Modest agreement between magnetic resonance and pathological tumor regression after neoadjuvant therapy for rectal cancer in the real world.

Autor: Achilli P; Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA.; Department of Mini-invasive Surgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy., Magistro C; Department of Mini-invasive Surgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy., Abd El Aziz MA; Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA., Calini G; Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA., Bertoglio CL; Department of Mini-invasive Surgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy., Ferrari G; Department of Mini-invasive Surgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy., Mari G; Department of Surgery, Desio Hospital, Desio, Italy., Maggioni D; Department of Surgery, Desio Hospital, Desio, Italy., Peros G; Department of Biomedical Sciences, Humanitas University, Milan, Italy., Tamburello S; Department of Biomedical Sciences, Humanitas University, Milan, Italy., Coppola E; Department of Biomedical Sciences, Humanitas University, Milan, Italy., Spinelli A; Department of Biomedical Sciences, Humanitas University, Milan, Italy.; IRCCS Humanitas Research Hospital, Milan, Italy., Grass F; Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland., Martin D; Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland., Hahnloser D; Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland., Salvatori A; Branch of Medical Statistics, Biometry, and Epidemiology 'G. A. Maccacaro,' Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy., De Simoni S; Department of Radiology, Grande Ospedale Metropolitano Niguarda, Milan, Italy., Sheedy SP; Mayo Clinic Department of Radiology, Rochester, Minnesota, USA., Fletcher JG; Mayo Clinic Department of Radiology, Rochester, Minnesota, USA., Larson DW; Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Jazyk: angličtina
Zdroj: International journal of cancer [Int J Cancer] 2022 Jul 01; Vol. 151 (1), pp. 120-127. Date of Electronic Publication: 2022 Mar 09.
DOI: 10.1002/ijc.33975
Abstrakt: Magnetic resonance imaging (MRI) is routinely used for preoperative tumor staging and to assess response to therapy in rectal cancer patients. The aim of our study was to evaluate the accuracy of MRI based restaging after neoadjuvant chemoradiotherapy (CRT) in predicting pathologic response. This multicenter cohort study included adult patients with histologically confirmed locally advanced rectal adenocarcinoma treated with neoadjuvant CRT followed by curative intent elective surgery between January 2014 and December 2019 at four academic high-volume institutions. Magnetic resonance tumor regression grade (mrTRG) and pathologic tumor regression grade (pTRG) were reviewed and compared for all the patients. The agreement between radiologist and pathologist was assessed with the weighted k test. Risk factors for poor agreement were investigated using logistic regression. A total of 309 patients were included. Modest agreement was found between mrTRG and pTRG when regression was classified according to standard five-tier systems (k = 0.386). When only two categories were considered for each regression system, (pTRG 0-3 vs pTRG 4; mrTRG 2-5 vs mrTRG 1) an accuracy of 78% (95% confidence interval [CI] 0.73-0.83) was found between radiologic and pathologic assessment with a k value of 0.185. The logistic regression model revealed that "T3 greater than 5 mm extent" was the only variable significantly impacting on disagreement (OR 0.33, 95% CI 0.15-0.68, P = .0034). Modest agreement exists between mrTRG and pTRG. The chances of appropriate assessment of the regression grade after neoadjuvant CRT appear to be higher in case of a T3 tumor with at least 5 mm extension in the mesorectal fat at the pretreatment MRI.
(© 2022 UICC.)
Databáze: MEDLINE
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