Magnetic resonance imaging tumor response score (mrTRS) predicts therapeutic effect and prognosis of locally advanced rectal cancer after neoadjuvant chemoradiotherapy: A prospective, multi-center study
Magnetic resonance imaging tumor response score (mrTRS) predicts therapeutic effect and prognosis of locally advanced rectal cancer after neoadjuvant chemoradiotherapy: A prospective, multi-center study
复制标题
磁共振成像肿瘤反应评分（mrTRS）预测局部晚期直肠癌新辅助放化疗后的治疗效果和预后：一项前瞻性、多中心研究
DOI：
10.1016/j.radonc.2020.08.028
复制
发表时间：
2020-10-01
影响因子：
5.7
通讯作者：
Sun, Ying-Shi
中科院分区：
文献类型：
--
作者：
Guan, Zhen;Sun, Rui-Jia;Sun, Ying-Shi
背景和目的：MRI评估的肿瘤消退等级（mrTRG）由于其主观性和与病理肿瘤消退等级（pTRG）的一致性差而受到限制。材料与方法：回顾性分析214例局部进展期直肠癌（LARC）患者（未发表资料）的MRI肿瘤反应评分（mrTRS），建立新的MRI肿瘤反应评分（mrTRS）标准。随后，878例LARC患者入组了一项前瞻性多中心研究。收集术前及术后MRI资料，并结合病理、临床及随访资料，分析其影像学特征。采用Kaplan-Meier法结合log-rank估计和多变量考克斯回归模型对新辅助放化疗（NACRT）后的LARC患者的mrTRS预后进行评估。结果：mrTRS和mrTRG对3年预后的预测能力分别为：m按良好和中度应答者分层的mrTRS显示死亡风险显著降低（HR = 0.04，95%CI 0.01-0.31; HR = 0.35，95%CI 0.23-0.52），远处转移（HR = 0.25，95%CI 0.13-0.52; HR = 0.42，95%CI 0.30-0.58）和局部复发（HR = 0.01，95%CI 0.23-0.52;HR = 0.38，95%CI 0.16-0.90）。相比之下，在mrTRG分层组中未观察到显著差异。观察者间对mrTRS和mrTRG评价的一致性分别为（kappa = 0.92和0.62）。结论：mrTRS可作为评估LARC患者NACRT肿瘤消退等级的有效预测因子。(C)2020年，任作家。由爱思唯尔公司出版
Background and purpose: The MRI-assessed tumor regression grade (mrTRG) is limited due to its subjec-tivity and poor consistency on pathological tumor regression grade (pTRG). A new MRI criterion was established to predict the prognosis of locally advanced rectal cancer (LARC).Materials and methods: The new MRI criterion magnetic resonance imaging tumor response score (mrTRS) was based on the retrospective sample of 214 LARC patients (unpublished data). Subsequently, 878 LARC patients were enrolled for a prospective, multicenter study. Baseline and postoperative MRI were obtained, and imaging features were measured by collecting the pathological, clinical and follow-up data. Kaplan-Meier method with log-rank estimate and multivariate cox regression model was used to determine the prognosis of mrTRS in LARC patients with neoadjuvant chemoradiotherapy (NACRT). The predictive capability of 3-year prognosis between mrTRS and mrTRG was determined by time-dependent ROC curves.Results: The results demonstrated that mrTRS acted as an independent predictor of survival outcomes. mrTRS stratified by good and moderate responders showed significantly lower risk of death (HR = 0.04, 95%CI 0.01-0.31; HR = 0.35, 95%CI 0.23-0.52), distant metastasis (HR = 0.25, 95%CI 0.13-0.52; HR = 0.42, 95%CI 0.30-0.58), and local recurrence when compared with poor responders(HR = 0.0 1 95%CI 0.23-0.52;HR = 0.38, 95%CI 0.16-0.90). In contrast, no significant difference was observed among mrTRG stratified groups. Excellent and substantial interobserver agreement for mrTRS and mrTRG evaluation was observed (kappa = 0.92 and 0.62), respectively.Conclusion: mrTRS can serve as an effective predictor for assessing tumor regression grade in LARC patients with NACRT. (C) 2020 The Authors. Published by Elsevier B.V.