文章摘要
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 locally advanced rectal cancer
投稿时间：2023-11-19  
DOI：10.3969/j.issn.1000-0399.2024.06.003
中文关键词: 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
英文关键词: Multi-modal magnetic resonance imaging  Rectal cancer  Neoadjuvant chemoradiotherapy  MRI tumor regression grade
基金项目:
作者单位
周燕飞 230031 安徽合肥 中国科学院合肥肿瘤医院医学影像中心 
李雪萌 233030 安徽蚌埠 蚌埠医学院研究生院 
凡健 230031 安徽合肥 中国科学院合肥肿瘤医院医学影像中心 
王璜 230031 安徽合肥 中国科学院合肥肿瘤医院医学影像中心 
孙秋艳 230031 安徽合肥 中国科学院合肥肿瘤医院医学病理中心 
高飞 230031 安徽合肥 中国科学技术大学附属第一医院西区影像科 
董江宁 230031 安徽合肥 中国科学技术大学附属第一医院西区影像科 
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中文摘要:
      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。
英文摘要:
      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 advanced 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 Technology 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 underwent 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. Receiver 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 margin (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 parameters (P＜0.05), and there was no statistically significant differences between the combined model and mrTRG mark(P=0.07).Conclusion Preoperative 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.
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