Assessment of Clinical Complete Response After Chemoradiation for Rectal Cancer with Digital Rectal Examination, Endoscopy, and MRI: Selection for Organ-Saving Treatment.
Assessment of Clinical Complete Response After Chemoradiation for Rectal Cancer with Digital Rectal Examination, Endoscopy, and MRI: Selection for Organ-Saving Treatment.
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DOI：
10.1245/s10434-015-4687-9
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发表时间：
2015-11
影响因子：
3.7
通讯作者：
Beets GL
中科院分区：
文献类型：
--
作者：
Maas M;Lambregts DM;Nelemans PJ;Heijnen LA;Martens MH;Leijtens JW;Sosef M;Hulsewé KW;Hoff C;Breukink SO;Stassen L;Beets-Tan RG;Beets GL
直肠癌放化疗（CRT）的反应可以通过临床检查（包括直肠指检（DRE）和内窥镜检查）以及MRI来评估。选择完全缓解（CR）进行器官保留治疗需要高准确性。本研究的目的是评价临床检查（内镜检查，有或无活检和DRE），T2 W-MRI和弥散加权MRI（DWI）检测CRT后CR的价值。这项在大学医院进行的前瞻性队列研究招募了50名患者，这些患者在CRT后6-8周接受了临床评估（DRE、内镜检查（有或无活检））、T2 W-MRI和DWI。使用置信水平对CR的可能性进行评分。参考标准是组织病理学或等待观察方法病例的无复发间隔>12个月。通过受试者操作特征曲线下面积计算诊断性能，并具有相应的灵敏度和特异性。使用似然比对策略进行评估和比较。50例患者中有17例（34%）达到CR。临床评估的曲线下面积为0.88（0.78-1.00），T2 W-MRI和DWI为0.79（0.66-0.92）。结合这些方式，预测CR的后测概率为98%。相反，当所有模式均显示肿瘤残留时，15%的患者仍达到CR。CRT后的临床评估是识别CRT后CR的唯一最准确的方式。MRI与DWI的结合进一步提高了诊断性能，可以推荐联合使用作为CRT后安全准确选择CR的最佳策略。
The response to chemoradiotherapy (CRT) for rectal cancer can be assessed by clinical examination, consisting of digital rectal examination (DRE) and endoscopy, and by MRI. A high accuracy is required to select complete response (CR) for organ-preserving treatment. The aim of this study was to evaluate the value of clinical examination (endoscopy with or without biopsy and DRE), T2W-MRI, and diffusion-weighted MRI (DWI) for the detection of CR after CRT. This prospective cohort study in a university hospital recruited 50 patients who underwent clinical assessment (DRE, endoscopy with or without biopsy), T2W-MRI, and DWI at 6–8 weeks after CRT. Confidence levels were used to score the likelihood of CR. The reference standard was histopathology or recurrence-free interval of >12 months in cases of wait-and-see approaches. Diagnostic performance was calculated by area under the receiver operator characteristics curve, with corresponding sensitivities and specificities. Strategies were assessed and compared by use of likelihood ratios. Seventeen (34 %) of 50 patients had a CR. Areas under the curve were 0.88 (0.78–1.00) for clinical assessment and 0.79 (0.66–0.92) for T2W-MRI and DWI. Combining the modalities led to a posttest probability for predicting a CR of 98 %. Conversely, when all modalities indicated residual tumor, 15 % of patients still experienced CR. Clinical assessment after CRT is the single most accurate modality for identification of CR after CRT. Addition of MRI with DWI further improves the diagnostic performance, and the combination can be recommended as the optimal strategy for a safe and accurate selection of CR after CRT.