
| | - Wei Cheng
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, 400000, China
| | - Jie Bi
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, 400000, China
| | - An-Ping Ren
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, 400000, China
| | - Xiao Chen
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, 400000, China
| | - Tao Li
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, 400000, 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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Wang G, Yao K, Yang Y, Chen H, Tang Z, Ye J, Fu M, Xue X, Shen Q, Tang H, Guo Y, Huang Y. Local resection versus radical resection after neoadjuvant chemoradiotherapy for patients with locally advanced rectal cancer: a propensity-score matched cohort analysis. BMC Gastroenterol 2023; 23:205. [PMID: 37312044 DOI: 10.1186/s12876-023-02809-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 05/09/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND We aimed to address the shortage of evidence regarding the safety of the local resection approach by comparing long-term oncological outcomes between patients managed by local resection and those who underwent radical resection. METHODS This was a propensity-score matched cohort analysis study that included patients of all ages diagnosed with locally advanced rectal cancer (LARC) who had received neoadjuvant chemoradiotherapy (nCRT) at the Fujian Medical University Union Hospital and Fujian Medical University Affiliated Zhangzhou Hospital, China, between Jan 10, 2011, to Dec 28, 2021. Partial patients with a significant downstage of the tumor were offered management with the local resection approach, and most of the rest were offered radical resection if eligible. FINDINGS One thousand six hundred ninety-three patients underwent radical resection after nCRT, and another 60 patients performed local resection. The median follow-up times were 44.0 months (interquartile range = 4-107 months). After propensity-core matching (PSM), in the Kaplan-Meier curves, local resection (n = 56) or radical resection (n = 211) was not significantly associated with 1-, 3-, and 5-year cumulative incidence of overall survival (OS) (HR = 1.103, 95% CI: 0.372 ~ 3.266), disease-free survival (DFS) ((HR = 0.972, 95% CI: 0.401 ~ 2.359), local recurrence (HR = 1.044, 95% CI: 0.225 ~ 4.847), and distant metastasis (HR = 0.818, 95% CI: 0.280 ~ 2.387) (all log-rank P > 0.05). Similarly, multivariate Cox regression analysis indicates that local excision still was not an independent risk factor for OS (HR = 0.863, 95% CI: 0.267 ~ 2.785, P = 0.805) and DFS (HR = 0.885, 95% CI: 0.353 ~ 2.215, p = 0.794). CONCLUSION Local resection can be a management option in selected patients with middle-low rectal cancer after nCRT for LARC and without loss of oncological safety at five years.
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Affiliation(s)
- Guancong Wang
- Department of Colorectal and Anal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, China
| | - Kaiyuan Yao
- Department of Colorectal and Anal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, China
| | - Yugang Yang
- Department of Colorectal and Anal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, China
| | - Hongying Chen
- Department of Colorectal and Anal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, China
| | - Zihan Tang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Jiahong Ye
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Muhai Fu
- Department of Colorectal and Anal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, China
| | - Xiajuan Xue
- Department of Colorectal and Anal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, China
| | - Qiyuan Shen
- Department of Colorectal and Anal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, China
| | - Haiwen Tang
- Department of Colorectal and Anal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, China
| | - Yincong Guo
- Department of Colorectal and Anal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, China.
| | - Ying Huang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China.
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Bedrikovetski S, Dudi-Venkata NN, Kroon HM, Traeger LH, Seow W, Vather R, Wilks M, Moore JW, Sammour T. A prospective study of diagnostic accuracy of multidisciplinary team and radiology reporting of preoperative colorectal cancer local staging. Asia Pac J Clin Oncol 2023; 19:206-213. [PMID: 35712999 PMCID: PMC10084150 DOI: 10.1111/ajco.13795] [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: 11/25/2021] [Revised: 04/22/2022] [Accepted: 05/07/2022] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The aim of this study was to correlate and assess diagnostic accuracy of preoperative staging at multidisciplinary team meeting (MDT) against the original radiology reports and pathological staging in colorectal cancer patients. METHODS A prospective observational study was conducted at two institutions. Patients with histologically proven colorectal cancer and available preoperative imaging were included. Preoperative tumor and nodal staging (cT and cN) as determined by the MDT and the radiology report (computed tomography [CT] and/or magnetic resonance imaging [MRI]) were recorded. Kappa statistics were used to assess agreement between MDT and the radiology report for cN staging in colon cancer, cT and cN in rectal cancer, and tumor regression grade (TRG) in patients with rectal cancer who received neoadjuvant therapy. Pathological report after surgery served as the reference standard for local staging, and AUROC curves were constructed to compare diagnostic accuracy of the MDT and radiology report. RESULTS A total of 481 patients were included. Agreement between MDT and radiology report for cN stage was good in colon cancer (k = .756, Confidence Interval (CI) 95% .686-.826). Agreement for cT and cN and in rectal cancer was very good (kw = .825, CI 95% .758-.892) and good (kw = .792, CI 95% .709-.875), respectively. In the rectal cancer group that received neoadjuvant therapy, agreement on TRG was very good (kw = .919, CI 95% .846-.993). AUROC curves using pathological staging indicated no difference in diagnostic accuracy between MDT and radiology reports for either colon or rectal cancer. CONCLUSION Preoperative colorectal cancer local staging was consistent between specialist MDT review and original radiology reports, with no significant differences in diagnostic accuracy identified.
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Affiliation(s)
- Sergei Bedrikovetski
- Discipline of Surgery, Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.,Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Nagendra N Dudi-Venkata
- Discipline of Surgery, Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.,Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Hidde M Kroon
- Discipline of Surgery, Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.,Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Luke H Traeger
- Discipline of Surgery, Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.,Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Warren Seow
- Discipline of Surgery, Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Ryash Vather
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Michael Wilks
- Department of Interventional Radiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - James W Moore
- Discipline of Surgery, Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.,Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Tarik Sammour
- Discipline of Surgery, Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.,Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Opara CO, Khan FY, Kabiraj DG, Kauser H, Palakeel JJ, Ali M, Chaduvula P, Chhabra S, Lamsal Lamichhane S, Ramesh V, Mohammed L. The Value of Magnetic Resonance Imaging and Endorectal Ultrasound for the Accurate Preoperative T-staging of Rectal Cancer. Cureus 2022; 14:e30499. [DOI: 10.7759/cureus.30499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022] Open
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11
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Liu M, Feng Y, Zhang Y, Liu H. Evaluation of Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio on Predicting Responsiveness to Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer Patients. BIOMED RESEARCH INTERNATIONAL 2022; 2022:3839670. [PMID: 36212713 PMCID: PMC9534654 DOI: 10.1155/2022/3839670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/31/2022] [Accepted: 09/03/2022] [Indexed: 11/17/2022]
Abstract
Objective Neutrophil-lymphocyte ratio (NLR) and Platelet-lymphocyte ratio (PLR) have been proposed as prognostic biomarkers in multiple cancers. However, the implications of NLR and PLR in the responsiveness to neoadjuvant chemoradiotherapy (nCRT) remain to be clarified in locally advanced rectal cancer (LARC) patients. This retrospective study investigated the prognostic value of NLR and PLR in nCRT responsiveness of LARC patients. Methods A total number of 86 patients diagnosed with LARC and treated with nCRT and total mesorectal excision were retrospectively followed from 2013 to 2016. Receiver operating characteristic (ROC) curve was used to determine the cutoff values of NLR and PLR, and the patients were divided into NLR elevation and NLR decrease groups, or PLR elevation and PLR decrease groups. The correlation between NLR and PLR changes, and clinicopathological factors were analyzed. The relationship between NLR and PLR changes and the curative responsiveness towards nCRT were further evaluated. Results NLR and PLR changes after nCRT were significantly correlated with the distance of tumors to the anus and BMI (body mass index) (P < 0.05). The clinical remission rate of patients with NLR reduction was 72.09% (31/43), which was significantly higher than that in patients with NLR increment (22/43, 51.16%). There was no significant difference in the clinic remission rate between the patients with PLR reduction and those with PLR increment (P > 0.05). However, the pathological responsiveness rate was significantly higher in patients with PLR reduction (21/43, 48.84%) when compared to the ones with PLR increment (9/43, 20.9%) (P = 0.036). Conclusion Our data indicate that in LARC patients with nCRT, the reduction of NLR and the reduction of PLR could serves as predictors for the clinic remission rate and pathological responsiveness rate, respectively. The combination of NLR and PLR changes may be employed as a simple and effective prognostic parameter to predict the treatment outcome of nCRT in LARC.
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Affiliation(s)
- Maoxi Liu
- Department of Anorectal Surgery, Shanxi Cancer Hospital, Taiyuan, 030013 Shanxi, China
| | - Yi Feng
- Department of Anorectal Surgery, Shanxi Cancer Hospital, Taiyuan, 030013 Shanxi, China
| | - Yixun Zhang
- Department of Anorectal Surgery, Shanxi Cancer Hospital, Taiyuan, 030013 Shanxi, China
| | - Haiyi Liu
- Department of Anorectal Surgery, Shanxi Cancer Hospital, Taiyuan, 030013 Shanxi, China
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12
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Hayes IP, Milanzi E, Pelly RM, Gibbs P, Reece JC. T‐stage downstaging of locally advanced rectal cancer after neoadjuvant chemoradiotherapy is not associated with reduced recurrence after adjusting for tumour characteristics. J Surg Oncol 2022; 126:728-739. [PMID: 35635190 PMCID: PMC9543614 DOI: 10.1002/jso.26932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/16/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Ian P. Hayes
- Colorectal Surgery Unit, Royal Melbourne Hospital Melbourne Victoria Australia
- Department of Surgery The University of Melbourne Melbourne Victoria Australia
| | - Elasma Milanzi
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health The University of Melbourne Carlton Victoria Australia
- Australasian Kidney Trials Network University of Queensland Brisbane Australia
| | - Rachel M. Pelly
- Health Services Research Unit, The Royal Children's Hospital Melbourne Victoria Australia
- Health Services, Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Peter Gibbs
- Personalised Oncology Division The Walter and Eliza Hall Institute of Medical Research Melbourne Victoria Australia
- Faculty of Medicine, Dentistry and Health Sciences The University of Melbourne Melbourne Victoria Australia
- Department of Medical Oncology Western Health Melbourne Victoria Australia
| | - Jeanette C. Reece
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health The University of Melbourne Carlton Victoria Australia
- Centre for Cancer Research The University of Melbourne Melbourne Victoria Australia
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13
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Voogt EL, Nordkamp S, van Zoggel DM, Daniëls-Gooszen AW, Nieuwenhuijzen GA, Bloemen JG, Creemers GJ, Cnossen JS, van Lijnschoten G, Burger JW, Rutten HJ, Nederend J. MRI tumour regression grade in locally recurrent rectal cancer. BJS Open 2022; 6:zrac033. [PMID: 35552373 PMCID: PMC9097816 DOI: 10.1093/bjsopen/zrac033] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/03/2022] [Accepted: 02/12/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study aimed to investigate the agreement between magnetic resonance tumour regression grade (mrTRG) and pathological regression grade (pTRG) in patients with locally recurrent rectal cancer (LRRC). Also, the reproducibility of mrTRG was investigated. METHODS All patients with LRRC who underwent a resection between 2010 and 2018 after treatment with induction chemotherapy and neoadjuvant chemo(re)irradiation in whom a restaging MRI was available were retrospectively selected. All MRI scans were reassessed by two independent radiologists using the mrTRG, and the pTRG was reassessed by an independent pathologist. The interobserver agreement between the radiologists as well as between the radiologists and the pathologist was assessed with the weighted kappa test. A subanalysis was performed to evaluate the influence of the interval between imaging and surgery. RESULTS Out of 313 patients with LRRC treated during the study interval, 124 patients were selected. Interobserver agreement between the radiologists was fair (k = 0.28) using a two-tier grading system (mrTRG 1-2 versus mrTRG 3-5). For the lead radiologist, agreement with pTRG was moderate (k = 0.52; 95 per cent c.i. 0.36 to 0.68) when comparing good (mrTRG 1-2 and Mandard 1-2) and intermediate/poor responders (mrTRG 3-5 and Mandard 3-5), and the agreement was fair between the other abdominal radiologist and pTRG (k = 0.39; 95 per cent c.i. 0.22 to 0.56). A shorter interval (less than 7 weeks) between MRI and surgery resulted in an improved agreement (k = 0.69), compared with an interval more than 7 weeks (k = 0.340). For the lead radiologist, the positive predictive value for predicting good responders was 95 per cent (95 per cent c.i. 71 per cent to 99 per cent), whereas this was 56 per cent (95 per cent c.i. 44 per cent to 66 per cent) for the other radiologist. CONCLUSION This study showed that, in LRRC, the reproducibility of mrTRG among radiologists is limited and the agreement of mrTRG with pTRG is low. However, a shorter interval between MRI and surgery seems to improve this agreement and, if assessed by a dedicated radiologist, mrTRG could predict good responders.
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Affiliation(s)
- Eva L.K. Voogt
- Department of Surgery, Catherina Hospital, Eindhoven, the Netherlands
| | - Stefi Nordkamp
- Department of Surgery, Catherina Hospital, Eindhoven, the Netherlands
| | | | | | | | | | - Geert-Jan Creemers
- Department of Medical Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - Jeltsje S. Cnossen
- Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands
| | - Gesina van Lijnschoten
- Department of Pathology, PAMM Laboratory for Pathology and Medical Microbiology, Eindhoven, the Netherlands
| | | | - Harm J.T. Rutten
- Department of Surgery, Catherina Hospital, Eindhoven, the Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Joost Nederend
- Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands
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14
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Improved Overall Survival of Colorectal Cancer under Multidisciplinary Team: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5541613. [PMID: 33997003 PMCID: PMC8110396 DOI: 10.1155/2021/5541613] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/23/2021] [Indexed: 01/09/2023]
Abstract
Purpose The purpose of the current meta-analysis was to evaluate whether multidisciplinary team improved overall survival of colorectal cancer. Methods PubMed, EMBASE, and Cochrane Library database were searched from inception to October 25, 2020. The hazard ratio (HR) and 95% confidence (CI) of overall survival (OS) were calculated. Results A total of 11 studies with 30814 patients were included in this meta-analysis. After pooling the HRs, the MDT group was associated with better OS compared with the non-MDT group (HR = 0.81, 95% CI 0.69-0.94, p = 0.005). In subgroup analysis of stage IV colorectal cancer, the MDT group was associated with better OS as well (HR = 0.73, 95% CI 0.59-0.90, p = 0.004). However, in terms of postoperative mortality, no significant difference was found between MDT and non-MDT groups (OR = 0.84, 95% CI 0.44-1.61, p = 0.60). Conclusion MDT could improve OS of colorectal cancer patients.
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15
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Church J. Staging rectal cancer in 2020. ANZ J Surg 2021; 91:8. [PMID: 33590632 DOI: 10.1111/ans.16466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/15/2020] [Indexed: 11/29/2022]
Affiliation(s)
- James Church
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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16
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Reginelli A, Clemente A, Sangiovanni A, Nardone V, Selvaggi F, Sciaudone G, Ciardiello F, Martinelli E, Grassi R, Cappabianca S. Endorectal Ultrasound and Magnetic Resonance Imaging for Rectal Cancer Staging: A Modern Multimodality Approach. J Clin Med 2021; 10:jcm10040641. [PMID: 33567516 PMCID: PMC7915333 DOI: 10.3390/jcm10040641] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 12/11/2022] Open
Abstract
Preoperative staging represents a crucial point for the management, type of surgery, and candidacy for neoadjuvant therapy in patient with rectal cancer. The most recent clinical guidelines in oncology recommend an accurate preoperative evaluation in order to address early and advanced tumors to different therapeutic options. In particular, potential pitfalls may occur in the assessment of T3 tumors, which represents the most common stage at diagnosis. The depth of tumor invasion is known to be an important prognostic factor in rectal carcinoma; as a consequence, the T3 imaging classification has a substantial importance for treatment strategy and patient survival. However, the differentiation between tumor invasion of perirectal fat and mesorectal desmoplastic reactions remains a main goal for radiologists. Magnetic resonance imaging (MRI) is actually considered as the best imaging modality for rectal cancer staging. Although the endorectal ultrasound (ERUS) is the preferred staging method for early tumors, it could also be useful in identifying perirectal fat invasion. Moreover, the addiction of diffusion weighted imaging (DWI) improves the diagnostic performance of MRI in rectal cancer staging by adding functional information about rectal tumor and adjacent mesorectal tissues. This study investigated the diagnostic performance of conventional MRI alone, in combination with the DWI technique and ERUS in order to assess the best diagnostic imaging combination for rectal cancer staging.
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Affiliation(s)
- Alfonso Reginelli
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.R.); (A.S.); (R.G.); (S.C.)
| | - Alfredo Clemente
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.R.); (A.S.); (R.G.); (S.C.)
- Correspondence: ; Tel.: +39-0815665200
| | - Angelo Sangiovanni
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.R.); (A.S.); (R.G.); (S.C.)
| | - Valerio Nardone
- Unit of Radiation Oncology, Ospedale del Mare, 80147 Naples, Italy;
| | - Francesco Selvaggi
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (F.S.); (G.S.)
| | - Guido Sciaudone
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (F.S.); (G.S.)
| | - Fortunato Ciardiello
- Medical Oncology, Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (F.C.); (E.M.)
| | - Erika Martinelli
- Medical Oncology, Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (F.C.); (E.M.)
| | - Roberto Grassi
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.R.); (A.S.); (R.G.); (S.C.)
| | - Salvatore Cappabianca
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.R.); (A.S.); (R.G.); (S.C.)
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