Pretreatment outcome prediction of rectal cancer based on baseline pelvic MRI

doi:10.3877/cma.j.issn.2095-3224.2021.04.010

Abstract

Abstract:

Objective

To expror pretreatment prognostic factors in patients of MR-defined T3 stage locally advanced rectal cancer (mrT3-LARC) on the basis of baseline pelvic MRI, in order to promote indivadulized therapy and improve patient outcomes.

Methods

The clinical data of 157 patients of mrT3-LARC who received neoadjuvant chemoradiotherapy (NCRT) and radical surgery in our hospital from 2008 to 2012 were retrospectivly rereviewed, and their follow-up information were recorded as progression-free survival (PFS). Baseline pelvic MRI features were evaluated independently by two experienced radiologists and consensus was reached. Kaplan-Meier (K-M) survival curve and Cox analysis were performed using SPSS software.

Results

The ratio of male to female was about 2∶1, and the average age was (55±12) years. The median follow-up period was 6.6 (3.5~9.8) years. In K-M analysis, all the MRI features showed an effect on PFS, while age and sex did not. In Cox analysis, T3 substage (HR=7.36, P＜0.001), EMVI grade (HR=2.72, P＜0.001) and mucinous adenocarcinoma subtype (HR=2.36, P=0.024) as assessed by baseline MRI were proved to be independent risk factors for PFS in patients with mrT3-LARC.

Conclusion

Baseline pelvic MRI can independently predict survival risk in patients with mrT3- LARC, and accurate reporting can promote individualized treatment and improve patient outcomes.

Key words: Rectal neoplasms, MRI, Neoadjuvant chemoradiotherapy, Survival analysis

Qing Zhao, Hongmei Zhang. Pretreatment outcome prediction of rectal cancer based on baseline pelvic MRI[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2021, 10(04): 392-398.

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Figures/Tables 6

References 25

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序列	重复时间TR（ms）	回波时间TE（ms）	矩阵	视场角（mm²）	回波链	激励次数	层厚（mm）	层间距（mm）
斜轴位高分辨T2加权成像	6 000~6 500	95~105	256×320	160	21	4	3	0.3
矢状/冠状位T2加权成像	6 000~6 500	95~105	256×320	240	21	4	4	0.4
轴位T1加权成像	500~600	8~10	288×320	220	4	2	5	0.5
轴位T2加权脂肪抑制成像	4 500~5 000	80~90	256×320	300	18	2	4	0.4
轴位弥散加权成像（b=0或1 000 s/mm²）	2 000~2 500	0	128×128	300	1	8	3	0.5
T1加权动态增强成像	3~8	1~3	256×320	300	1	1	2	0.5

序列	重复时间TR（ms）	回波时间TE（ms）	矩阵	视场角（mm²）	回波链	激励次数	层厚（mm）	层间距（mm）
斜轴位高分辨T2加权成像	6 000~6 500	95~105	256×320	160	21	4	3	0.3
矢状/冠状位T2加权成像	6 000~6 500	95~105	256×320	240	21	4	4	0.4
轴位T1加权成像	500~600	8~10	288×320	220	4	2	5	0.5
轴位T2加权脂肪抑制成像	4 500~5 000	80~90	256×320	300	18	2	4	0.4
轴位弥散加权成像（b=0或1 000 s/mm²）	2 000~2 500	0	128×128	300	1	8	3	0.5
T1加权动态增强成像	3~8	1~3	256×320	300	1	1	2	0.5

MRI征象	评价标准
肿瘤位置^［9］	矢状位T2加权图像选取显示肿瘤最长径层面，从肿瘤隆起的最头端测量起至肛缘水平止，＜5 cm为下段直肠癌，5 cm~10 cm为中段直肠癌，＞10 cm为上段直肠癌
最长径	矢状位T2加权图像选取显示肿瘤头尾长度最大的层面测量
最大厚度	斜轴位高分辨T2加权图像选取显示肿瘤横截面积最大层面测量
最大环周比	斜轴位高分辨T2加权图像选取显示肿瘤占肠壁环周比例最大层面测量
T3亚分期^［9］	斜轴位高分辨T2加权图像从肿瘤所在部位的肠壁固有肌层外缘起至肿瘤向外延伸最远端止，测量肿瘤壁外浸润深度（EMD）：T3a（EMD＜5 mm），T3b（EMD，5~10 mm），T3c（EMD＞10 mm）
EMVI分级^［9］	0级：肿瘤在肌层延伸形态呈非结节状，肿瘤浸润区附近无血管结构 1级：肿瘤有极少的壁外条索或结节状延伸，但并不在血管结构附近 2级：壁外血管周围可见条状肿瘤组织，但血管管腔直径正常，并且在血管内没有明确的肿瘤信号 3级：壁外血管内可见类似肿瘤的信号、血管轮廓和管径略扩张 4级：壁外血管轮廓明显不规则，或在血管管腔内出现明确的肿瘤信号且呈结节状扩张
MRF受累^［9］	斜轴位高分辨T2加权图像测量肿瘤、（或）癌结节、（或）转移淋巴结、（或）受侵的壁外血管最外缘与直肠系膜筋膜的最短垂直距离：≤1 mm为受累
黏液腺癌亚型^［10］	黏液成分在T2加权图像表现为高于盆腔脂肪组织的高信号，若黏液成分占据肿瘤总体积超过50%，则诊断为黏液腺癌亚型
淋巴结转移^{［11, 12］}	淋巴结短径＞8 mm，（或）T2加权图像呈类似肿瘤的不均匀稍高信号，（或）形态边缘不规整

MRI征象	评价标准
肿瘤位置^［9］	矢状位T2加权图像选取显示肿瘤最长径层面，从肿瘤隆起的最头端测量起至肛缘水平止，＜5 cm为下段直肠癌，5 cm~10 cm为中段直肠癌，＞10 cm为上段直肠癌
最长径	矢状位T2加权图像选取显示肿瘤头尾长度最大的层面测量
最大厚度	斜轴位高分辨T2加权图像选取显示肿瘤横截面积最大层面测量
最大环周比	斜轴位高分辨T2加权图像选取显示肿瘤占肠壁环周比例最大层面测量
T3亚分期^［9］	斜轴位高分辨T2加权图像从肿瘤所在部位的肠壁固有肌层外缘起至肿瘤向外延伸最远端止，测量肿瘤壁外浸润深度（EMD）：T3a（EMD＜5 mm），T3b（EMD，5~10 mm），T3c（EMD＞10 mm）
EMVI分级^［9］	0级：肿瘤在肌层延伸形态呈非结节状，肿瘤浸润区附近无血管结构 1级：肿瘤有极少的壁外条索或结节状延伸，但并不在血管结构附近 2级：壁外血管周围可见条状肿瘤组织，但血管管腔直径正常，并且在血管内没有明确的肿瘤信号 3级：壁外血管内可见类似肿瘤的信号、血管轮廓和管径略扩张 4级：壁外血管轮廓明显不规则，或在血管管腔内出现明确的肿瘤信号且呈结节状扩张
MRF受累^［9］	斜轴位高分辨T2加权图像测量肿瘤、（或）癌结节、（或）转移淋巴结、（或）受侵的壁外血管最外缘与直肠系膜筋膜的最短垂直距离：≤1 mm为受累
黏液腺癌亚型^［10］	黏液成分在T2加权图像表现为高于盆腔脂肪组织的高信号，若黏液成分占据肿瘤总体积超过50%，则诊断为黏液腺癌亚型
淋巴结转移^{［11, 12］}	淋巴结短径＞8 mm，（或）T2加权图像呈类似肿瘤的不均匀稍高信号，（或）形态边缘不规整

危险因素	患者数（例）	无进展生存期（PFS）
危险因素	患者数（例）	HR	95%CI	P值
年龄（岁）		1.538	0.861~2.747	0.146
≤55	86
＞55	71
性别		0.798	0.442~1.444	0.456
女性	56
男性	101
肿瘤位置		1.666	1.026~2.705	0.039
上段	16
中段	73
下段	68
肿瘤最长径^a（mm）		4.777	2.423~9.417	＜0.001
≤38	84
＞38	73
肿瘤最大厚度^a（mm）		5.409	2.741~10.676	＜0.001
≤18	86
＞18	71
肿瘤最大环周比^a（%）		2.857	1.568~5.205	0.001
≤60	92
＞60	65
T3亚分期		13.059	6.244~27.314	＜0.001
T3a	35
T3b	72
T3c	50
EMVI分级		2.884	2.088~3.985	＜0.001
0级	8
1级	38
2级	59
3级	43
4级	9
MRF受累		3.876	2.125~7.070	＜0.001
阴性	130
阳性	27
黏液腺癌亚型		6.052	3.179~11.523	＜0.001
阴性	142
阳性	15
区域淋巴结转移		2.902	1.625~5.180	＜0.001
阴性	114
阳性	43
侧方淋巴结转移		4.707	2.500~8.862	＜0.001
阴性	138
阳性	19

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