ABSTRACT
AIM: Neoadjuvant rectal (NAR) score is an early surrogate for longer-term outcomes in rectal cancer undergoing radiotherapy and resection. In an era of increasing organ preservation, resection specimens are not always available to calculate the NAR score. Post-treatment magnetic resonance imaging (MRI) re-staging of regression is subjective, limiting reproducibility. We explored the potential for a novel MRI-based NAR score (mrNAR) adapted from the NAR formula. METHODS: Locally advanced rectal cancer patients undergoing neoadjuvant therapy (nCRT) and surgery were retrospectively identified between 2008 and 2020 in a single cancer network. mrNAR was calculated by adapting the NAR formula, replacing pathological (p) stages with post-nCRT MR stages (ymr). Cox regression assessed relationships between clinicopathological characteristics, NAR and mrNAR with overall survival (OS) and recurrence-free survival (RFS). RESULTS: In total, 381 NAR and 177 mrNAR scores were calculated. On univariate analysis NAR related to OS (hazard ratio [HR] 2.05, 95% confidence interval [CI] 1.33-3.14, p = 0.001) and RFS (HR 2.52, 95% CI 1.77-3.59, p = 0.001). NAR 3-year OS <8 was 95.3%, 8-16 was 88.6% and >16 was 80%. mrNAR related to OS (HR 2.96, 95% CI 1.38-6.34, p = 0.005) and RFS (HR 2.99, 95% CI 1.49-6.00, p = 0.002). 3-year OS for mrNAR <8 was 96.2%, 8-16 was 92.4% and >16 was 78%. On multivariate analysis, mrNAR was a stage-independent predictor of OS and RFS. mrNAR corresponded to NAR score category in only 15% (positive predictive value 0.23) and 47.5% (positive predictive value 0.48) of cases for categories <8 and >16, respectively. CONCLUSIONS: Neoadjuvant rectal score is validated as a surrogate end-point for long-term outcomes. mrNAR categories do not correlate with NAR but have stage-independent prognostic value. mrNAR may represent a novel surrogate end-point for future neoadjuvant treatments that focus on organ preservation.
Subject(s)
Neoplasms, Second Primary , Rectal Neoplasms , Humans , Neoadjuvant Therapy , Retrospective Studies , Reproducibility of Results , Prognosis , Rectal Neoplasms/diagnostic imaging , Rectal Neoplasms/therapy , Chemoradiotherapy , Chemoradiotherapy, Adjuvant , Biomarkers , Magnetic Resonance Imaging , Treatment Outcome , Neoplasm StagingABSTRACT
A 28-year-old veteran presented to the Wilford Hall dermatology clinic in San Antonio, Texas, with a six-month history of a rash that his primary care physician diagnosed as molluscum contagiosum. The rash consisted of clusters of 3 to 6mm yellowish papules with erythematous borders that concentrated on the extensor surfaces of his extremities, lower back, and buttocks. A biopsy determined that the patient had a case of eruptive xanthoma. Subsequent laboratory testing revealed that the patient had a type IV familial hyperlipidemia with a triglyceride count of 1718mg/dL.
ABSTRACT
The authors report a case of portal vein thrombosis, with no underlying malignant cause identified, which was initially detected by fludeoxyglucose positron emission tomography/CT (FDG PET/CT) and subsequently confirmed by both contrast enhanced CT and MRI. The multimodality imaging findings are outlined, the potential clinical implications discussed and note made of the possible FDG PET/CT mimics of this disorder.