多模态磁共振成像对局部进展期直肠癌新辅助放化疗反应的评估
Multi-modal magnetic resonance imaging for evaluatimg the efficacy after neoadjuvant concurrent chemoradiotherapy for lo-cally advanced rectal cancer
周燕飞 1李雪萌 2凡健 1王璜 1孙秋艳 3高飞 4董江宁4
作者信息
- 1. 230031 安徽合肥 中国科学院合肥肿瘤医院医学影像中心
- 2. 233030 安徽蚌埠 蚌埠医学院研究生院
- 3. 230031 安徽合肥 中国科学院合肥肿瘤医院医学病理中心
- 4. 230031 安徽合肥 中国科学技术大学附属第一医院西区影像科
- 折叠
摘要
目的 探讨基于多模态MRI的术前磁共振肿瘤退缩分级(mrTRG)联合基线MRI形态学参数评估局部进展期直肠癌新辅助放化疗(NCRT)反应的诊断能效.方法 收集2019年5月至2023年9月在中国科学院合肥肿瘤医院、中国科学技术大学附属第一医院西区(安徽省肿瘤医院)接受NCRT后进行手术治疗的48例局部进展期直肠癌(T3～T4期)患者临床资料,根据术后肿瘤病理退缩分级(pTRG)分为反应好组(n=19)和反应差组(n=29).所有患者在NCRT前后均进行多模态高分辨直肠磁共振检查(MRI),以pTRG为金标准,采用 Kappa检验分析mrTRG的诊断效能,比较两组患者基线MRI形态学参数,采用受试者工作特征(ROC)曲线确定mrTRG联合MRI形态学参数评估NCRT反应的诊断效能.结果 采用改良的二分法肿瘤退缩分级方案,mrTRG与pTRG诊断一致性提高,Kappa值为0.698(95%CI:0.492～0.904,P＜0.05).单因素分析显示,影响NCRT反应的形态学参数包括基线T3a期及环周切缘(CRM)(P＜0.05).mrTRG、基线T3a期、CRM评估NCRT反应的曲线下面积(AUC)分别为0.842、0.693、0.721,联合评估的灵敏度为89.5%,特异度为82.8%,AUC为0.907,显著优于基线形态学参数(P＜0.05),但与mrTRG的诊断效能差异无统计学意义(P>0.05).结论 术前mrTRG联合基线形态学参数对评估直肠癌 NCRT反应具有较高的诊断效能,可为临床制定个体化治疗方案提供影像学依据.
Abstract
Objective To investigate the clinical value of multi-modal magnetic resonance imaging using magnetic resonance tumor regression grading(mrTRG)combined with MRI morphological parameters in evaluating the prediction efficacy after neoadjuvant concurrent chemoradiotherapy for locally advanced rectal cancer preoperatively.Methods The clinical data were collected of 48 patients with locally ad-vanced rectal cancer(stage T3～T4)patients undergoing surgical treatment after neoadjuvant concurrent chemoradiotherapy(NCRT)at Hefei Cancer Hospital of Chinese Academy of Sciences and the Western Branch of the First Affiliated Hospital of University of Science and Technol-ogy of China(Anhui Cancer Hospital)from May 2019 to September 2023.According to the postoperative pathological tumor regression grade(pTRG),the patients were divided into the good curative effect group(19 cases)and the poor curative effect group(29 cases).All patients under-went high-resolution rectal multi-modal MRI before and after neoadjuvant chemoradiotherapy.The diagnostic efficacy of mrTRG was analyzed using the Kappa test with pTRG as the gold standard,and baseline MRI morphological parameters were compared between the two groups.Re-ceiver operating characteristic(ROC)curves were used to determine the efficacy of multi-modal magnetic resonance imaging using mrTRG combined with MRI morphological parameters in evaluating the therapeutic effect after neoadjuvant concurrent chemoradiotherapy.Results The modified dichotomous tumor regression grading scheme was adopted.mrTRG showed medium-high concordance with pTRG,with a kappa value of 0.698(95%CI:0.492～0.904,P＜0.05).Single factor analysis showed that the differences in T3a stage,circumferential resection mar-gin(CRM)and mrTRGbiomarks between the good and poor curative effect groups were statistically significant(P<0.05).The area under the curve(AUC)of NCRT response assessed by mrTRG,baseline T3a stage,and CRM was 0.842,0.693,and 0.721,respectively,and the combined model had a sensitivity of 89.5%,a specificity of 82.8%,and an AUC of 0.907,which was significantly superior to baseline morphologic param-eters(P<0.05),and there was no statistically significant differences between the combined model and mrTRG mark(P=0.07).Conclusion Preop-erative mrTRG combined with baseline morphological parameters has high diagnostic efficacy in assessing NCRT response in rectal cancer,and it provides an imaging evidence for the clinical setting of individualized treatment plan.
关键词
多模态磁共振成像/直肠癌/新辅助放化疗/磁共振肿瘤退缩分级Key words
Multi-modal magnetic resonance imaging/Rectal cancer/Neoadjuvant chemoradiotherapy/MRI tumor regression grade引用本文复制引用
出版年
2024
NETL
NSTL
万方数据