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[Predictive value of combination of MRI tumor regression grade and apparent diffusion coefficient for pathological complete remission after neoadjuvant treatment of locally advanced rectal cancer].
Xu, N; Huang, F C; Li, W L; Luan, X; Jiang, Y M; He, B.
  • Xu N; Department of Oncology, the First Affiliate Hospital, Kunming Medical University, Kunming 650032, China.
  • Huang FC; Department of Oncology, the First Affiliate Hospital, Kunming Medical University, Kunming 650032, China.
  • Li WL; Department of Oncology, the First Affiliate Hospital, Kunming Medical University, Kunming 650032, China.
  • Luan X; Department of Oncology, the First Affiliate Hospital, Kunming Medical University, Kunming 650032, China.
  • Jiang YM; Medical Imaging Center, the First Affiliate Hospital, Kunming Medical University, Kunming 650032, China.
  • He B; Medical Imaging Center, the First Affiliate Hospital, Kunming Medical University, Kunming 650032, China.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(4): 359-365, 2021 Apr 25.
Article in Chinese | MEDLINE | ID: covidwho-827753
Semantic information from SemMedBD (by NLM)
1. Magnetic Resonance Imaging USES High resolution
Subject
Magnetic Resonance Imaging
Predicate
USES
Object
High resolution
2. Neoadjuvant Therapy TREATS Locally Advanced Malignant Neoplasm
Subject
Neoadjuvant Therapy
Predicate
TREATS
Object
Locally Advanced Malignant Neoplasm
3. Locally Advanced Malignant Neoplasm PROCESS_OF Patients
Subject
Locally Advanced Malignant Neoplasm
Predicate
PROCESS_OF
Object
Patients
4. Neoadjuvant Chemoradiotherapy ADMINISTERED_TO Patients
Subject
Neoadjuvant Chemoradiotherapy
Predicate
ADMINISTERED_TO
Object
Patients
5. Neoadjuvant Chemoradiotherapy PRECEDES Diffusion weighted imaging
Subject
Neoadjuvant Chemoradiotherapy
Predicate
PRECEDES
Object
Diffusion weighted imaging
6. Neoadjuvant Chemoradiotherapy PRECEDES T2 (Observed)-Weighted Imaging
Subject
Neoadjuvant Chemoradiotherapy
Predicate
PRECEDES
Object
T2 (Observed)-Weighted Imaging
7. Magnetic Resonance Imaging ADMINISTERED_TO Patients
Subject
Magnetic Resonance Imaging
Predicate
ADMINISTERED_TO
Object
Patients
8. Clinical Complete Response PROCESS_OF Patients
Subject
Clinical Complete Response
Predicate
PROCESS_OF
Object
Patients
9. Pathologic Complete Response PROCESS_OF Patients
Subject
Pathologic Complete Response
Predicate
PROCESS_OF
Object
Patients
10. Neoadjuvant Chemoradiotherapy TREATS Locally Advanced Malignant Neoplasm
Subject
Neoadjuvant Chemoradiotherapy
Predicate
TREATS
Object
Locally Advanced Malignant Neoplasm
11. Magnetic Resonance Imaging USES High resolution
Subject
Magnetic Resonance Imaging
Predicate
USES
Object
High resolution
12. Neoadjuvant Therapy TREATS Locally Advanced Malignant Neoplasm
Subject
Neoadjuvant Therapy
Predicate
TREATS
Object
Locally Advanced Malignant Neoplasm
13. Locally Advanced Malignant Neoplasm PROCESS_OF Patients
Subject
Locally Advanced Malignant Neoplasm
Predicate
PROCESS_OF
Object
Patients
14. Neoadjuvant Chemoradiotherapy ADMINISTERED_TO Patients
Subject
Neoadjuvant Chemoradiotherapy
Predicate
ADMINISTERED_TO
Object
Patients
15. Neoadjuvant Chemoradiotherapy PRECEDES Diffusion weighted imaging
Subject
Neoadjuvant Chemoradiotherapy
Predicate
PRECEDES
Object
Diffusion weighted imaging
16. Neoadjuvant Chemoradiotherapy PRECEDES T2 (Observed)-Weighted Imaging
Subject
Neoadjuvant Chemoradiotherapy
Predicate
PRECEDES
Object
T2 (Observed)-Weighted Imaging
17. Magnetic Resonance Imaging ADMINISTERED_TO Patients
Subject
Magnetic Resonance Imaging
Predicate
ADMINISTERED_TO
Object
Patients
18. Clinical Complete Response PROCESS_OF Patients
Subject
Clinical Complete Response
Predicate
PROCESS_OF
Object
Patients
19. Pathologic Complete Response PROCESS_OF Patients
Subject
Pathologic Complete Response
Predicate
PROCESS_OF
Object
Patients
20. Neoadjuvant Chemoradiotherapy TREATS Locally Advanced Malignant Neoplasm
Subject
Neoadjuvant Chemoradiotherapy
Predicate
TREATS
Object
Locally Advanced Malignant Neoplasm
ABSTRACT

Objective:

Pelvic high-resolution magnetic resonance imaging (MRI) has now become a standard method for evaluating the efficacy of neoadjuvant treatment for locally advanced rectal cancer (LARC). However, this traditional morphological qualitative assessment method based on T2-weighted imaging (T2WI) is not effective in predicting pathological complete remission (pCR). The purpose of this study is to investigate whether combining the magnetic resonance tumor regression grade (mrTRG) with apparent diffusion coefficient (ADC) can improve diagnostic value for pCR after preoperative neoadjuvant chemoradiotherapy (nCRT) of LARC.

Methods:

This was a diagnostic study. Clinicopathological data of 134 LARC patients who received nCRT and radical surgery in the First Affiliated Hospital of Kunming Medical University from January 2017 to December 2019 were retrospectively analyzed. All the patients underwent MRI which included T2WI and DWI sequences before and 8 weeks after nCRT. Two radiologists independently drew ROIs on T2WI and DWI to estimate mrTRG stage and calculate the mean ADC value. Receiver operating characteristics (ROC) method was applied to evaluate the predict value of mrTRG combined with mean ADC value for pCR.

Results:

Of 134 LARC patients, 85 were male and 49 were female with median age of 58 (28-82) years. After nCRT, MRI suggested 21 patients (15.7%) had clinical complete remission (cCR), e.g. mrTRG stage 1-2. Postoperative pathology revealed 31 (23.1%) patients had pCR. The evaluations of mrTRG and ADC value by the two readers were highly consistent, and the intra-group correlation coefficients were 0.83 (95% CI 0.703-0.881) and 0.96 (95% CI 0.989-0.996), respectively. There was a negative correlation between mrTRG and pCR (r(s)=-0.505, P<0.01), and a positive correlation between mean ADC value and pCR (r(s)=0.693, P<0.01). The ROC curve showed that mrTRG alone had a medium predictive value for pCR, with an area under the curve (AUC) of 0.832 (95% CI 0.743-0.921); the mean ADC value had a higher predictive value for pCR, with AUC of 0.906 (95% CI 0.869-0.962). The predictive value of the combined model of mrTRG and ADC value for pCR was significantly better than that of mrTRG alone (P=0.015), and the AUC was 0.908 (95% CI 0.849-0.968).

Conclusion:

Both mrTRG and mean ADC value can be non-invasive methods to predict the efficacy of nCRT for LARC. Combining the mean ADC value with mrTRG can result in better pCR prediction.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Rectal Neoplasms / Neoadjuvant Therapy Type of study: Experimental Studies / Observational study / Prognostic study / Qualitative research Limits: Aged / Female / Humans / Male / Middle aged Language: Chinese Journal: Zhonghua Wei Chang Wai Ke Za Zhi Journal subject: Gastroenterology Year: 2021 Document Type: Article Affiliation country: Cma.j.cn.441530-20200225-00089

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Rectal Neoplasms / Neoadjuvant Therapy Type of study: Experimental Studies / Observational study / Prognostic study / Qualitative research Limits: Aged / Female / Humans / Male / Middle aged Language: Chinese Journal: Zhonghua Wei Chang Wai Ke Za Zhi Journal subject: Gastroenterology Year: 2021 Document Type: Article Affiliation country: Cma.j.cn.441530-20200225-00089