{"title":"动脉期粘膜线性增强作为pMMR/MSS局部晚期直肠癌免疫治疗后病理完全缓解的指标","authors":"Jingjing Liu, Gengyun Miao, Wentao Tang, Lamei Deng, Shengxiang Rao, Mengsu Zeng, Liheng Liu","doi":"10.1007/s11547-025-02099-4","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Immunotherapy-based neoadjuvant chemoradiotherapy (iNCRT) has recently emerged for proficient mismatch repair/microsatellite stable (pMMR/MSS) locally advanced rectal cancer (LARC). Accurate identification of pathological complete response for primary tumor (ptPCR) post-treatment is critical for selecting patients eligible for watch-and-wait strategies. This study aimed to evaluate arterial-phase mucosal linear enhancement (AMLE) on contrast-enhanced T1-weighted imaging (CE-T1WI) for predicting ptPCR after iNCRT in pMMR/MSS LARC, compared to conventional T2-weighted/diffusion-weighted imaging (T2DWI) and rectal endoscopy.</p><p><strong>Methods: </strong>This retrospective study included patients with pMMR/MSS LARC who underwent total mesorectal excision after iNCRT between July 2022 and Oct 2024 at a tertiary referral academic center. Preoperative re-staging examinations were rectal endoscopy and MRI, included T2DWI and arterial-phase CE-T1WI for primary tumor assessment. Baseline and post-therapy features associated with ptPCR were identified using univariate and multivariable regression analysis. Diagnostic performance of endoscopy and different MRI protocols to identify ptPCR after iNCRT was evaluated using ROC curves.</p><p><strong>Results: </strong>In total, 75 patients (mean age, 57 years ± 10 [SD]; 54 male patients) were assessed. At histopathology, 29 patients achieved ptPCR. AMLE was more common in the ptPCR group than in the non-ptPCR group after iNCRT (75.9% vs 15.2%, respectively; P < 0.001). AMLE was associated with higher odds of ptPCR in the multivariable regression analysis (odds ratio, 19.14; 95% CI 4.03, 90.87; P = 0.001). And AMLE exhibited the best diagnostic performance in identifying ptPCR after iNCRT, with highest sensitivity, specificity, PPV, NPV, and AUC (0.80; 95% CI 0.70, 0.89).</p><p><strong>Conclusion: </strong>AMLE at CE-TlWI of rectal MRI could be a potential indicator of ptPCR after a new iNCRT in pMMR/MSS LARC, suggesting a relatively credible preoperative evaluation strategy for this group of patients in clinical practice to accurately exclude residual tumors and select watch-and-wait approach, avoiding unnecessary surgery.</p>","PeriodicalId":20817,"journal":{"name":"Radiologia Medica","volume":" ","pages":""},"PeriodicalIF":4.8000,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Arterial-phase mucosal linear enhancement as an indicator of pathological complete response after immunotherapy in pMMR/MSS locally advanced rectal cancer.\",\"authors\":\"Jingjing Liu, Gengyun Miao, Wentao Tang, Lamei Deng, Shengxiang Rao, Mengsu Zeng, Liheng Liu\",\"doi\":\"10.1007/s11547-025-02099-4\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Immunotherapy-based neoadjuvant chemoradiotherapy (iNCRT) has recently emerged for proficient mismatch repair/microsatellite stable (pMMR/MSS) locally advanced rectal cancer (LARC). Accurate identification of pathological complete response for primary tumor (ptPCR) post-treatment is critical for selecting patients eligible for watch-and-wait strategies. This study aimed to evaluate arterial-phase mucosal linear enhancement (AMLE) on contrast-enhanced T1-weighted imaging (CE-T1WI) for predicting ptPCR after iNCRT in pMMR/MSS LARC, compared to conventional T2-weighted/diffusion-weighted imaging (T2DWI) and rectal endoscopy.</p><p><strong>Methods: </strong>This retrospective study included patients with pMMR/MSS LARC who underwent total mesorectal excision after iNCRT between July 2022 and Oct 2024 at a tertiary referral academic center. Preoperative re-staging examinations were rectal endoscopy and MRI, included T2DWI and arterial-phase CE-T1WI for primary tumor assessment. Baseline and post-therapy features associated with ptPCR were identified using univariate and multivariable regression analysis. Diagnostic performance of endoscopy and different MRI protocols to identify ptPCR after iNCRT was evaluated using ROC curves.</p><p><strong>Results: </strong>In total, 75 patients (mean age, 57 years ± 10 [SD]; 54 male patients) were assessed. At histopathology, 29 patients achieved ptPCR. AMLE was more common in the ptPCR group than in the non-ptPCR group after iNCRT (75.9% vs 15.2%, respectively; P < 0.001). AMLE was associated with higher odds of ptPCR in the multivariable regression analysis (odds ratio, 19.14; 95% CI 4.03, 90.87; P = 0.001). And AMLE exhibited the best diagnostic performance in identifying ptPCR after iNCRT, with highest sensitivity, specificity, PPV, NPV, and AUC (0.80; 95% CI 0.70, 0.89).</p><p><strong>Conclusion: </strong>AMLE at CE-TlWI of rectal MRI could be a potential indicator of ptPCR after a new iNCRT in pMMR/MSS LARC, suggesting a relatively credible preoperative evaluation strategy for this group of patients in clinical practice to accurately exclude residual tumors and select watch-and-wait approach, avoiding unnecessary surgery.</p>\",\"PeriodicalId\":20817,\"journal\":{\"name\":\"Radiologia Medica\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":4.8000,\"publicationDate\":\"2025-09-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Radiologia Medica\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s11547-025-02099-4\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Radiologia Medica","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11547-025-02099-4","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
Arterial-phase mucosal linear enhancement as an indicator of pathological complete response after immunotherapy in pMMR/MSS locally advanced rectal cancer.
Purpose: Immunotherapy-based neoadjuvant chemoradiotherapy (iNCRT) has recently emerged for proficient mismatch repair/microsatellite stable (pMMR/MSS) locally advanced rectal cancer (LARC). Accurate identification of pathological complete response for primary tumor (ptPCR) post-treatment is critical for selecting patients eligible for watch-and-wait strategies. This study aimed to evaluate arterial-phase mucosal linear enhancement (AMLE) on contrast-enhanced T1-weighted imaging (CE-T1WI) for predicting ptPCR after iNCRT in pMMR/MSS LARC, compared to conventional T2-weighted/diffusion-weighted imaging (T2DWI) and rectal endoscopy.
Methods: This retrospective study included patients with pMMR/MSS LARC who underwent total mesorectal excision after iNCRT between July 2022 and Oct 2024 at a tertiary referral academic center. Preoperative re-staging examinations were rectal endoscopy and MRI, included T2DWI and arterial-phase CE-T1WI for primary tumor assessment. Baseline and post-therapy features associated with ptPCR were identified using univariate and multivariable regression analysis. Diagnostic performance of endoscopy and different MRI protocols to identify ptPCR after iNCRT was evaluated using ROC curves.
Results: In total, 75 patients (mean age, 57 years ± 10 [SD]; 54 male patients) were assessed. At histopathology, 29 patients achieved ptPCR. AMLE was more common in the ptPCR group than in the non-ptPCR group after iNCRT (75.9% vs 15.2%, respectively; P < 0.001). AMLE was associated with higher odds of ptPCR in the multivariable regression analysis (odds ratio, 19.14; 95% CI 4.03, 90.87; P = 0.001). And AMLE exhibited the best diagnostic performance in identifying ptPCR after iNCRT, with highest sensitivity, specificity, PPV, NPV, and AUC (0.80; 95% CI 0.70, 0.89).
Conclusion: AMLE at CE-TlWI of rectal MRI could be a potential indicator of ptPCR after a new iNCRT in pMMR/MSS LARC, suggesting a relatively credible preoperative evaluation strategy for this group of patients in clinical practice to accurately exclude residual tumors and select watch-and-wait approach, avoiding unnecessary surgery.
期刊介绍：
Felice Perussia founded La radiologia medica in 1914. It is a peer-reviewed journal and serves as the official journal of the Italian Society of Medical and Interventional Radiology (SIRM). The primary purpose of the journal is to disseminate information related to Radiology, especially advancements in diagnostic imaging and related disciplines. La radiologia medica welcomes original research on both fundamental and clinical aspects of modern radiology, with a particular focus on diagnostic and interventional imaging techniques. It also covers topics such as radiotherapy, nuclear medicine, radiobiology, health physics, and artificial intelligence in the context of clinical implications. The journal includes various types of contributions such as original articles, review articles, editorials, short reports, and letters to the editor. With an esteemed Editorial Board and a selection of insightful reports, the journal is an indispensable resource for radiologists and professionals in related fields. Ultimately, La radiologia medica aims to serve as a platform for international collaboration and knowledge sharing within the radiological community.
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