One millimetre is the safe cut-off for magnetic resonance imaging prediction of surgical margin status in rectal cancer
One millimetre is the safe cut-off for magnetic resonance imaging prediction of surgical margin status in rectal cancer
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DOI：
10.1002/bjs.7458
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发表时间：
2011-06-01
影响因子：
9.6
通讯作者：
Brown, G.
中科院分区：
文献类型：
--
作者：
Taylor, F. G. M.;Quirke, P.;Brown, G.
背景：病理累及的直肠癌边缘被定义为距离手术切除边缘1mm以内的肿瘤。磁共振成像（MRI）的预测安全范围没有标准定义。本研究的目的是根据术前MRI对环切缘（CRM）的评估，评估哪个截点（1,2,5 mm）是局部复发的最佳预测指标。方法：在MERCURY研究中，前瞻性地收集记录有放射学边缘状态的患者肿瘤与直肠系膜筋膜之间的距离的数据。比较肿瘤到直肠系膜筋膜的MRI距离为1mm或小于1mm、大于1mm至2mm、大于2mm至5mm和大于5mm时的阳性边缘和局部复发率。采用Cox比例风险回归法确定切缘受累程度对局部复发时间的影响。结果:单变量分析表明,相对于核磁共振测量的距离超过5毫米,局部复发的风险比(人力资源)为3.90(95%可信区间1.99到7.63;P < 0.001), 1毫米或更少的利润,0.81(0.36到1.85;P = 0.620)的优势超过1毫米到2毫米,和0.33(0.10到1.08;P = 0.067)的利润率大于2毫米5毫米。多变量分析显示，MRI与直肠系膜筋膜的距离和术前治疗对局部复发的影响，无论术前治疗如何，1 mm或更小的边缘仍然显著（HR 3.72, 1.43至9.71;P = 0.007）。结论：对于直肠癌的术前分期，MRI预测CRM累及的最佳截止距离为1mm。使用大于此的临界值似乎不能确定局部复发风险较高的患者。
Background: A pathologically involved margin in rectal cancer is defined as tumour within 1 mm of the surgical resection margin. There is no standard definition of a predicted safe margin on magnetic resonance imaging (MRI). The aim of this study was to assess which cut-off (1, 2 or 5 mm) was the best predictor of local recurrence based on preoperative MRI assessment of the circumferential resection margin (CRM).Methods: Data were collected prospectively on the distance between the tumour and mesorectal fascia for patients with documented radiological margin status in the MERCURY study. Positive margin and local recurrence rates were compared for MRI distances from the tumour to the mesorectal fascia of 1 mm or less, more than 1 mm up to 2 mm, more than 2 mm up to 5 mm, and more than 5 mm. The Cox proportional hazard regression method was used to determine the effect of level of margin involvement on time to local recurrence.Results: Univariable analysis showed that, relative to a distance measured by MRI of more than 5 mm, the hazard ratio (HR) for local recurrence was 3.90 (95 per cent confidence interval 1.99 to 7.63; P < 0.001) for a margin of 1 mm or less, 0.81 (0.36 to 1.85; P = 0.620) for a margin of more than 1 mm up to 2 mm, and 0.33 (0.10 to 1.08; P = 0.067) for a margin greater than 2 mm up to 5 mm. Multivariable analysis of the effect of MRI distance to the mesorectal fascia and preoperative treatment on local recurrence showed that a margin of 1 mm or less remained significant regardless of preoperative treatment (HR 3.72, 1.43 to 9.71; P = 0.007).Conclusion: For preoperative staging of rectal cancer, the best cut-off distance for predicting CRM involvement using MRI is 1 mm. Using a cut-off greater than this does not appear to identify patients at higher risk of local recurrence.