Prospective Validation of a Low Rectal Cancer Magnetic Resonance Imaging Staging System and Development of a Local Recurrence Risk Stratification Model

医学 磁共振成像 优势比 前瞻性队列研究 置信区间 放射科 结直肠癌 切除缘 肛缘 放射治疗 癌症 外科 内科学 切除术
作者
Nicholas J. Battersby,Peter How,Brendan Moran,Sigmar Stelzner,Nicholas P. West,Graham Branagan,Joachim Straßburg,Philip Quirke,Paris Tekkis,Bodil Ginnerup Pedersen,Mark Gudgeon,Bill Heald,Gina Brown
出处
期刊:Annals of Surgery [Lippincott Williams & Wilkins]
卷期号:263 (4): 751-760 被引量:269
标识
DOI:10.1097/sla.0000000000001193
摘要

Objective: This study aimed to validate a magnetic resonance imaging (MRI) staging classification that preoperatively assessed the relationship between tumor and the low rectal cancer surgical resection plane (mrLRP). Background: Low rectal cancer oncological outcomes remain a global challenge, evidenced by high pathological circumferential resection margin (pCRM) rates and unacceptable variations in permanent colostomies. Methods: Between 2008 and 2012, a prospective, observational, multicenter study (MERCURY II) recruited 279 patients with adenocarcinoma 6 cm or less from the anal verge. MRI assessed the following: mrLRP “safe or unsafe,” venous invasion (mrEMVI), depth of spread, node status, tumor height, and tumor quadrant. MRI-based treatment recommendations were compared against final management and pCRM outcomes. Results: Overall pCRM involvement was 9.0% [95% confidence interval (CI), 5.9–12.3], significantly lower than previously reported rates of 30%. Patients with no adverse MRI features and a “safe” mrLRP underwent sphincter-preserving surgery without preoperative radiotherapy, resulting in a 1.6% pCRM rate. The pCRM rate increased 5-fold for an “unsafe” compared with “safe” preoperative mrLRP [odds ratio (OR) = 5.5; 95% CI, 2.3–13.3)]. Posttreatment MRI reassessment indicated a “safe” ymrLRP in 33 of 113 (29.2%), none of whom had ypCRM involvement. In contrast, persistent “unsafe” ymrLRP posttherapy resulted in 17.5% ypCRM involvement. Further independent MRI assessed risk factors were EMVI (OR = 3.8; 95% CI, 1.5–9.6), tumors less than 4.0 cm from the anal verge (OR = 3.4; 95% CI, 1.3–8.8), and anterior tumors (OR = 2.8; 95% CI, 1.1–6.8). Conclusions: The study validated MRI low rectal plane assessment, reducing pCRM involvement and avoiding overtreatment through selective preoperative therapy and rationalized use of permanent colostomy. It also highlights the importance of posttreatment restaging.
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