使用内窥镜和放射学方法结合中期和最终分析在新辅助治疗中的作用。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2024-11-19 DOI:10.1016/j.amjsurg.2024.116104

Kamil Erozkan , David Liska , Ayda Oktem , Ali Alipouriani , Lukas Schabl , Michael A. Valente , Jacob A. Miller , Andrei S. Purysko , Scott R. Steele , Emre Gorgun

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引用次数: 0

摘要

背景：我们旨在比较柔性乙状结肠镜（FS）、直肠磁共振成像（MRI）及其组合在中期（i）和最终（f）分析中的相对性能，以评估直肠癌全新药辅助治疗（TNT）后与完全缓解（CR）的一致性：方法：对2015年至2022年期间选择TNT并接受FS和MRI重新分期的患者进行评估。采用加权κ检验分析评估方法与CR之间的一致性：由208名患者组成的队列显示，CR率为42.3%。在对单个方法进行评估时，单用 fFS 检测 CR 的灵敏度最高（68.2%），一致性达到中等水平（κ = 0.46）。只有iFS-fFS和fFS-fMRI的组合才能达到与单独使用fFS相当的一致性水平：结论：在现有的诊断工具中，最终 MRI 和 FS 的组合与 CR 的一致性似乎仍然最高，敏感性也相对较高。此外，中期磁共振成像可能不会增加显著的临床价值，因此可以省略。

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The role of combining interim and final analysis by using endoscopic and radiologic methods in total neoadjuvant treatment

Background

We aim to compare the relative performance of flexible sigmoidoscopy (FS), rectal magnetic resonance imaging (MRI), and their combinations during interim (i) and final (f) analysis to evaluate concordance with complete response (CR) following total neoadjuvant treatment (TNT) in rectal cancer.

Method

Patients who opted TNT and underwent restaging with FS and MRI between 2015 and 2022 were evaluated. Concordance between the assessment methods and CR was analyzed using the weighted-κ test.

Results

A cohort comprising 208 patients revealed CR rate of 42.3 %. When evaluating individual methods, fFS alone demonstrated the most heightened sensitivity (68.2 %) for CR detection, with a moderate level of concordance (κ = 0.46). Only the combinations of iFS-fFS and fFS-fMRI reached a comparable level of concordance to that achievable by fFS alone.

Conclusion

Among the available diagnostic tools, the combination of final MRI and FS still appears to offer the highest concordance with CR, with relatively higher sensitivity. Additionally, interim MRI may not add significant clinical value and could be omitted.

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.