Share:
Share this content in WeChat
X
Experience Exchange
Tumor regression grade after neoadjuvant chemoradiotherapy for locally advanced rectal cancer: MRI and pathological control study
DONG Longchun  LI Yiming  SUN Chao  BAO Cuiping  YANG Jun  ZHANG Mingqing  YANG Zhengduo  ZHONG Jin 

Cite this article as: Dong LC, Li YM, Sun C, et al. Tumor regression grade after neoadjuvant chemoradiotherapy for locally advanced rectal cancer: MRI and pathological control study[J]. Chin J Magn Reson Imaging, 2022, 13(9): 91-94, 103. DOI:10.12015/issn.1674-8034.2022.09.017.


[Abstract] Objective To investigate the diagnostic efficacy of magnetic resonance tumor regression grade (mrTRG) and affecting factors.Materials and Methods A retrospective study was conducted in 129 cases with locally advanced low rectal cancer admitted to the Anorectal Disease Diagnosis and Treatment Center of Tianjin Union Medical Center from October 2017 to June 2021. All patients received conventional long-term concurrent chemoradiotherapy and radical surgery. MRI scans were performed 1 week before and 4 weeks after the end of concurrent chemoradiotherapy. Using pathologic tumor regression grade (pTRG) as the gold standard, Kappa test was used to analyze the diagnostic efficacy of mrTRG. The effects of different MR factors [diffusion-weighted imaging (DWI), T staging, high signal intensity on T2WI, mesorectal fascia invasion positive (MRF+), extramural vascular invasion positive (EMVI+)] on the diagnostic efficacy of mrTRG were evaluated by stratified analysis.Results Using T2WI alone, 57 cases were mrTRG 1-2 and 72 cases were mrTRG 3-5. Using T2WI combined with DWI, 70 cases were mrTRG 1-2 and 59 cases were mrTRG 3-5. The pathological results showed that 66 cases were pTRG 0-1 and 63 cases were pTRG 2-3. mrTRG was moderately consistent with pTRG (T2WI alone: Kappa=0.602, P<0.001; T2WI+DWI: Kappa=0.693, P<0.001). Compared with T2WI, T2WI combined with DWI increased the sensitivity (86.4% vs. 82.9%), specificity (83.9% vs. 77.1%), negative predictive value (89.7% vs. 79.4%), Jorden index (70.3% vs. 60.0%) and total coincidence rate (84.9% vs. 80.2%) of mrTRG. High T stage, T2WI high signal intensity, MRF+ and EMVI+ reduced the sensitivity, specificity, positive predictive value, negative predictive value, Jordon index and total coincidence rate of mrTRG in varying degrees (except the effect of high T2WI signal on mrTRG sensitivity).Conclusions T2WI combined with DWI can improve the diagnostic efficiency of mrTRG. High T stage, T2WI high signal intensity, MRF+, EMVI+ before neoadjuvant chemoradiotherapy will reduce the accuracy of mrTRG assessment.
[Keywords] rectal cancer;neoadjuvant chemoradiotherapy;tumor regression grade;magnetic resonance imaging;diffusion-weighted imaging

DONG Longchun1   LI Yiming1   SUN Chao1   BAO Cuiping1   YANG Jun1   ZHANG Mingqing2   YANG Zhengduo3   ZHONG Jin1*  

1 Department of Radiology, Tianjin Union Medical Center, Tianjin 300010, China

2 Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin 300010, China

3 Department of Pathology, Tianjin Union Medical Center, Tianjin 300010, China

*Zhong J, E-mail: zhongjin20@sina.com

Conflicts of interest   None.

Received  2022-05-20
Accepted  2022-08-23
DOI: 10.12015/issn.1674-8034.2022.09.017
Cite this article as: Dong LC, Li YM, Sun C, et al. Tumor regression grade after neoadjuvant chemoradiotherapy for locally advanced rectal cancer: MRI and pathological control study[J]. Chin J Magn Reson Imaging, 2022, 13(9): 91-94, 103.DOI:10.12015/issn.1674-8034.2022.09.017

[1]
Battersby NJ, Dattani M, Rao S, et al. A rectal cancer feasibility study with an embedded phase Ⅲ trial design assessing magnetic resonance tumour regression grade (mrTRG) as a novel biomarker to stratify management by good and poor response to chemoradiotherapy (TRIGGER): study protocol for a randomised controlled trial[J/OL]. Trials, 2017, 18(1) [2022-05-19]. https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-017-2085-2. DOI: 10.1186/s13063-017-2085-2.
[2]
Maas M, Nelemans PJ, Valentini V, et al. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data[J]. Lancet Oncol, 2010, 11(9): 835-844. DOI: 10.1016/S1470-2045(10)70172-8.
[3]
Mignanelli ED, de Campos-Lobato LF, Campos-Lobato LF, et al. Downstaging after chemoradiotherapy for locally advanced rectal cancer: is there more (tumor) than meets the eye?[J]. Dis Colon Rectum, 2010, 53(3): 251-256. DOI: 10.1007/DCR.0b013e3181bcd3cc.
[4]
Suwanthanma W, Kitudomrat S, Euanorasetr C. Clinical outcome of neoadjuvant chemoradiation in rectal cancer treatment[J/OL]. Medicine (Baltimore), 2021, 100(38) [2022-4-22]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8462585/. DOI: 10.1097/MD.0000000000027366.
[5]
Zhao F, Wang JL, Yu H, et al. Neoadjuvant radiotherapy improves overall survival for T3/4N+M0 rectal cancer patients: a population-based study of 20300 patients[J/OL]. Radiat Oncol, 2020, 15(1) [2022-05-19]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7045410. DOI: 10.1186/s13014-020-01497-4.
[6]
Pang XL, Gao YH, Yi HC, et al. Associations between clinical characteristics and tumor response to neoadjuvant chemoradiotherapy in rectal cancer[J]. Cancer Med, 2021, 10(14): 4832-4843. DOI: 10.1002/cam4.4051.
[7]
Nahas SC, Nahas CSR, Cama GM, et al. Diagnostic performance of magnetic resonance to assess treatment response after neoadjuvant therapy in patients with locally advanced rectal cancer[J]. Abdom Radiol (NY), 2019, 44(11): 3632-3640. DOI: 10.1007/s00261-019-01894-8.
[8]
Patel UB, Taylor F, Blomqvist L, et al. Magnetic resonance imaging-detected tumor response for locally advanced rectal cancer predicts survival outcomes: mercury experience[J]. J Clin Oncol, 2011, 29(28): 3753-3760. DOI: 10.1200/JCO.2011.34.9068.
[9]
Chow OS, Patil S, Keskin M, et al. Variation in the thoroughness of pathologic assessment and response rates of locally advanced rectal cancers after chemoradiation[J]. J Gastrointest Surg, 2019, 23(4): 794-799. DOI: 10.1007/s11605-019-04119-x.
[10]
China Colorectal cancer Diagnosis and Treatment Standards (2020edition) expert group.National Health Commission Of China colorectal cancer diagnosis and treatment guidelines (2020 edition)[J].Chinese Journal of Gastrointestinal Surgery, 2020, 23(6): 521-540. DOI: 10.3760/cma.j.cn.441530-20200520-00289.
[11]
Voogt ELK, Nordkamp S, van Zoggel DMGI, et al. MRI tumour regression grade in locally recurrent rectal cancer[J/OL]. BJS Open, 2022, 6(3)[2022-4-22]. https://academic.oup.com/bjsopen/article/6/3/zrac033/6584654?login=true. DOI: 10.1093/bjsopen/zrac033.
[12]
Yoen H, Park HE, Kim SH, et al. Prognostic value of tumor regression grade on MR in rectal cancer: a large-scale, single-center experience[J]. Korean J Radiol, 2020, 21(9): 1065-1076. DOI: 10.3348/kjr.2019.0797.
[13]
Ren JW, Hao YJ, Wang J, et al. Evaluation value of DWMRI in preoperative neoadjuvant chemoradiotherapy for rectal cancer[J]. Chin J Radiat Oncol, 2016, 25(10): 1106-1107. DOI: 10.3760/cma.j.issn.1004-4221.2016.10.18.
[14]
Chandramohan A, Siddiqi UM, Mittal R, et al. Diffusion weighted imaging improves diagnostic ability of MRI for determining complete response to neoadjuvant therapy in locally advanced rectal cancer[J/OL]. Eur J Radiol Open, 2020, 7 [2022-4-22]. https://www.sciencedirect.com/science/article/pii/S2352047720300125. DOI: 10.1016/j.ejro.2020.100223.
[15]
Popita AR, Lisencu C, Rusu A, et al. MRI evaluation of complete and near-complete response after neoadjuvant therapy in patients with locally advanced rectal cancer[J/OL]. Diagnostics (Basel), 2022, 12(4) [2022-05-19]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9027294. DOI: 10.3390/diagnostics12040921.
[16]
Zhao MJ, Zhao LH, Yang H, et al. Apparent diffusion coefficient for the prediction of tumor response to neoadjuvant chemo-radiotherapy in locally advanced rectal cancer[J/OL]. Radiat Oncol, 2021, 16(1) [2022-05-19]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7819172. DOI: 10.1186/s13014-020-01738-6.
[17]
Kudou M, Nakanishi M, Kuriu Y, et al. Value of intra-tumor heterogeneity evaluated by diffusion-weighted MRI for predicting pathological stages and therapeutic responses to chemoradiotherapy in lower rectal cancer[J]. J Cancer, 2020, 11(1): 168-176. DOI: 10.7150/jca.38354.
[18]
Moon SJ, Cho SH, Kim GC, et al. Complementary value of pre-treatment apparent diffusion coefficient in rectal cancer for predicting tumor recurrence[J]. Abdom Radiol (NY), 2016, 41(7): 1237-1244. DOI: 10.1007/s00261-016-0648-4.
[19]
Enkhbaatar NE, Inoue S, Yamamuro H, et al. MR imaging with apparent diffusion coefficient histogram analysis: evaluation of locally advanced rectal cancer after chemotherapy and radiation therapy[J]. Radiology, 2018, 288(1): 129-137. DOI: 10.1148/radiol.2018171804.
[20]
Jang JK, Lee CM, Park SH, et al. How to combine diffusion-weighted and T2-weighted imaging for MRI assessment of pathologic complete response to neoadjuvant chemoradiotherapy in patients with rectal cancer?[J]. Korean J Radiol, 2021, 22(9): 1451-1461. DOI: 10.3348/kjr.2020.1403.
[21]
Chand M, Swift RI, Tekkis PP, et al. Extramural venous invasion is a potential imaging predictive biomarker of neoadjuvant treatment in rectal cancer[J]. Br J Cancer, 2014, 110(1): 19-25. DOI: 10.1038/bjc.2013.603.
[22]
Schaap DP, Voogt ELK, Burger JWA, et al. Prognostic implications of MRI-detected EMVI and tumor deposits and their response to neoadjuvant therapy in cT3 and cT4 rectal cancer[J]. Int J Radiat Oncol Biol Phys, 2021, 111(3): 816-825. DOI: 10.1016/j.ijrobp.2021.06.013.
[23]
Guner OS, Tumay LV. Persistent extramural vascular invasion positivity on magnetic resonance imaging after neoadjuvant chemoradiotherapy predicts poor outcome in rectal cancer[J]. Asian J Surg, 2021, 44(6): 841-847. DOI: 10.1016/j.asjsur.2021.01.011.
[24]
Enblad M, Hammarström K, Folkesson J, et al. Mucinous rectal cancers: clinical features and prognosis in a population-based cohort[J/OL]. BJS Open, 2022, 6(2) [2022-4-25]. https://academic.oup.com/bjsopen/article/6/2/zrac039/6573991?login=true. DOI: 10.1093/bjsopen/zrac039.
[25]
Kim E, Kim K, Kim SH, et al. Impact of mucin proportion in the pretreatment MRI on the outcomes of rectal cancer patients undergoing neoadjuvant chemoradiotherapy[J]. Cancer Res Treat, 2019, 51(3): 1188-1197. DOI: 10.4143/crt.2018.434.
[26]
Zhang KK, Xu YS, Gao Y, et al. Advances in application of radiomics in colorectal cancer[J]. Chin J Magn Reson Imaging, 2021, 12(3): 112-115. DOI: 10.12015/issn.1674-8034.2021.03.028.
[27]
Coppola F, Mottola M, Lo Monaco S, et al. The heterogeneity of skewness in T2W-based radiomics predicts the response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer[J/OL]. Diagnostics (Basel), 2021, 11(5) [2022-05-19]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8146691. DOI: 10.3390/diagnostics11050795.
[28]
Chen HH, Shi LT, Nguyen KNB, et al. MRI radiomics for prediction of tumor response and downstaging in rectal cancer patients after preoperative chemoradiation[J]. Adv Radiat Oncol, 2020, 5(6): 1286-1295. DOI: 10.1016/j.adro.2020.04.016.
[29]
Cui YF, Yang XT, Shi ZQ, et al. Radiomics analysis of multiparametric MRI for prediction of pathological complete response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer[J]. Eur Radiol, 2019, 29(3): 1211-1220. DOI: 10.1007/s00330-018-5683-9.
[30]
Horvat N, Veeraraghavan H, Khan M, et al. MR imaging of rectal cancer: radiomics analysis to assess treatment response after neoadjuvant therapy[J]. Radiology, 2018, 287(3): 833-843. DOI: 10.1148/radiol.2018172300.
[31]
Filitto G, Coppola F, Curti N, et al. Automated prediction of the response to neoadjuvant chemoradiotherapy in patients affected by rectal cancer[J/OL]. Cancers (Basel), 2022, 14(9) [2022-05-19]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9100060. DOI: 10.3390/cancers14092231.

PREV Value of diffusion-weighted imaging combined with diffusion kurtosis imaging in the hierarchical diagnosis and prognosis assessment of glioma
NEXT Difference of MRI characteristics and HIFU related parameters of four subtypes of adenomyosis
  



Tel & Fax: +8610-67113815    E-mail: editor@cjmri.cn