MRI Predicts Residual Disease and Outcomes in Watch-and-Wait Patients with Rectal Cancer.
IF 12.1
1区 医学
Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Hannah Williams, Dana M Omer, Hannah M Thompson, Sabrina T Lin, Floris S Verheij, Joao Miranda, Jonathan B Yuval, James Buckley, Michael R Marco, Li-Xuan Qin, David A Dombroski, Rajendra Kedar, Aytekin Oto, Elena Korngold, Joseph C Veniero, Sunil Gandhi, Arun Krishnaraj, Minal Jagtiani, Kirk Ohanian, Dan Vu, Thomas A Hope, Sonia Lee, Ashish P Wasnik, Nikhil Madhuripan, Marc J Gollub, Julio Garcia-Aguilar
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Abstract
Background MRI plays a crucial role in restaging locally advanced rectal cancer treated with total neoadjuvant therapy (TNT); however, prospective studies have not evaluated its ability to accurately select patients for nonoperative management. Purpose To evaluate the ability of restaging MRI to predict oncologic outcomes and identify imaging features associated with residual disease (RD) after TNT. Materials and Methods This was a secondary analysis of the Organ Preservation in Rectal Adenocarcinoma (OPRA) trial, which randomized participants from April 2014 to March 2020 with stages II or III rectal adenocarcinoma to undergo either induction or consolidation TNT. Participants enrolled in the OPRA trial who underwent restaging MRI were eligible for inclusion in the present study. Radiologists classified participants as having clinical complete response (cCR), near-complete clinical response (nCR), or incomplete clinical response (iCR) based on restaging MRI at a mean of 8 weeks ± 4 (SD) after treatment. Oncologic outcomes according to MRI response category were assessed using Kaplan-Meier curves. Logistic regression analysis was performed to identify imaging characteristics associated with RD. Results A total of 277 participants (median age, 58 years [IQR, 17 years]; 179 male) who were randomized in the OPRA trial had restaging MRI forms completed. The median follow-up duration was 4.1 years. Participants with cCR had higher rates of organ preservation compared with those with nCR (65.3% vs 41.6%, log-rank P < .001). Five-year disease-free survival for participants with cCR, nCR, and iCR was 81.8%, 67.6%, and 49.6%, respectively (log-rank P < .001). The MRI response category also predicted overall survival (log-rank P < .001), distant recurrence-free survival (log-rank P = .005), and local regrowth (log-rank P = .02). Among the 266 participants with at least 2 years of follow-up, 129 (48.5%) had RD. At multivariable analysis, the presence of restricted diffusion (odds ratio, 2.50; 95% CI: 1.22, 5.24) and abnormal nodal morphologic features (odds ratio, 5.04; 95% CI: 1.43, 23.9) remained independently associated with RD. Conclusion The MRI response category was predictive of organ preservation and survival. Restricted diffusion and abnormal nodal morphologic features on restaging MRI scans were associated with increased likelihood of residual tumor. ClinicalTrials.gov identifier: NCT02008656 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Milot in this issue.
磁共振成像预测直肠癌患者的残留病灶和预后
背景 MRI 在对接受全新药辅助治疗 (TNT) 的局部晚期直肠癌进行重新分期方面发挥着重要作用;然而,前瞻性研究尚未评估其准确选择患者接受非手术治疗的能力。目的 评估 MRI 重分期预测肿瘤预后的能力,并确定与 TNT 后残留疾病(RD)相关的影像学特征。材料与方法 这是直肠腺癌器官保留(OPRA)试验的一项二次分析,该试验在 2014 年 4 月至 2020 年 3 月期间对 II 期或 III 期直肠腺癌患者进行随机分组,让他们接受诱导或巩固 TNT 治疗。参加 OPRA 试验并接受磁共振成像重分期的参与者符合纳入本研究的条件。根据治疗后平均 8 周 ± 4 (SD) 的磁共振成像重分期结果,放射科医生将参与者分为临床完全应答 (cCR)、临床接近完全应答 (nCR) 或临床不完全应答 (iCR)。使用卡普兰-梅耶曲线评估根据磁共振成像反应类别得出的肿瘤学结果。进行逻辑回归分析以确定与RD相关的影像学特征。结果 在 OPRA 试验中,共有 277 名随机参与者(中位年龄 58 岁 [IQR,17 岁];179 名男性)填写了 MRI 重分期表。中位随访时间为 4.1 年。与nCR患者相比,cCR患者的器官保留率更高(65.3% vs 41.6%,log-rank P < .001)。cCR、nCR和iCR患者的五年无病生存率分别为81.8%、67.6%和49.6%(对数秩P < .001)。MRI 反应类别还能预测总生存率(对数秩 P < .001)、无远处复发生存率(对数秩 P = .005)和局部再生率(对数秩 P = .02)。在随访至少 2 年的 266 名参与者中,129 人(48.5%)患有 RD。在多变量分析中,弥散受限(几率比为 2.50;95% CI:1.22, 5.24)和结节形态特征异常(几率比为 5.04;95% CI:1.43, 23.9)仍与 RD 独立相关。结论 MRI 反应类别可预测器官保存和生存率。重新分期的 MRI 扫描中弥散受限和结节形态特征异常与肿瘤残留可能性增加有关。ClinicalTrials.gov 标识符:NCT02008656 © RSNA, 2024 本文有补充材料。另请参阅本期Milot的社论。
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