Comparison between MRI and pathology in the assessment of tumour regression grade in rectal cancer
Sclafani, Francesco (Department of Medicine, The Royal Marsden NHS Foundation Trust)
Brown, Gina (Department of Radiology, The Royal Marsden NHS Foundation Trust)
Cunningham, David (Department of Medicine, The Royal Marsden NHS Foundation Trust)
Wotherspoon, Andrew (Department of Histopathology, The Royal Marsden NHS Foundation Trust)
Mendes, Larissa Sena Teixeira (Department of Histopathology, The Royal Marsden NHS Foundation Trust)
Balyasnikova, Svetlana (Department of Radiology, The Royal Marsden NHS Foundation Trust)
Evans, Jessica (Department of Radiology, The Royal Marsden NHS Foundation Trust)
Peckitt, Clare (Clinical Research & Development, The Royal Marsden NHS Foundation Trust)
Begum, Ruwaida (Department of Medicine, The Royal Marsden NHS Foundation Trust)
Tait, Diana (Department of Medicine, The Royal Marsden NHS Foundation Trust)
Tabernero, Josep (Universitat Autònoma de Barcelona. Departament de Medicina)
Glimelius, Bengt (Department of Immunology, Genetics and Pathology, Section of Experimental and Clinical Oncology, University of Uppsala)
Roselló, Susana (Department of Haematology and Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia)
Thomas, Janet (Department of Medicine, The Royal Marsden NHS Foundation Trust)
Oates, Jacqui (Department of Medicine, The Royal Marsden NHS Foundation Trust)
Chau, Ian (Department of Medicine, The Royal Marsden NHS Foundation Trust)

Fecha:	2017
Resumen:	Limited data exist regarding the correlation between MRI tumour regression grade (mrTRG) and pathological TRG (pTRG) in rectal cancer. mrTRG and pTRG were compared in rectal cancer patients from two phase II trials (EXPERT and EXPERT-C). The agreement between radiologist and pathologist was assessed with the weighted κ test while the Kaplan-Meier method was used to estimate survival outcomes. One hundred ninety-one patients were included. Median time from completion of neoadjuvant treatment to pre-operative MRI and surgery was 4. 1 weeks (interquartile range (IQR): 3. 7-4. 7) and 6. 6 weeks (IQR: 5. 9-7. 6), respectively. Fair agreement was found between mrTRG and pTRG when regression was classified according to standard five-tier systems (κ =0. 24) or modified three-tier systems (κ =0. 25). Sensitivity and specificity of mrTRG 1-2 (complete/good radiological regression) for the prediction of pathological complete response was 74. 4% (95% CI: 58. 8-86. 5) and 62. 8% (95% CI: 54. 5-70. 6), respectively. Survival outcomes of patients with intermediate pathological regression (pTRG 2) were numerically better if complete/good regression was also observed on imaging (mrTRG 1-2) compared to poor regression (mrTRG 3-5) (5-year recurrence-free survival 76. 9% vs 65. 9%, P =0. 18; 5-year overall survival 80. 6% vs 68. 8%, P =0. 22). The agreement between mrTRG and pTRG is low and mrTRG cannot be used as a surrogate of pTRG. Further studies are warranted to assess the ability of mrTRG to identify pathological complete responders for the adoption of non-operative management strategies and to provide complementary prognostic information to pTRG for better risk-stratification after surgery.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials i que es distribueixin sota la mateixa llicència que regula l'obra original. Cal que es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Pathological tumour regression grade ; Magnetic resonance tumour regression grade ; Rectal cancer
Publicado en:	British journal of cancer, Vol. 117 (09 2017) , p. 1478-1485, ISSN 1532-1827

DOI: 10.1038/bjc.2017.320
PMID: 28934761

8 p, 196.5 KB

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