Prospective Correlation of Magnetic Resonance Tumor Regression Grade With Pathologic Outcomes in Total Neoadjuvant Therapy for Rectal Adenocarcinoma

医学 磁共振成像 新辅助治疗 前瞻性队列研究 卡帕 磁共振弥散成像 核医学 分级(工程) 腺癌 试验预测值 相关性 有效扩散系数 结直肠癌 放射科 内科学 癌症 乳腺癌 语言学 哲学 土木工程 几何学 数学 工程类
作者
William A. Hall,Jiahe Li,Y. Nancy You,Marc J. Gollub,Joseph R. Grajo,Mark Rosen,Gregory dePrisco,Greg Yothers,Jennifer Dorth,Osama E. Rahma,Marcia M. Russell,Howard M. Gross,Samuel A. Jacobs,Bryan A. Faller,Sagila George,Tareq Al Baghdadi,Michael G. Haddock,Richard K. Valicenti,Theodore S. Hong,Thomas J. George
出处
期刊:Journal of Clinical Oncology [American Society of Clinical Oncology]
卷期号:41 (29): 4643-4651 被引量:9
标识
DOI:10.1200/jco.22.02525
摘要

PURPOSE Total neoadjuvant therapy (TNT) is a newly established standard treatment for rectal adenocarcinoma. Current methods to communicate magnitudes of regression during TNT are subjective and imprecise. Magnetic resonance tumor regression grade (MR-TRG) is an existing, but rarely used, regression grading system. Prospective validation of MR-TRG correlation with pathologic response in patients undergoing TNT is lacking. Utility of adding diffusion-weighted imaging to MR-TRG is also unknown. METHODS We conducted a multi-institutional prospective imaging substudy within NRG-GI002 (ClinicalTrials.gov identifier: NCT02921256 ) examining the ability of MR-based imaging to predict pathologic complete response (pCR) and correlate MR-TRG with the pathologic neoadjuvant response score (NAR). Serial MRIs were needed from 110 patients. Three radiologists independently, then collectively, reviewed each MRI for complete response (mriCR), which was tested for positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity with pCR. MR-TRG was examined for association with the pathologic NAR score. All team members were blinded to pathologic data. RESULTS A total of 121 patients from 71 institutions met criteria: 28% were female (n = 34), 84% White (n = 101), and median age was 55 (24-78 years). Kappa scores for T- and N-stage after TNT were 0.38 and 0.88, reflecting fair agreement and near-perfect agreement, respectively. Calling an mriCR resulted in a kappa score of 0.82 after chemotherapy and 0.56 after TNT reflected near-perfect agreement and moderate agreement, respectively. MR-TRG scores were associated with pCR ( P < .01) and NAR ( P < .0001), PPV for pCR was 40% (95% CI, 26 to 53), and NPV was 84% (95% CI, 75 to 94). CONCLUSION MRI alone is a poor tool to distinguish pCR in rectal adenocarcinoma undergoing TNT. However, the MR-TRG score presents a now validated method, correlated with pathologic NAR, which can objectively measure regression magnitude during TNT.
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