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Park S, Park HS, Jang S, Cho J, Kim JH, Yu MH, Jung SI, Kim YJ, Hwang DY. Utility of abbreviated MRI in the post-treatment evaluation of rectal cancer. Acta Radiol 2024:2841851241253936. [PMID: 38778748 DOI: 10.1177/02841851241253936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND Post-treatment evaluation of patients with rectal cancer (RC) using magnetic resonance imaging (MRI) burdens medical resources, necessitating an exploration of abbreviated protocols. PURPOSE To evaluate the diagnostic performance of abbreviated MRI (A-MRI) for the post-treatment evaluation of RC patients. MATERIAL AND METHODS This retrospective study included RC patients who underwent non-contrast rectal MRI and standard liver MRI, as well as abdominal contrast-enhanced computed tomography (CECT) for post-treatment evaluation. A-MRI comprised diffusion-weighted imaging (DWI) and T2-weighted imaging of the upper abdomen and the pelvic cavity. Three radiologists independently reviewed A-MRI, CECT, and standard liver MRI in the detection of viable disease. The diagnostic performances were compared using a reference standard considering all available information, including pathology, FDG-PET, endoscopic results, and clinical follow-up. RESULTS We included 78 patients (50 men, 28 women; mean age=60.9 ± 10.2 years) and observed viable disease in 34 (43.6%). On a per-patient-basis analysis, A-MRI showed significantly higher sensitivity (95% vs. 81%, P = 0.04) and higher accuracy (93% vs. 82%, P < 0.01), compared to those of CECT, while A-MRI showed comparable sensitivity (91% vs. 91%, P = 0.42) and accuracy (97% vs. 98%, P = 0.06) to that of standard liver MRI. On a per-lesion-based analysis, A-MRI exhibited significantly superior lesion detectability than that of CECT (figure of merit 0.91 vs. 0.77, P < 0.01) and comparable to that of standard liver MRI (figure of merit 0.91 vs. 0.92, P = 0.75). CONCLUSION A-MRI exhibited higher sensitivity and diagnostic accuracy than those of CECT in the post-treatment evaluation of RC, while it showed comparable performances with standard liver MRI. A-MRI provides diagnostic added value in the follow-up of RC patients.
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Affiliation(s)
- Sungeun Park
- Department of Radiology, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Hee Sun Park
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Siwon Jang
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Jungheum Cho
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae Hyun Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Mi Hye Yu
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sung Il Jung
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Young Jun Kim
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Dae-Yong Hwang
- Department of Surgery, Colorectal Cancer Center, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
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2
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van Geffen EGM, Langhout JMA, Hazen SJA, Sluckin TC, van Dieren S, Beets GL, Beets-Tan RGH, Borstlap WAA, Burger JWA, Horsthuis K, Intven MPW, Aalbers AGJ, Havenga K, Marinelli AWKS, Melenhorst J, Nederend J, Peulen HMU, Rutten HJT, Schreurs WH, Tuynman JB, Verhoef C, de Wilt JHW, Marijnen CAM, Tanis PJ, Kusters M, On Behalf Of The Dutch Snapshot Research Group. Evolution of clinical nature, treatment and survival of locally recurrent rectal cancer: Comparative analysis of two national cross-sectional cohorts. Eur J Cancer 2024; 202:114021. [PMID: 38520925 DOI: 10.1016/j.ejca.2024.114021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/04/2024] [Accepted: 03/10/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND In the Netherlands, use of neoadjuvant radiotherapy for rectal cancer declined after guideline revision in 2014. This decline is thought to affect the clinical nature and treatability of locally recurrent rectal cancer (LRRC). Therefore, this study compared two national cross-sectional cohorts before and after the guideline revision with the aim to determine the changes in treatment and survival of LRRC patients over time. METHODS Patients who underwent resection of primary rectal cancer in 2011 (n = 2094) and 2016 (n = 2855) from two nationwide cohorts with a 4-year follow up were included. Main outcomes included time to LRRC, synchronous metastases at time of LRRC diagnosis, intention of treatment and 2-year overall survival after LRRC. RESULTS Use of neoadjuvant (chemo)radiotherapy for the primary tumour decreased from 88.5% to 60.0% from 2011 to 2016. The 3-year LRRC rate was not significantly different with 5.1% in 2011 (n = 114, median time to LRRC 16 months) and 6.3% in 2016 (n = 202, median time to LRRC 16 months). Synchronous metastasis rate did not significantly differ (27.2% vs 33.7%, p = 0.257). Treatment intent of the LRRC shifted towards more curative treatment (30.4% vs. 47.0%, p = 0.009). In the curatively treated group, two-year overall survival after LRRC diagnoses increased from 47.5% to 78.7% (p = 0.013). CONCLUSION Primary rectal cancer patients in 2016 were treated less often with neoadjuvant (chemo)radiotherapy, while LRRC rates remained similar. Those who developed LRRC were more often candidate for curative intent treatment compared to the 2011 cohort, and survival after curative intent treatment also improved substantially.
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Affiliation(s)
- E G M van Geffen
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Treatment and Quality of Life and Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - J M A Langhout
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - S J A Hazen
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Treatment and Quality of Life and Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - T C Sluckin
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Treatment and Quality of Life and Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - S van Dieren
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - G L Beets
- GROW School of Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands; Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - R G H Beets-Tan
- GROW School of Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Radiology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - W A A Borstlap
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Treatment and Quality of Life and Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - J W A Burger
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - K Horsthuis
- Department of Radiology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - M P W Intven
- Department of Radiotherapy, Division Imaging and Oncology, University Medical Centre Utrecht, the Netherlands
| | - A G J Aalbers
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - K Havenga
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - A W K S Marinelli
- Department of Surgery, Haaglanden Medisch Centrum, Den Haag, the Netherlands
| | - J Melenhorst
- GROW School of Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands; Department of Surgery and Colorectal Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - J Nederend
- Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands
| | - H M U Peulen
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - H J T Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - W H Schreurs
- Department of Surgery, Nothwest Clinics, Alkmaar, the Netherlands
| | - J B Tuynman
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Treatment and Quality of Life and Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - C Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - J H W de Wilt
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C A M Marijnen
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Radiation Oncology, Leiden University Medical Centre, Leiden, the Netherlands
| | - P J Tanis
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - M Kusters
- Treatment and Quality of Life and Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands; Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.
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Xu L, Huang G, Wang Y, Huang G, Liu J, Chen R. 2-[ 18F]FDG PET-based quantification of lymph node metabolic heterogeneity for predicting lymph node metastasis in patients with colorectal cancer. Eur J Nucl Med Mol Imaging 2024; 51:1729-1740. [PMID: 38150017 DOI: 10.1007/s00259-023-06578-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/15/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND AND PURPOSE The pre-surgical estimation of lymph node (LN) metastasis in colorectal cancer (CRC) poses a significant diagnostic predicament. The associations between LN morphology, density, and metabolic heterogeneity and LN metastasis status in CRCs have been seldomly examined through the lens of radiomics. This research aimed to assess 2-[18F]FDG PET-based quantification of intratumoral metabolic heterogeneity for predicting lymph node metastasis in patients with colorectal cancer. MATERIALS AND METHODS The construction of the model utilized data from 264 CRC patients, all of whom underwent preoperative 2-[18F]FDG PET/CT. Radiomic features were extracted from PET and CT images of LNs. Least absolute shrinkage and selection operator (LASSO) regression was implemented for selecting pertinent imaging features with a tenfold cross-validation. The predictive accuracy for LN metastasis status was juxtaposed against traditional methodologies (comprising CT-reported LN status and PET/CT-reported LN status) by deploying the receiver operating characteristic (ROC) curve analysis. The radiomics signature was evaluated based on discrimination, calibration, and clinical utility parameters. The model was further subjected to validation using an independent cohort of 132 patients from the period of January 2012 to June 2020. RESULTS The radiomics model was composed of eight significant radiomic features (five from PET and three from CT), encapsulating metabolic and density heterogeneity. The radiomics signature (area under the curve (AUC), 0.908) showcased a significantly superior performance compared to CT-reported LN status (AUC, 0.563, P < 0.001) and PET/CT-reported LN status (AUC, 0.64, P < 0.001) for predicting LN-positive or LN-negative status. The radiomics signature (AUC, 0.885) also showcased a significantly superior performance compared to CT-reported LN status (AUC, 0.587, P < 0.001) and PET/CT-reported LN status (AUC, 0.621, P < 0.001) to identify N1 and N2. This signature maintained its independence from clinical risk factors and exhibited robustness in the validation test set. Decision curve analysis attested to the clinical utility of the radiomics signature. CONCLUSIONS The radiomics signature based on 2-[18F]FDG PET/CT, which derived image features directly from LNs irrespective of clinical risk factors, displayed enhanced diagnostic performance compared to conventional CT or PET/CT-reported LN status. This allows for the identification of pre-surgical LN metastasis status and facilitates a patient-specific prediction of LN metastasis status in CRC patients.
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Affiliation(s)
- Lian Xu
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200000, China
| | - Gan Huang
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200000, China
| | - Yining Wang
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200000, China
| | - Gang Huang
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200000, China
| | - Jianjun Liu
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200000, China.
| | - Ruohua Chen
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200000, China.
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Troester AM, Gaertner WB. Contemporary management of rectal cancer. Surg Open Sci 2024; 18:17-22. [PMID: 38312301 PMCID: PMC10832461 DOI: 10.1016/j.sopen.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/02/2024] [Indexed: 02/06/2024] Open
Abstract
The management of rectal cancer has undergone significant changes over the past 50 years, and this has been associated with major improvements in overall outcomes and quality of life. From standardization of total mesorectal excision to refinements in radiation delivery and shifting of chemoradiotherapy treatment to favor a neoadjuvant approach, as well as the development of targeted chemotherapeutics, these management strategies have continually aimed to achieve locoregional and systemic control while limiting adverse effects and enhance overall survival. This article highlights evolving aspects of rectal cancer therapy including improved staging modalities, total neoadjuvant therapy, the role of short-course and more selective radiotherapy strategies, as well as organ preservation. We also discuss the evolving role of minimally invasive surgery and comment on lateral pelvic lymph node dissection. Key message Rectal cancer management is constantly evolving through refinements in radiation timing and delivery, modification of chemoradiotherapy treatment schedules, and increasing utilization of minimally invasive surgical techniques and organ preservation strategies. This manuscript aims to provide a synopsis of recent changes in the management of rectal cancer, highlighting contemporary modifications in neoadjuvant approaches and surgical management to enhance the knowledge of surgeons who care for this challenging population.
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Affiliation(s)
- Alexander M. Troester
- Department of Surgery, University of Minnesota, Minneapolis, MN, United States of America
| | - Wolfgang B. Gaertner
- Department of Surgery, University of Minnesota, Minneapolis, MN, United States of America
- Division of Colon & Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, United States of America
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Hazen SMJA, Sluckin TC, Intven MPW, Beets GL, Beets-Tan RGH, Borstlap WAA, Buffart TE, Buijsen J, Burger JWA, van Dieren S, Furnée EJB, Geijsen ED, Hompes R, Horsthuis K, Leijtens JWA, Maas M, Melenhorst J, Nederend J, Peeters KCMJ, Rozema T, Tuynman JB, Verhoef C, de Vries M, van Westreenen HL, de Wilt JH, Zimmerman DDE, Marijnen CAM, Tanis PJ, Kusters M. Abandonment of Routine Radiotherapy for Nonlocally Advanced Rectal Cancer and Oncological Outcomes. JAMA Oncol 2024; 10:202-211. [PMID: 38127337 PMCID: PMC10739079 DOI: 10.1001/jamaoncol.2023.5444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/30/2023] [Indexed: 12/23/2023]
Abstract
Importance Neoadjuvant short-course radiotherapy was routinely applied for nonlocally advanced rectal cancer (cT1-3N0-1M0 with >1 mm distance to the mesorectal fascia) in the Netherlands following the Dutch total mesorectal excision trial. This policy has shifted toward selective application after guideline revision in 2014. Objective To determine the association of decreased use of neoadjuvant radiotherapy with cancer-related outcomes and overall survival at a national level. Design, Setting, and Participants This multicenter, population-based, nationwide cross-sectional cohort study analyzed Dutch patients with rectal cancer who were treated in 2011 with a 4-year follow-up. A similar study was performed in 2021, analyzing all patients that were surgically treated in 2016. From these cohorts, all patients with cT1-3N0-1M0 rectal cancer and radiologically unthreatened mesorectal fascia were included in the current study. The data of the 2011 cohort were collected between May and October 2015, and the data of the 2016 cohort were collected between October 2020 and November 2021. The data were analyzed between May and October 2022. Main Outcomes and Measures The main outcomes were 4-year local recurrence and overall survival rates. Results Among the 2011 and 2016 cohorts, 1199 (mean [SD] age, 68 [11] years; 430 women [36%]) of 2095 patients (57.2%) and 1576 (mean [SD] age, 68 [10] years; 547 women [35%]) of 3057 patients (51.6%) had cT1-3N0-1M0 rectal cancer and were included, with proportions of neoadjuvant radiotherapy of 87% (2011) and 37% (2016). Four-year local recurrence rates were 5.8% and 5.5%, respectively (P = .99). Compared with the 2011 cohort, 4-year overall survival was significantly higher in the 2016 cohort (79.6% vs 86.4%; P < .001), with lower non-cancer-related mortality (13.8% vs 6.3%; P < .001). Conclusions and Relevance The results of this cross-sectional study suggest that an absolute 50% reduction in radiotherapy use for nonlocally advanced rectal cancer did not compromise cancer-related outcomes at a national level. Optimizing clinical staging and surgery following the Dutch total mesorectal excision trial has potentially enabled safe deintensification of treatment.
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Affiliation(s)
- Sanne-Marije J. A. Hazen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Surgery, Amsterdam, the Netherlands
- Department of Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands
- Department of Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Tania C. Sluckin
- Amsterdam UMC location Vrije Universiteit Amsterdam, Surgery, Amsterdam, the Netherlands
- Department of Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands
- Department of Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Martijn P. W. Intven
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Geerard L. Beets
- Department of Surgery, the Netherlands Cancer Institute, Amsterdam, the Netherlands
- GROW School of Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands
| | - Regina G. H. Beets-Tan
- GROW School of Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Wernard A. A. Borstlap
- Department of Surgery, Amsterdam UMC location of the University of Amsterdam, Amsterdam, the Netherlands
| | - Tineke E. Buffart
- Department of Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands
- Department of Medical Oncology, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Jeroen Buijsen
- Department of Radiation Oncology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - Susan van Dieren
- Department of Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands
- Department of Surgery and Clinical Epidemiology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Edgar J. B. Furnée
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - E. Debby Geijsen
- Department of Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands
- Department of Radiation Oncology, Amsterdam UMC location of the University of Amsterdam, Amsterdam, the Netherlands
| | - Roel Hompes
- Department of Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands
- Department of Surgery, Amsterdam UMC location of the University of Amsterdam, Amsterdam, the Netherlands
| | - Karin Horsthuis
- Department of Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
- Department of Radiology, Amsterdam UMC location of Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Monique Maas
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jarno Melenhorst
- GROW School of Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Joost Nederend
- Department of Radiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | | | - Tom Rozema
- Department of Radiation Oncology, Verbeeten Institute, Tilburg, the Netherlands
| | - Jurriaan B. Tuynman
- Amsterdam UMC location Vrije Universiteit Amsterdam, Surgery, Amsterdam, the Netherlands
- Department of Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands
- Department of Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Marianne de Vries
- Department of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Johannes H.W. de Wilt
- Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | | | - Corrie A. M. Marijnen
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Pieter J. Tanis
- Department of Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands
- Department of Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
- Department of Surgery, Amsterdam UMC location of the University of Amsterdam, Amsterdam, the Netherlands
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Miranda Kusters
- Amsterdam UMC location Vrije Universiteit Amsterdam, Surgery, Amsterdam, the Netherlands
- Department of Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands
- Department of Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
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İsmail E, Kutlu B, Acar Hİ, Yörübulut M, Akkoca M, Kocaay AF, Elhan A, Kuzu MA. Lateral Lymph Node Dissection for Locally Advanced Rectal Carcinoma: A Step-by-Step Description of Surgical Anatomical Planes During Cadaveric Dissection and Minimally Invasive Surgery. Surg Laparosc Endosc Percutan Tech 2024; 34:101-107. [PMID: 38134383 DOI: 10.1097/sle.0000000000001241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/15/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE Total mesorectal excision (TME) is accepted as gold standard method in rectal cancer globally. But there is no standard for lateral lymph nodes. Combination of neoadjuvant treatment plus lateral lymph node dissection (LLND) in select patients might be a promising method. Our purpose is to describe the anatomic landmarks of LLND on cadavers and minimally invasive surgery. MATERIALS AND METHODS Local advanced rectal cancer and lateral lymph node (LLN) metastasis are accepted as an indication of neoadjuvant treatment. LLND was performed according to preoperative imaging after radiochemotherapy. RESULTS Twenty-eight (10.5%) of 267 patients with rectal cancer who had suspected lateral lymph node metastasis (LLNM) with magnetic resonance imaging (MRI) underwent LLND in addition to TME after neoadjuvant chemoradiotherapy. Eight of them had LLNM. Three patients had bilateral LLND and only 1 had LLNM. The median number of harvested lymph nodes was 6. The rates of LLNM increased with the presence of poor prognosis markers. One regional and 1 distant recurrence were detected in patients who had no LLN metastasis compared with2 regional and 4 distant recurrences in the LLN-positive group. CONCLUSIONS Local advanced rectal cancer cases may benefit from LLND, but it does not appear to have an effect on overall survival. There is no consensus whether size and/or morphologic criteria in MRI are the ideal guide for LLND.
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Affiliation(s)
- Erkin İsmail
- Acibadem Hospital; Departments of General Surgery and Anatomy, Faculty of Medicine, Ankara University; SBU Etlik City Hospital, Ankara, Turkey
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7
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Ma W, Chen B, Zhu F, Yang C, Yang J. Diagnostic role of F-18 FDG PET/CT in determining preoperative Lymph node status of patients with rectal cancer: a meta-analysis. Abdom Radiol (NY) 2024:10.1007/s00261-023-04140-4. [PMID: 38281158 DOI: 10.1007/s00261-023-04140-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE To obtain performance values of PET/CT for determining the nodal status of rectal cancer. MATERIALS A comprehensive literature search was performed on PubMed and Embase for original diagnostic accuracy studies on the diagnostic performance of PET-CT for detection of LN metastasis in rectal cancer. The QUADAS-2 was used to evaluate the methodological quality of each study. Pooled sensitivity, specificity, and AUC were calculated to estimate the diagnostic role of PET/CT using a random-effects model. A subgroup analysis was performed to investigate the influence of different parameters on diagnostic performance. RESULTS A total of 15 studies and 1209 patients were included. A publication bias was observed. The pooled sensitivity, specificity, and AUC for PET/CT was 0.62 (95% CI 0.49, 0.74), 0.94 (95% CI 0.87, 0.97), and 0.87 (95% CI 0.83-0.89), respectively. Per-node basis yields higher accuracy than per-patient basis, with pooled sensitivities of 0.65 (95% CI 0.50-0.79) vs. 0.56 (95% CI 0.36-0.77) and specificities of 0.96 (95% CI 0.92-1.00) vs. 0.88 (95% CI 0.76-1.00), but there were no significant differences in diagnostic accuracy. CONCLUSION PET/CT has high specificity but moderate sensitivity for the detection of LN metastasis in rectal cancer. The current data suggests that the diagnostic capabilities of this method is limited due to its moderate sensitivity.
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Affiliation(s)
- Weili Ma
- Department of Radiology, Key Laboratory of Functional Molecular Imaging of Tumor and Interventional Diagnosis and Treatment of Shaoxing City, Shaoxing People's Hospital, Shaoxing, 312000, China
| | - Bo Chen
- Department of Radiology, Key Laboratory of Functional Molecular Imaging of Tumor and Interventional Diagnosis and Treatment of Shaoxing City, Shaoxing People's Hospital, Shaoxing, 312000, China
| | - Fandong Zhu
- Department of Radiology, Key Laboratory of Functional Molecular Imaging of Tumor and Interventional Diagnosis and Treatment of Shaoxing City, Shaoxing People's Hospital, Shaoxing, 312000, China
| | - Chen Yang
- Department of Radiology, Key Laboratory of Functional Molecular Imaging of Tumor and Interventional Diagnosis and Treatment of Shaoxing City, Shaoxing People's Hospital, Shaoxing, 312000, China
| | - Jianfeng Yang
- Department of Radiology, Key Laboratory of Functional Molecular Imaging of Tumor and Interventional Diagnosis and Treatment of Shaoxing City, Shaoxing People's Hospital, Shaoxing, 312000, China.
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8
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Kwakman JJM, Bond MJG, Demichelis RM, Koopman M, Hompes R, Elferink MAG, Punt CJA. Adjuvant chemotherapy in patients with clinically node-negative but pathologically node-positive rectal cancer in the Netherlands: A retrospective analysis. Eur J Cancer 2024; 197:113466. [PMID: 38061213 DOI: 10.1016/j.ejca.2023.113466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 01/02/2024]
Abstract
INTRODUCTION Accurate clinical staging of rectal cancer is hampered by suboptimal sensitivity of MRI in the detection of regional lymph node metastases. Consequently, some patients may be understaged and have been withheld neoadjuvant (chemo)radiotherapy in retrospect. Although Dutch guidelines do not advocate adjuvant chemotherapy (ACT) in rectal cancer, some of these clinically understaged patients receive ACT according to local policy. We aim to assess the benefit of ACT in these patients. METHODS Population-based data from patients with clinically node-negative (cN0) but pathologically node-positive (pN+) rectal cancer that underwent total mesorectal excision (TME) without neoadjuvant treatment between 2008 and 2018 were obtained from the Netherlands Cancer Registry. Missing data were handled by multiple imputation. Stabilised inverse probability treatment weighting (sIPTW) was used to balance clinical characteristics. Overall survival (OS) was compared in ACT and non-ACT patients. RESULTS Of 34,724 patients, 13,861 had cN0 disease of whom 3016 were pN+ (21.8%). 1466 (48.6%) of these patients underwent upfront TME and were included. Median follow-up was 84 months (95% confidence interval [CI] 76-97) versus 79 months (95% CI 77-81) in patients that did (n = 290, 19.8%) and did not (n = 1176, 80.2%) receive ACT, respectively. After sIPTW adjustment, ACT was associated with improved OS (hazard ratio 0.70; 95% CI 0.49-0.99; p = 0.04). The estimated 5-year OS rate was 74.2% versus 65.3%, respectively. CONCLUSION In this population-based cohort of patients with cN0 but pN+ rectal cancer who underwent upfront TME, ACT was associated with a significant OS benefit. These data support to discuss ACT in this population.
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Affiliation(s)
- Johannes J M Kwakman
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands.
| | - Marinde J G Bond
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Ramzi M Demichelis
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands.
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands.
| | - Roel Hompes
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands.
| | - Marloes A G Elferink
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.
| | - Cornelis J A Punt
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
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Yan H, Yang H, Jiang P, Dong L, Zhang Z, Zhou Y, Zeng Q, Li P, Sun Y, Zhu S. A radiomics model based on T2WI and clinical indexes for prediction of lateral lymph node metastasis in rectal cancer. Asian J Surg 2024; 47:450-458. [PMID: 37833219 DOI: 10.1016/j.asjsur.2023.09.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/19/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVE The aim of this study was to explore the clinical value of a radiomics prediction model based on T2-weighted imaging (T2WI) and clinical indexes in predicting lateral lymph node (LLN) metastasis in rectal cancer patients. METHODS This was a retrospective analysis of 106 rectal cancer patients who had undergone LLN dissection. The clinical risk factors for LLN metastasis were selected by multivariable logistic regression analysis of the clinical indicators of the patients. The LLN radiomics features were extracted from the pelvic T2WI of the patients. The least absolute shrinkage and selection operator algorithm and backward stepwise regression method were adopted for feature selection. Three LLN metastasis prediction models were established through logistic regression analysis based on the clinical risk factors and radiomics features. Model performance was assessed in terms of discriminability and decision curve analysis in the training, verification and test sets. RESULTS The model based on the combined T2WI radiomics features and clinical risk factors demonstrated the highest accuracy, surpassing the models based solely on either T2WI radiomics features or clinical risk factors. Specifically, the model achieved an AUC value of 0.836 in the test set. Decision curve analysis revealed that this model had the greatest clinical utility for the vast majority of the threshold probability range from 0.4 to 1.0. CONCLUSION Combining T2WI radiomics features with clinical risk factors holds promise for the noninvasive assessment of the biological characteristics of the LLNs in rectal cancer, potentially aiding in therapeutic decision-making and optimizing patient outcomes.
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Affiliation(s)
- Hao Yan
- Department of Oncology, Tianjin Union Medical Center, Nankai University, Tianjin, 300121, China
| | - Hongjie Yang
- Nankai University, Tianjin, 300071, China; The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, 300121, China; Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China
| | | | - Longchun Dong
- Department of Radiology, Tianjin Union Medical Center, Tianjin, 300121, China
| | - Zhichun Zhang
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, 300121, China; Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China
| | - Yuanda Zhou
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, 300121, China; Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China
| | - Qingsheng Zeng
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, 300121, China; Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China
| | - Peng Li
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, 300121, China; Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China
| | - Yi Sun
- Nankai University, Tianjin, 300071, China; The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, 300121, China; Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China.
| | - Siwei Zhu
- Department of Oncology, Tianjin Union Medical Center, Nankai University, Tianjin, 300121, China; Nankai University, Tianjin, 300071, China; The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, 300121, China.
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Ozaki K, Kurose Y, Kawai K, Kobayashi H, Itabashi M, Hashiguchi Y, Miura T, Shiomi A, Harada T, Ajioka Y. Development of a Diagnostic Artificial Intelligence Tool for Lateral Lymph Node Metastasis in Advanced Rectal Cancer. Dis Colon Rectum 2023; 66:e1246-e1253. [PMID: 37260284 DOI: 10.1097/dcr.0000000000002719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Metastatic lateral lymph node dissection can improve survival in patients with rectal adenocarcinoma, with or without chemoradiotherapy. However, the optimal imaging diagnostic criteria for lateral lymph node metastases remain undetermined. OBJECTIVE To develop a lateral lymph node metastasis diagnostic artificial intelligence tool using deep learning, for patients with rectal adenocarcinoma who underwent radical surgery and lateral lymph node dissection. DESIGN Retrospective study. SETTINGS Multicenter study. PATIENTS A total of 209 patients with rectal adenocarcinoma, who underwent radical surgery and lateral lymph node dissection at 15 participating hospitals, were enrolled in the study and allocated to training (n = 139), test (n = 17), or validation (n = 53) cohorts. MAIN OUTCOME MEASURES In the neoadjuvant treatment group, images taken before pretreatment were classified as baseline images and those taken after pretreatment as presurgery images. In the upfront surgery group, presurgery images were classified as both baseline and presurgery images. We constructed 2 types of artificial intelligence, using baseline and presurgery images, by inputting the patches from these images into ResNet-18, and we assessed their diagnostic accuracy. RESULTS Overall, 124 patients underwent surgery alone, 52 received neoadjuvant chemotherapy, and 33 received chemoradiotherapy. The number of resected lateral lymph nodes in the training, test, and validation cohorts was 2418, 279, and 850, respectively. The metastatic rates were 2.8%, 0.7%, and 3.7%, respectively. In the validation cohort, the precision-recall area under the curve was 0.870 and 0.963 for the baseline and presurgery images, respectively. Although both baseline and presurgery images provided good accuracy for diagnosing lateral lymph node metastases, the accuracy of presurgery images was better than that of baseline images. LIMITATIONS The number of cases is small. CONCLUSIONS An artificial intelligence tool is a promising tool for diagnosing lateral lymph node metastasis with high accuracy. DESARROLLO DE UNA HERRAMIENTA DE INTELIGENCIA ARTIFICIAL PARA EL DIAGNSTICO DE METSTASIS EN GANGLIOS LINFTICOS LATERALES EN CNCER DE RECTO AVANZADO ANTECEDENTES:Disección de nódulos linfáticos laterales metastásicos puede mejorar la supervivencia en pacientes con adenocarcinoma del recto, con o sin quimiorradioterapia. Sin embargo, aún no se han determinado los criterios óptimos de diagnóstico por imágenes de los nódulos linfáticos laterales metastásicos.OBJETIVO:Nuestro objetivo fue desarrollar una herramienta de inteligencia artificial para el diagnóstico de metástasis en nódulos linfáticos laterales mediante el aprendizaje profundo, para pacientes con adenocarcinoma del recto que se sometieron a cirugía radical y disección de nódulos linfáticos laterales.DISEÑO:Estudio retrospectivo.AJUSTES:Estudio multicéntrico.PACIENTES:Un total de 209 pacientes con adenocarcinoma del recto, que se sometieron a cirugía radical y disección de nódulos linfáticos laterales en 15 hospitales participantes, se inscribieron en el estudio y se asignaron a cohortes de entrenamiento (n = 139), prueba (n = 17) o validación (n = 53).PRINCIPALES MEDIDAS DE RESULTADO:En el grupo de tratamiento neoadyuvante, las imágenes tomadas antes del tratamiento se clasificaron como imágenes de referencia y las posteriores al tratamiento, como imágenes previas a la cirugía. En el grupo de cirugía inicial, las imágenes previas a la cirugía se clasificaron como imágenes de referencia y previas a la cirugía. Construimos dos tipos de inteligencia artificial, utilizando imágenes de referencia y previas a la cirugía, ingresando los parches de estas imágenes en ResNet-18. Evaluamos la precisión diagnóstica de los dos tipos de inteligencia artificial.RESULTADOS:En general, 124 pacientes se sometieron a cirugía solamente, 52 recibieron quimioterapia neoadyuvante y 33 recibieron quimiorradioterapia. El número de nódulos linfáticos laterales removidos en los cohortes de entrenamiento, prueba y validación fue de 2,418; 279 y 850, respectivamente. Las tasas metastásicas fueron 2.8%, 0.7%, y 3.7%, respectivamente. En el cohorte de validación, el área de recuperación de precisión bajo la curva fue de 0.870 y 0.963 para las imágenes de referencia y antes de la cirugía, respectivamente. Aunque tanto las imágenes previas a la cirugía como las iniciales proporcionaron una buena precisión para diagnosticar metástasis en los nódulos linfáticos laterales, la precisión de las imágenes previas a la cirugía fue mejor que la de las imágenes iniciales.LIMITACIONES:El número de casos es pequeño.CONCLUSIÓN:La inteligencia artificial es una herramienta prometedora para diagnosticar metástasis en los nódulos linfáticos laterales con alta precisión. (Traducción-Dr. Aurian Garcia Gonzalez ).
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Affiliation(s)
- Kosuke Ozaki
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yusuke Kurose
- Research Center for Advanced Science and Technology, University of Tokyo, Tokyo, Japan
- Center for Advanced Intelligence Project, RIKEN, Tokyo, Japan
| | - Kazushige Kawai
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | | | - Michio Itabashi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yojiro Hashiguchi
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Takuya Miura
- Department of Gastroenterological Surgery, Hirosaki University, Graduate School of Medicine, Aomori, Japan
| | - Akio Shiomi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Tatsuya Harada
- Research Center for Advanced Science and Technology, University of Tokyo, Tokyo, Japan
- Center for Advanced Intelligence Project, RIKEN, Tokyo, Japan
- Research Center for Medical Bigdata, National Institute of Informatics, Tokyo, Japan
| | - Yoichi Ajioka
- Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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Ke J, Jin C, Tang J, Cao H, He S, Ding P, Jiang X, Zhao H, Cao W, Meng X, Gao F, Lan P, Li R, Wu X. A Longitudinal MRI-Based Artificial Intelligence System to Predict Pathological Complete Response After Neoadjuvant Therapy in Rectal Cancer: A Multicenter Validation Study. Dis Colon Rectum 2023; 66:e1195-e1206. [PMID: 37682775 DOI: 10.1097/dcr.0000000000002931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
BACKGROUND Accurate prediction of response to neoadjuvant chemoradiotherapy is critical for subsequent treatment decisions for patients with locally advanced rectal cancer. OBJECTIVE To develop and validate a deep learning model based on the comparison of paired MRI before and after neoadjuvant chemoradiotherapy to predict pathological complete response. DESIGN By capturing the changes from MRI before and after neoadjuvant chemoradiotherapy in 638 patients, we trained a multitask deep learning model for response prediction (DeepRP-RC) that also allowed simultaneous segmentation. Its performance was independently tested in an internal and 3 external validation sets, and its prognostic value was also evaluated. SETTINGS Multicenter study. PATIENTS We retrospectively enrolled 1201 patients diagnosed with locally advanced rectal cancer who underwent neoadjuvant chemoradiotherapy before total mesorectal excision. Patients had been treated at 1 of 4 hospitals in China between January 2013 and December 2020. MAIN OUTCOME MEASURES The main outcome was the accuracy of predicting pathological complete response, measured as the area under receiver operating curve for the training and validation data sets. RESULTS DeepRP-RC achieved high performance in predicting pathological complete response after neoadjuvant chemoradiotherapy, with area under the curve values of 0.969 (0.942-0.996), 0.946 (0.915-0.977), 0.943 (0.888-0.998), and 0.919 (0.840-0.997) for the internal and 3 external validation sets, respectively. DeepRP-RC performed similarly well in the subgroups defined by receipt of radiotherapy, tumor location, T/N stages before and after neoadjuvant chemoradiotherapy, and age. Compared with experienced radiologists, the model showed substantially higher performance in pathological complete response prediction. The model was also highly accurate in identifying the patients with poor response. Furthermore, the model was significantly associated with disease-free survival independent of clinicopathological variables. LIMITATIONS This study was limited by its retrospective design and absence of multiethnic data. CONCLUSIONS DeepRP-RC could be an accurate preoperative tool for pathological complete response prediction in rectal cancer after neoadjuvant chemoradiotherapy. UN SISTEMA DE IA BASADO EN RESONANCIA MAGNTICA LONGITUDINAL PARA PREDECIR LA RESPUESTA PATOLGICA COMPLETA DESPUS DE LA TERAPIA NEOADYUVANTE EN EL CNCER DE RECTO UN ESTUDIO DE VALIDACIN MULTICNTRICO ANTECEDENTES:La predicción precisa de la respuesta a la quimiorradioterapia neoadyuvante es fundamental para las decisiones de tratamiento posteriores para los pacientes con cáncer de recto localmente avanzado.OBJETIVO:Desarrollar y validar un modelo de aprendizaje profundo basado en la comparación de resonancias magnéticas pareadas antes y después de la quimiorradioterapia neoadyuvante para predecir la respuesta patológica completa.DISEÑO:Al capturar los cambios de las imágenes de resonancia magnética antes y después de la quimiorradioterapia neoadyuvante en 638 pacientes, entrenamos un modelo de aprendizaje profundo multitarea para la predicción de respuesta (DeepRP-RC) que también permitió la segmentación simultánea. Su rendimiento se probó de forma independiente en un conjunto de validación interna y tres externas, y también se evaluó su valor pronóstico.ESCENARIO:Estudio multicéntrico.PACIENTES:Volvimos a incluir retrospectivamente a 1201 pacientes diagnosticados con cáncer de recto localmente avanzado y sometidos a quimiorradioterapia neoadyuvante antes de la escisión total del mesorrecto. Eran de cuatro hospitales en China en el período entre enero de 2013 y diciembre de 2020.PRINCIPALES MEDIDAS DE RESULTADO:Los principales resultados fueron la precisión de la predicción de la respuesta patológica completa, medida como el área bajo la curva operativa del receptor para los conjuntos de datos de entrenamiento y validación.RESULTADOS:DeepRP-RC logró un alto rendimiento en la predicción de la respuesta patológica completa después de la quimiorradioterapia neoadyuvante, con valores de área bajo la curva de 0,969 (0,942-0,996), 0,946 (0,915-0,977), 0,943 (0,888-0,998), y 0,919 (0,840-0,997) para los conjuntos de validación interna y las tres externas, respectivamente. DeepRP-RC se desempeñó de manera similar en los subgrupos definidos por la recepción de radioterapia, la ubicación del tumor, los estadios T/N antes y después de la quimiorradioterapia neoadyuvante y la edad. En comparación con los radiólogos experimentados, el modelo mostró un rendimiento sustancialmente mayor en la predicción de la respuesta patológica completa. El modelo también fue muy preciso en la identificación de los pacientes con mala respuesta. Además, el modelo se asoció significativamente con la supervivencia libre de enfermedad independientemente de las variables clinicopatológicas.LIMITACIONES:Este estudio estuvo limitado por el diseño retrospectivo y la ausencia de datos multiétnicos.CONCLUSIONES:DeepRP-RC podría servir como una herramienta preoperatoria precisa para la predicción de la respuesta patológica completa en el cáncer de recto después de la quimiorradioterapia neoadyuvante. (Traducción-Dr. Felipe Bellolio ).
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Affiliation(s)
- Jia Ke
- Department of General Surgery, Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Cheng Jin
- Department of Radiation Oncology, School of Medicine, Stanford University, California
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai City, China
| | - Jinghua Tang
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou City, China
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou City, China
| | - Haimei Cao
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou City, China
| | - Songbing He
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou City, China
| | - Peirong Ding
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou City, China
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou City, China
| | - Xiaofeng Jiang
- Department of General Surgery, Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Hengyu Zhao
- Department of General Surgery, Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Wuteng Cao
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Xiaochun Meng
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Feng Gao
- Department of General Surgery, Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Ping Lan
- Department of General Surgery, Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Ruijiang Li
- Department of Radiation Oncology, School of Medicine, Stanford University, California
| | - Xiaojian Wu
- Department of General Surgery, Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
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Yang S, Lin Y, Zhong W, Xu W, Huang Z, Cai S, Chen W, Zhang B. Effect of laparoscopic versus open surgery on postoperative wound complications in patients with low rectal cancer: A meta-analysis. Int Wound J 2023; 21:e14471. [PMID: 37935425 PMCID: PMC10898391 DOI: 10.1111/iwj.14471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 11/09/2023] Open
Abstract
This meta-analysis was conducted to evaluate the effect of microinvasive and open operations on postoperative wound complications in low rectal carcinoma patients. Research on limited English has been conducted systematically in PubMed, Embase, Cochrane Library and Web of Science. The date up to the search was in August 2023. Following review of the classification and exclusion criteria for this research and the evaluation of its quality in the literature, there were a total of 266 related papers, which were reviewed for inclusion in the period from 2004 to 2017. A total of 1774 cases of low rectal cancer were enrolled. Of these 913 cases, the laparoscopic operation was performed on 913 cases, while 861 cases were operated on low rectal carcinoma. The overall sample was between 10 and 482. Five trials described the efficacy of laparoscopy have lower risk than open on postoperative wound infection in patients with low rectal cancer (OR, 0.72;95 % CI, 0.48,1.09 p = 0.12). Three studies results showed that the anastomotic leak was not significantly different between open and laparoscopy (OR, 0.86; 95% CI, 0.58,1.26 p = 0.44). Six surgical trials in low rectal cancer patients reported haemorrhage, and five cases of surgical time were reported, with laparoscopy having fewer bleeding compared with open surgery (MD, -188.89; 95% CI, -341.27, -36.51 p = 0.02). Compared with laparoscopy, the operation time was shorter for the open operation (MD, 33.06; 95% CI, 30.56, 35.57 p < 0.0001). Overall, there is no significant difference between laparoscopy and open surgery in terms of incidence of infection and anastomosis leak. However, the rate of haemorrhage in laparoscopy is lower,and operation time in open surgery is lower.
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Affiliation(s)
- Shu Yang
- Department of Traditional Chinese Medicine, The second affiliated hospital of Fujian Medical University, Quanzhou, China
| | - Yuting Lin
- Department of Traditional Chinese Medicine, The second affiliated hospital of Fujian Medical University, Quanzhou, China
| | - Wenjin Zhong
- Department of Clinical Laboratory, The second affiliated hospital of Fujian Medical University, Quanzhou, China
| | - Wenji Xu
- Department of gastroenterology, The second affiliated hospital of Fujian Medical University, Quanzhou, China
| | - Zhongxin Huang
- Department of Pathology, The second affiliated hospital of Fujian Medical University, Quanzhou, China
| | - Suqin Cai
- Department of Pathology, The second affiliated hospital of Fujian Medical University, Quanzhou, China
| | - Wen Chen
- Department of Traditional Chinese Medicine, The second affiliated hospital of Fujian Medical University, Quanzhou, China
| | - Baogen Zhang
- Department of Traditional Chinese Medicine, The second affiliated hospital of Fujian Medical University, Quanzhou, China
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Wang R, Xu Q, Guo H, Yang G, Zhang J, Wang H, Xu T, Guo C, Yuan J, He Y, Zhang X, Fu H, Xu G, Zhao B, Xie J, Zhao T, Huang L, Zhang J, Peng B, Yao X, Yang B. Concordance and Clinical Significance of Genomic Alterations in Progressive Tumor Tissue and Matched Circulating Tumor DNA in Aggressive-variant Prostate Cancer. CANCER RESEARCH COMMUNICATIONS 2023; 3:2221-2232. [PMID: 37877742 PMCID: PMC10624154 DOI: 10.1158/2767-9764.crc-23-0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 09/09/2023] [Accepted: 10/18/2023] [Indexed: 10/26/2023]
Abstract
Sequencing of circulating tumor DNA (ctDNA) is a minimally invasive approach to reveal the genomic alterations of cancer; however, its comparison with sequencing of tumor tissue has not been well documented in real-world patients with aggressive-variant prostate cancer (AVPC). Concordance of genomic alterations was assessed between progressive tumor tissue and matched ctDNA by next-generation sequencing for 63 patients with AVPC. Associations of genomic alterations with progression-free survival (PFS) and overall survival (OS) were investigated using Kaplan-Meier and Cox regression analyses. A total of 161 somatic mutations (SMs) and 84 copy-number variants (CNVs) were detected in tumors, of which 97 were also found in ctDNA, giving concordance of 39.6% (97/245) across all SMs and CNVs, 49.7% for SMs only and 20.2% for CNVs only. Across all patients with AVPC, chemotherapy was associated with significantly longer median PFS (6 vs. 0.75 months, P = 0.001) and OS (11 vs. 8 months, P < 0.001) than next-generation hormonal therapy (NHT). Among types of chemotherapy, additional platinum-based chemotherapy was associated with significantly longer median PFS and OS than docetaxel only in patients with TP53, RB1, or PTEN alterations, and in those with ctDNA% ≥ 13.5%. The concordance analysis first provides evidence for combining the sequencing of ctDNA and tumor tissue in real-world patients with AVPC. Chemotherapy is associated with significantly better survival than NHT, and the benefit of additional platinum-based chemotherapy may depend on the presence of alterations in TP53, RB1, or PTEN and on a sufficiently high proportion of ctDNA in patients with AVPC. SIGNIFICANCE AVPC is a highly malignant and heterogeneous disease. Sequencing of ctDNA is a minimally invasive approach to reveal genomic alterations. On the basis of the current real-world study, we found ctDNA does not fully recapitulate the landscape of genomic alterations from progressive tumor tissue in AVPC. We also revealed AVPC can benefit from chemotherapy, especially platinum-based regimens. TP53/RB1/PTEN alterations in ctDNA or tumor tissue could be biomarkers for platinum-based chemotherapy in this setting.
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Affiliation(s)
- Ruiliang Wang
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P.R. China
- Urologic Cancer Institute, Tongji University School of Medicine, Shanghai, P.R. China
| | - Qiufan Xu
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P.R. China
- Urologic Cancer Institute, Tongji University School of Medicine, Shanghai, P.R. China
| | - Hanxu Guo
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P.R. China
- Urologic Cancer Institute, Tongji University School of Medicine, Shanghai, P.R. China
| | - Guanjie Yang
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P.R. China
- Urologic Cancer Institute, Tongji University School of Medicine, Shanghai, P.R. China
| | - Jun Zhang
- Department of Urology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, P.R. China
| | - Hong Wang
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P.R. China
- Urologic Cancer Institute, Tongji University School of Medicine, Shanghai, P.R. China
| | - Tianyuan Xu
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P.R. China
- Urologic Cancer Institute, Tongji University School of Medicine, Shanghai, P.R. China
| | - Changcheng Guo
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P.R. China
- Urologic Cancer Institute, Tongji University School of Medicine, Shanghai, P.R. China
| | - Jing Yuan
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P.R. China
- Urologic Cancer Institute, Tongji University School of Medicine, Shanghai, P.R. China
| | - Yanyan He
- Department of Pathology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P.R. China
| | - Xiaoying Zhang
- Department of Nuclear Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P.R. China
| | - Hongliang Fu
- Department of Nuclear Medicine, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Guang Xu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P.R. China
| | - Binghui Zhao
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P.R. China
| | - Jun Xie
- Department of Urology, Shanghai Clinical College, Anhui Medical University, Shanghai, P.R. China
| | - Tingting Zhao
- Research Institute, GloriousMed Clinical Laboratory, Shanghai, P.R. China
| | - Longfei Huang
- Research Institute, GloriousMed Clinical Laboratory, Shanghai, P.R. China
| | - Jiansheng Zhang
- Department of Urology, Shanghai Tenth People's Hospital, Nanjing Medical University, Nanjing, P.R. China
| | - Bo Peng
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P.R. China
- Urologic Cancer Institute, Tongji University School of Medicine, Shanghai, P.R. China
- Department of Urology, Shanghai Clinical College, Anhui Medical University, Shanghai, P.R. China
- Department of Urology, Shanghai Tenth People's Hospital, Nanjing Medical University, Nanjing, P.R. China
| | - Xudong Yao
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P.R. China
- Urologic Cancer Institute, Tongji University School of Medicine, Shanghai, P.R. China
- Department of Urology, Shanghai Clinical College, Anhui Medical University, Shanghai, P.R. China
- Department of Urology, Shanghai Tenth People's Hospital, Nanjing Medical University, Nanjing, P.R. China
| | - Bin Yang
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P.R. China
- Urologic Cancer Institute, Tongji University School of Medicine, Shanghai, P.R. China
- Department of Urology, Shanghai Tenth People's Hospital, Nanjing Medical University, Nanjing, P.R. China
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Son SY, Seo YS, Yoon JH, Hur BY, Bae JS, Kim SH. Diagnostic Performance of Rectal CT for Staging Rectal Cancer: Comparison with Rectal MRI and Histopathology. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:1290-1308. [PMID: 38107688 PMCID: PMC10721426 DOI: 10.3348/jksr.2022.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/21/2023] [Accepted: 03/10/2023] [Indexed: 12/19/2023]
Abstract
Purpose To compare the diagnostic performance of rectal CT with that of high-resolution rectal MRI and histopathology in assessing rectal cancer. Materials and Methods Sixty-seven patients with rectal cancer who underwent rectal CT with rectal distension using sonographic gel and high-resolution MRI were enrolled in this study. The distance from the anal verge/anorectal junction, distance to the mesorectal fascia (MRF), extramural depth (EMD), extramesorectal lymph node (LN) involvement, extramural venous invasion (EMVI), and T/N stages in rectal CT/MRI were analyzed by two gastrointestinal radiologists. The CT findings of 20 patients who underwent radical surgery without concurrent chemoradiotherapy were compared using histopathology. Interclass correlations and kappa statistics were used. Results The distance from the anal verge/anorectal junction showed an excellent intraclass correlation between CT and MRI for both reviewers. For EMD, the distance to the MRF, presence of LNs, extramesorectal LN metastasis, EMVI, T stage, and intermodality kappa or weighted kappa values between CT and MRI showed excellent agreement. Among the 20 patients who underwent radical surgery, T staging, circumferential resection margin involvement, EMVI, and LN metastasis on rectal CT showed acceptable concordance rates with histopathology. Conclusion Dedicated rectal CT may be on par with rectal MRI in providing critical information to patients with rectal cancer.
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Kimura CMS, Kawaguti FS, Horvat N, Nahas CSR, Marques CFS, Pinto RA, de Rezende DT, Segatelli V, Safatle-Ribeiro AV, Junior UR, Maluf-Filho F, Nahas SC. Magnifying chromoendoscopy is a reliable method in the selection of rectal neoplasms for local excision. Tech Coloproctol 2023; 27:1047-1056. [PMID: 36906661 DOI: 10.1007/s10151-023-02773-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/12/2023] [Indexed: 03/13/2023]
Abstract
PURPOSE Adequate staging of early rectal neoplasms is essential for organ-preserving treatments, but magnetic resonance imaging (MRI) frequently overestimates the stage of those lesions. We aimed to compare the ability of magnifying chromoendoscopy and MRI to select patients with early rectal neoplasms for local excision. METHODS This retrospective study in a tertiary Western cancer center included consecutive patients evaluated by magnifying chromoendoscopy and MRI who underwent en bloc resection of nonpedunculated sessile polyps larger than 20 mm, laterally spreading tumors (LSTs) [Formula: see text] 20 mm, or depressed-type lesions of any size (Paris 0-IIc). Sensitivity, specificity, accuracy, and positive and negative predictive values of magnifying chromoendoscopy and MRI to determine which lesions were amenable to local excision (i.e., [Formula: see text] T1sm1) were calculated. RESULTS Specificity of magnifying chromoendoscopy was 97.3% (95% CI 92.2-99.4), and accuracy was 92.7% (95% CI 86.7-96.6) for predicting invasion deeper than T1sm1 (not amenable to local excision). MRI had lower specificity (60.5%, 95% CI 43.4-76.0) and lower accuracy (58.3%, 95% CI 43.2-72.4). Magnifying chromoendoscopy incorrectly predicted invasion depth in 10.7% of the cases in which the MRI was correct, while magnifying chromoendoscopy provided a correct diagnosis in 90% of the cases in which the MRI was incorrect (p = 0.001). Overstaging occurred in 33.3% of the cases in which magnifying chromoendoscopy was incorrect and 75% of the cases in which MRI was incorrect. CONCLUSION Magnifying chromoendoscopy is reliable for predicting invasion depth in early rectal neoplasms and selecting patients for local excision.
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Affiliation(s)
- C M S Kimura
- Divisoin of Gastrointestinal Surgery, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
- Department of Surgery, Stanford University School of Medicine, Stanford, USA
| | - F S Kawaguti
- Division of Endoscopy, Instituto do Câncer do Estado de São Paulo, Dr. Arnaldo Av, 251, 2nd Floor, São Paulo, Zip Code 01246-000, Brazil.
| | - N Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - C S R Nahas
- Divisoin of Gastrointestinal Surgery, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - C F S Marques
- Divisoin of Gastrointestinal Surgery, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - R A Pinto
- Divisoin of Gastrointestinal Surgery, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - D T de Rezende
- Division of Endoscopy, Instituto do Câncer do Estado de São Paulo, Dr. Arnaldo Av, 251, 2nd Floor, São Paulo, Zip Code 01246-000, Brazil
| | - V Segatelli
- Division of Pathology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - A V Safatle-Ribeiro
- Division of Endoscopy, Instituto do Câncer do Estado de São Paulo, Dr. Arnaldo Av, 251, 2nd Floor, São Paulo, Zip Code 01246-000, Brazil
| | - U R Junior
- Divisoin of Gastrointestinal Surgery, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - F Maluf-Filho
- Division of Endoscopy, Instituto do Câncer do Estado de São Paulo, Dr. Arnaldo Av, 251, 2nd Floor, São Paulo, Zip Code 01246-000, Brazil
| | - S C Nahas
- Divisoin of Gastrointestinal Surgery, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
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Tan S, Gao Q, Cui Y, Ou Y, Huang S, Feng W. Oncologic outcomes of watch-and-wait strategy or surgery for low to intermediate rectal cancer in clinical complete remission after adjuvant chemotherapy: a systematic review and meta-analysis. Int J Colorectal Dis 2023; 38:246. [PMID: 37787779 DOI: 10.1007/s00384-023-04534-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND A watch-and-wait (WW) strategy or surgery for low to intermediate rectal cancer that has reached clinical complete remission (cCR) after neoadjuvant chemotherapy (nCRT) or total neoadjuvant therapy (TNT) has been widely used in the clinic, but both treatment strategies are controversial. OBJECTIVE The aim of this study was to compare the oncologic outcomes of a watch-and-wait strategy or a surgical approach to treat rectal cancer in complete remission and to report the evidence-based clinical advantages of the two treatment strategies. METHODS Seven national and international databases were searched for clinical trials comparing the watch-and-wait strategy with surgical treatment for oncological outcomes in patients with rectal cancer in clinical complete remission. RESULTS In terms of oncological outcomes, there was no significant difference between the watch-and-wait strategy and surgical treatment in terms of overall survival (OS) (HR = 0.92, 95% CI (0.52, 1.64), P = 0.777), and subgroup analysis showed no significant difference in 5-year disease-free survival (5-year DFS) between WW and both local excision (LE) and radical surgery (RS) (HR = 1.76, 95% CI (0.97, 3.19), P = 0.279; HR = 1.98, 95% CI (0.95, 4.13), P = 0.164), in distant metastasis rate (RR = 1.12, 95% CI (0.73, 1.72), P = 0.593), mortality rate (RR = 1.62, 95% CI (0.93, 2.84), P = 0.09), and organ preservation rate (RR = 1.05, 95% CI (0.94, 1.17), P = 0.394) which were not statistically significant and on the outcome indicators of local recurrence rate (RR = 2.09, 95% CI (1.44, 3.03), P < 0.001) and stoma rate (RR = 0.35, 95% CI (0.20, 0.61), P < 0.001). There were significant differences between the WW group and the surgical treatment group. CONCLUSION There were no differences in OS, 5-year DFS, distant metastasis, and mortality between the WW strategy group and the surgical treatment group. The WW strategy did not increase the risk of local recurrence compared with local resection but may be at greater risk of local recurrence compared with radical surgery, and the WW group was significantly better than the surgical group in terms of stoma rate; the WW strategy was evidently superior in preserving organ integrity compared to radical excision. Consequently, for patients who exhibit a profound inclination towards organ preservation and the evasion of stoma formation in the scenario of clinically complete remission of rectal cancer, the WW strategy can be contemplated as a pragmatic alternative to surgical interventions. It is, however, paramount to emphasize that the deployment of such a strategy should be meticulously undertaken within the ambit of a multidisciplinary team's management and within specialized centers dedicated to rectal cancer management.
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Affiliation(s)
- Shufa Tan
- Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Qiangqiang Gao
- Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Deputy No. 2, West Weiyang Road, Xianyang City, Shaanxi Province, 712000, China
| | - Yaping Cui
- Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Deputy No. 2, West Weiyang Road, Xianyang City, Shaanxi Province, 712000, China
| | - Yan Ou
- Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Deputy No. 2, West Weiyang Road, Xianyang City, Shaanxi Province, 712000, China
| | - Shuilan Huang
- Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Wenzhe Feng
- Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Deputy No. 2, West Weiyang Road, Xianyang City, Shaanxi Province, 712000, China.
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Arndt K, Vigna C, Kaul S, Fabrizio A, Cataldo T, Smith M, Messaris E. Magnetic resonance imaging accuracy in staging early and locally advanced rectal cancer. Surg Oncol 2023; 50:101987. [PMID: 37717374 DOI: 10.1016/j.suronc.2023.101987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/21/2023] [Accepted: 09/07/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Magnetic Resonance Imaging (MRI) is the standard pretreatment staging in patients with rectal cancer. Accurate tumor staging is paramount to determining the appropriate treatment course for patients diagnosed with rectal cancer. The current study aims to re-evaluate the accuracy of pre-operative MRI in staging of both early and locally advanced rectal cancer following completion of neoadjuvant therapy (NAT) compared to the pathologic stage. METHODS A retrospective review of patients treated for rectal cancer between 2015 and 2020 at a single academic institution. All patients underwent rectal cancer protocol MRIs before surgical resection. Analysis was carried out in two groups: early rectal cancer: T1/2 N0 tumors with upfront surgical resection (N = 40); and locally advanced disease: T3 or greater or N+ disease receiving NAT, with restaging MRI following NAT (n = 63). RESULTS 103 patients were included in analysis. MRI accuracy in early tumors was 35% ICC = 0.52 (95% CI 0.25-0.71) T stage and 66% ICC = 0 (95% CI -0.24, 0.29) for 29 patients with nodal data for N stage. There was 28% understaging of T2 tumors and 34% understaging of N0 stage by MRI. Post NAT MRI had 44% accuracy ICC = 0.57 (95% CI -0.15-0.20) T stage and 60% accuracy ICC = 0.32 (95% CI 0.08-0.52) N stage. Tumor invasion was overstaged on MRI: 40% T2, 29% T3, 90% T4. Nodal inaccuracy was due to overstaging, 61% N1, 90% N2. CONCLUSIONS In locally advanced rectal cancer MRI overstaged tumors, this could be due to the continued effect of NAT from MRI to resection. This overstaging is of little clinical significance as it doesn't alter the treatment plan, except in cases of complete clinical response. In early rectal cancer, MRI had limited accuracy compared to pathology, understaging a quarter of patients who would benefit from NAT before surgery. Other adjunct imaging modalities should be considered to improve accuracy in staging early rectal cancer and consideration of complete response and enrollment in watch and wait protocols.
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Affiliation(s)
- Kevin Arndt
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Carolina Vigna
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sumedh Kaul
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Anne Fabrizio
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Thomas Cataldo
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Martin Smith
- Department of Diagnostic Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Evangelos Messaris
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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18
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Xia Q, Cheng W, Bi J, Ren AP, Chen X, Li T. Value of biplane transrectal ultrasonography plus micro-flow imaging in preoperative T staging and rectal cancer diagnosis in combination with CEA/CA199 and MRI. BMC Cancer 2023; 23:860. [PMID: 37700269 PMCID: PMC10496222 DOI: 10.1186/s12885-023-11370-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 09/04/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Rectal cancer is one of the most common malignant tumors and has a high incidence rate and fatality rate. Accurate preoperative T staging of rectal cancer is critical for the selection of appropriate rectal cancer treatment. Various pre-operative imaging methods are available, and the identification of the most accurate method for clinical use is essential for patient care. We investigated the value of biplane transrectal ultrasonography (TRUS) combined with MFI in preoperative staging of rectal cancer and explored the value of combining TRUS plus MFI with CEA/CA199 and MRI. METHODS A total of 87 patients from Daping Hospital with rectal cancer who underwent TRUS examination plus MFI were included. Grades of MFI were determined by Alder classification. Among the total patients, 64 underwent MRI and serum CEA/CA199 tests additionally within one week of TRUS. Pathological results were used as the gold standard for cancer staging. Concordance rates between TRUS, MRI, and CEA/CA199 for tumors at different stages were compared. RESULTS There were no significant differences between the Alder classification and pathological T staging. The concordance rate of TRUS and MFI for rectal cancer T staging was 72.4% (K = 0.615, p < 0.001). Serum CEA and CA199 levels were significantly different in tumors at different stages and increased progressively by pathological stage (p < 0.001); the accuracy rate was 71.88% (K = 0.599, p < 0.001), while that of MRI was 51.56% (K = 0.303, p < 0.001), indicating that TRUS had higher consistency in the preoperative T staging of rectal cancer. The combination of TRUS, MRI, and CEA/CA199 yielded an accuracy rate of 90.6%, which was higher than that of any method alone. CONCLUSIONS Preoperative T staging of rectal cancer from biplane TRUS plus MFI was highly consistent with postoperative pathological T staging. TRUS combined with MRI and serum CEA/CA199 had a greater value in the diagnosis of rectal cancer and a higher diagnostic rate than any examination alone.
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Affiliation(s)
- Qin Xia
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, 400000, China
| | - Wei Cheng
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, 400000, China
| | - Jie Bi
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, 400000, China
| | - An-Ping Ren
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, 400000, China
| | - Xiao Chen
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, 400000, China
| | - Tao Li
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, 400000, China.
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Moreira P, Cardoso PM, Macedo G, Santos-Antunes J. Endoscopic Submucosal Dissection, Endoscopic Mucosal Resection, and Transanal Minimally Invasive Surgery for the Management of Rectal and Anorectal Lesions: A Narrative Review. J Clin Med 2023; 12:4777. [PMID: 37510892 PMCID: PMC10381236 DOI: 10.3390/jcm12144777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), and transanal minimally invasive surgery (TAMIS) are modern techniques that now play a crucial role in the treatment of colorectal lesions. ESD is a minimally invasive endoscopic procedure that allows for the resection of lesions of any size in a single piece, with clear advantages regarding oncological outcomes and recurrences. However, it is a complex technique, requiring high endoscopic skills, expertise, and specialized training, with higher rates of adverse events expected compared with EMR. EMR is another endoscopic technique used to remove superficial gastrointestinal tumors, particularly those that are limited to the mucosal layer. It is a faster and more accessible procedure, with fewer adverse events, although it only allows for an en-bloc resection of lesions measuring 15-20 mm. TAMIS is a minimally invasive surgical technique used to remove rectal tumors, involving the insertion of a single-port device through the anus, allowing for a better visualization and removal of the tumor with minimal disruption. This article reviews the current applications and evidence regarding these techniques, in search for the most adequate treatment for the removal of lesions in the rectum and anorectal junction, as these locations possess distinct characteristics that demand a more specific approach.
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Affiliation(s)
- Pedro Moreira
- Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Pedro Marílio Cardoso
- Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Gastroenterology Department, Centro Hospitalar São João, 4200-319 Porto, Portugal
| | - Guilherme Macedo
- Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Gastroenterology Department, Centro Hospitalar São João, 4200-319 Porto, Portugal
| | - João Santos-Antunes
- Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Gastroenterology Department, Centro Hospitalar São João, 4200-319 Porto, Portugal
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, 4099-030 Porto, Portugal
- IPATIMUP-Institute of Molecular Pathology and Immunology, University of Porto, 4200-450 Porto, Portugal
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Maliborska SV, Holotiuk VV, Partykevich YD, Holotiuk IS. DIAGNOSTICS OF LYMPHOGENIC METASTASIS IN PATIENTS WITH RECTAL CANCER BY COMBINING MRI WITH BLOOD CEA ASSESSMENT. Exp Oncol 2023; 45:99-106. [PMID: 37417277 DOI: 10.15407/exp-oncology.2023.01.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Indexed: 07/08/2023]
Abstract
AIM To improve the diagnostics of lymphogenic metastasis in patients with rectal cancer (RCa) by combining magnetic resonance imaging (MRI) with the blood carcinoembryonic antigen (CEA) level assessment. MATERIALS AND METHODS We have systematized and analyzed the results of the examination and treatment of 77 patients with stage II-III rectal adenocarcinoma (T2-3N0-2M0). Before the start of neoadjuvant treatment as well as 8 weeks after its completion, computed tomography (CT) and MRI were performed. We analyzed such prognostic criteria as the size, shape, and structure of lymph nodes as well as the patterns of contrast accumulation. As a prognostic marker, CEA levels in the blood of patients with RCa before surgical treatment were assessed. RESULTS Radiological exams showed a rounded shape and heterogeneous structure to be the most informative for predicting metastatic lymph node damage, increasing the probability by 4.39 and 4.98 times, respectively. After neoadjuvant treatment, the percentage of positive histopathological reports on lymph node involvement decreased significantly to 21.6% (р ˂ 0.001). MRI showed 76% sensitivity and 48% specificity for assessing lymphogenic metastasis. CEA levels differed significantly between stages II and III (N1-2) (р ˂ 0.032) with a threshold value of 3.95 ng/ml. CONCLUSIONS In order to increase the effectiveness of the diagnosis of lymphogenic metastasis using radiological examination methods in RCa patients, such prognostic criteria as the round shape and heterogeneous structure of the lymph nodes and the threshold level of CEA should be considered.
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Affiliation(s)
- S V Maliborska
- Ivano-Frankivsk National Medical University, Ivano-Frankivsk 76018, Ukraine
| | - V V Holotiuk
- Ivano-Frankivsk National Medical University, Ivano-Frankivsk 76018, Ukraine
| | - Y D Partykevich
- Ivano-Frankivsk National Medical University, Ivano-Frankivsk 76018, Ukraine
| | - I S Holotiuk
- Ivano-Frankivsk National Medical University, Ivano-Frankivsk 76018, Ukraine
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21
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Peng S, Liu X, Li Y, Yu H, Xie Y, Wang X, Zhou J, Zhu M, Luo Y, Huang M. Radiological lymph-node size improves the prognostic value of systemic inflammation index in rectal cancer with pathologically negative nodes. Cancer Med 2023; 12:10303-10314. [PMID: 36938675 PMCID: PMC10225194 DOI: 10.1002/cam4.5761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 02/08/2023] [Accepted: 02/17/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND The relationship between the radiological lymph node (rLN) size and survival outcome in node-negative rectal cancer is still uncertain. In this study, we aimed to explore the role of enlarged rLN in predicting the survival of node-negative rectal cancers. METHODS We retrospectively reviewed the records of 722 node-negative rectal cancer who underwent curative resection. Factors associated with DFS (disease-free survival) and CSS (cancer-specific survival) were assessed with univariate and multivariate analysis. Survival analysis was performed according to presence with or without enlarged rLN. Combining rLN with NLR as a new index-inflammation immune score (IIS) for predicting survival. Comparing different models to assess the predictive powers. RESULTS A total of 119 patients had tumor recurrence and 73 patients died due to cancer. Patients with enlarged rLN (≥5 mm) was significantly associated with better DFS (HR:0.517, 95%CI:0.339-0.787, p = 0.002) and CSS (HR:0.43, 95%CI:0.242-0.763, p = 0.004). The risk factors of recurrence were rLN, neutrophil-lymphocyte ratio (NLR), CEA level, and distance from the anal verge. The risk of recurrence increased by 1.88- and 2.83-fold for the high score in IIS compared with the low and intermediate score group (All p < 0.001). Similarly, the high score in IIS also increased the risk of cancer-specific death. In the model comparison, the AIC and LR were improved by including the rLN into the NLR model for DFS and CSS prediction (All p < 0.05). CONCLUSIONS Node-negative rectal cancer patients with enlarged rLN had a better survival outcome. IIS might be a more comprehensive and complete inflammation immune index for survival prediction.
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Affiliation(s)
- Shaoyong Peng
- Department of Colorectal Surgery, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
- Department of General Surgery, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
- Guangdong Institute of Gastroenterology, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
| | - Xiaoxia Liu
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
- Guangdong Institute of Gastroenterology, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
| | - Yingjie Li
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
- Guangdong Institute of Gastroenterology, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
| | - Huichuan Yu
- Department of Colorectal Surgery, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
- Department of General Surgery, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
- Guangdong Institute of Gastroenterology, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
| | - Yumo Xie
- Department of Colorectal Surgery, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
- Department of General Surgery, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
- Guangdong Institute of Gastroenterology, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
| | - Xiaolin Wang
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
- Guangdong Institute of Gastroenterology, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
| | - Jiaming Zhou
- Department of Colorectal Surgery, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
- Department of General Surgery, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
| | - Mingxuan Zhu
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
- Guangdong Institute of Gastroenterology, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
| | - Yanxin Luo
- Department of Colorectal Surgery, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
- Department of General Surgery, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
- Guangdong Institute of Gastroenterology, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
| | - Meijin Huang
- Department of Colorectal Surgery, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
- Department of General Surgery, The Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
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22
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Fowler KJ. Gastrointestinal Imaging: What Has Shaped and What Will Shape Our Field Going Forward. Radiology 2023; 307:e223251. [PMID: 36916893 DOI: 10.1148/radiol.223251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- Kathryn J Fowler
- From the Department of Diagnostic Radiology, Division of Body Imaging, University of California-San Diego, 6206 Lakewood St, San Diego, CA 92122
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23
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Stage IV Colorectal Cancer Management and Treatment. J Clin Med 2023; 12:jcm12052072. [PMID: 36902858 PMCID: PMC10004676 DOI: 10.3390/jcm12052072] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 03/08/2023] Open
Abstract
(1) Background: Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer-related mortality worldwide. Up to 50% of patients with CRC develop metastatic CRC (mCRC). Surgical and systemic therapy advances can now offer significant survival advantages. Understanding the evolving treatment options is essential for decreasing mCRC mortality. We aim to summarize current evidence and guidelines regarding the management of mCRC to provide utility when making a treatment plan for the heterogenous spectrum of mCRC. (2) Methods: A comprehensive literature search of PubMed and current guidelines written by major cancer and surgical societies were reviewed. The references of the included studies were screened to identify additional studies that were incorporated as appropriate. (3) Results: The standard of care for mCRC primarily consists of surgical resection and systemic therapy. Complete resection of liver, lung, and peritoneal metastases is associated with better disease control and survival. Systemic therapy now includes chemotherapy, targeted therapy, and immunotherapy options that can be tailored by molecular profiling. Differences between colon and rectal metastasis management exist between major guidelines. (4) Conclusions: With the advances in surgical and systemic therapy, as well as a better understanding of tumor biology and the importance of molecular profiling, more patients can anticipate prolonged survival. We provide a summary of available evidence for the management of mCRC, highlighting the similarities and presenting the difference in available literature. Ultimately, a multidisciplinary evaluation of patients with mCRC is crucial to selecting the appropriate pathway.
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24
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Zou P, Wu JS. SwinE-UNet3+: swin transformer encoder network for medical image segmentation. PROGRESS IN ARTIFICIAL INTELLIGENCE 2023. [DOI: 10.1007/s13748-023-00300-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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25
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Hollis R, Weber KT, Parikh S, Kobritz M, Gurien S, Greenwald ML. Correlation between lymph node size on pathology and metastatic disease in right-sided colon cancer: A retrospective review. Surg Oncol 2023; 46:101872. [PMID: 36566668 DOI: 10.1016/j.suronc.2022.101872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 09/17/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Identification of positive lymph nodes in colon cancer can significantly impact treatment. Few studies have examined the role of lymph node size in staging and prognosis. This study evaluated the relationship between lymph node size and lymph node metastases in right-sided colon cancer. METHODS Retrospective chart review was performed for patients undergoing colectomy for right-sided colon cancer from 2015 to 2020 across a single multi-hospital health system. Patients under age 18 or who did not have invasive adenocarcinoma upon pathological examination were excluded. Primary endpoints assessed lymph node size and lymph node metastases. 572 patients were stratified by lymph node size; lymph nodes ≥5 mm (n = 308) were characterized as enlarged. RESULTS All surgical specimens examined had adequate number of lymph nodes for staging. 33.9% of all specimens examined contained lymph node metastases. Patients with enlarged lymph nodes were significantly more likely to have lymph node metastases than those with normal-sized lymph nodes (p < 0.001). Enlarged lymph nodes were associated with advanced nodal staging. CONCLUSIONS Patients with enlarged nodes were significantly more likely to have lymph node metastases than those with normal-sized lymph nodes. Further research to analyze these enlarged lymph nodes on radiologic imaging is warranted to determine the role of radiographic assessment of lymph node size during pre-operative staging.
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Affiliation(s)
- Russell Hollis
- Northwell Health North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Kathryn T Weber
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Sajni Parikh
- Northwell Health North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Molly Kobritz
- Northwell Health North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Steven Gurien
- Northwell Health North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Marc L Greenwald
- Northwell Health North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
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26
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Bogveradze N, Snaebjornsson P, Grotenhuis BA, van Triest B, Lahaye MJ, Maas M, Beets GL, Beets-Tan RGH, Lambregts DMJ. MRI anatomy of the rectum: key concepts important for rectal cancer staging and treatment planning. Insights Imaging 2023; 14:13. [PMID: 36652149 PMCID: PMC9849549 DOI: 10.1186/s13244-022-01348-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/04/2022] [Indexed: 01/19/2023] Open
Abstract
A good understanding of the MRI anatomy of the rectum and its surroundings is pivotal to ensure high-quality diagnostic evaluation and reporting of rectal cancer. With this pictorial review, we aim to provide an image-based overview of key anatomical concepts essential for treatment planning, response evaluation and post-operative assessment. These concepts include the cross-sectional anatomy of the rectal wall in relation to T-staging; differences in staging and treatment between anal and rectal cancer; landmarks used to define the upper and lower boundaries of the rectum; the anatomy of the pelvic floor and anal canal, the mesorectal fascia, peritoneum and peritoneal reflection; and guides to help discern different pelvic lymph node stations on MRI to properly stage regional and non-regional rectal lymph node metastases. Finally, this review will highlight key aspects of post-treatment anatomy, including the assessment of radiation-induced changes and the evaluation of the post-operative pelvis after different surgical resection and reconstruction techniques.
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Affiliation(s)
- Nino Bogveradze
- grid.430814.a0000 0001 0674 1393Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands ,grid.5012.60000 0001 0481 6099GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands ,Department of Radiology, American Hospital Tbilisi, Tbilisi, Georgia
| | - Petur Snaebjornsson
- grid.430814.a0000 0001 0674 1393Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Brechtje A. Grotenhuis
- grid.430814.a0000 0001 0674 1393Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Baukelien van Triest
- grid.430814.a0000 0001 0674 1393Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Max J. Lahaye
- grid.430814.a0000 0001 0674 1393Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands
| | - Monique Maas
- grid.430814.a0000 0001 0674 1393Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands
| | - Geerard L. Beets
- grid.5012.60000 0001 0481 6099GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands ,grid.430814.a0000 0001 0674 1393Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina G. H. Beets-Tan
- grid.430814.a0000 0001 0674 1393Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands ,grid.5012.60000 0001 0481 6099GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands ,grid.10825.3e0000 0001 0728 0170Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Doenja M. J. Lambregts
- grid.430814.a0000 0001 0674 1393Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands
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27
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Kassam Z, Lang R, Bates DDB, Chang KJ, Fraum TJ, Friedman KA, Golia Pernicka JS, Gollub MJ, Harisinghani M, Khatri G, Lall C, Lee S, Magnetta M, Nougaret S, Paspulati RM, Paroder V, Shaish H, Kim DH. SAR user guide to the rectal MR synoptic report (primary staging). ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:186-199. [PMID: 35754053 DOI: 10.1007/s00261-022-03578-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 01/21/2023]
Abstract
Rectal MR is the key diagnostic exam at initial presentation for rectal cancer patients. It is the primary determinant in establishing clinical stage for the patient and greatly impacts the clinical decision-making process. Consequently, structured reporting for MR is critically important to ensure that all required information is provided to the clinical care team. The SAR initial staging reporting template has been constructed to address these important items, including locoregional extent and factors impacting the surgical approach and management of the patient. Potential outputs to each item are defined, requiring the radiologist to commit to a result. This provides essential information to the surgeon or oncologist to make specific treatment deisions for the patient. The SAR Initial Staging MR reporting template has now been officially adopted by the NAPRC (National Accreditation Program for Rectal Cancer) under the American College of Surgery. With the recent revisions to the reporting template, this user guide has been revamped to improve its practicality and support to the radiologist to complete the structured report. Each line item of the report is supplemented with clinical perspectives, images, and illustrations to help the radiologist understand the potential implications for a given finding. Common errors and pitfalls to avoid are highlighted. Ideally, rectal MR interpretation should not occur in a vacuum but in the context of a multi-disciplinary tumor board to ensure that healthcare providers use common terminology and share a solid understanding of the strengths and weaknesses of MR.
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Affiliation(s)
- Z Kassam
- Western University, London, Canada
| | - R Lang
- Western University, London, Canada
| | | | | | - T J Fraum
- Mallinckrodt Institute of Radiology, St. Louis, USA
| | - K A Friedman
- University Hospitals Cleveland Medical Center, Cleveland, USA
| | | | | | | | - G Khatri
- University of Texas Southwestern, Dallas, USA
| | - C Lall
- University of Florida-Jacksonville, Jacksonville, USA
| | - S Lee
- University of California, Irvine, USA
| | | | - S Nougaret
- Montpellier Cancer Institute, U1194, Montpellier University, Montpellier, France
| | - R M Paspulati
- University Hospital, Case Western Reserve University, Cleveland, USA
| | - V Paroder
- Memorial Sloan Kettering, New York, USA
| | - H Shaish
- Columbia University Medical Center, New York, USA
| | - D H Kim
- Department of Radiology, University of Wisconsin Medical School, University of Wisconsin, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI, 53792-3252, USA.
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28
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Ghoneem E, Shabana ASA, El Sherbini M, Zuhdy M, Eldamshety O, Gouda M, El Shamy A, Saleh GA, Saleh AAG. Endoluminal ultrasound versus magnetic resonance imaging in assessment of rectal cancer after neoadjuvant therapy. BMC Gastroenterol 2022; 22:542. [PMID: 36575373 PMCID: PMC9793528 DOI: 10.1186/s12876-022-02628-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Accurate rectal tumor staging guides the choice of treatment options. EUS and MRI are the main modalities for staging. AIM OF THE WORK To compare the performance of EUS and MRI for loco-regional staging of anorectal cancer after neo-adjuvant therapy. METHODS Seventy-three (37 male, 36 female) patients with rectal cancer after neo-adjuvant chemoradiotherapy were enrolled. Histopathological staging after surgery were used as reference for comparing the yield of loco-regional staging for EUS and MRI. EUS and MRI were done 1 month after completion of neo-adjuvant therapy. RESULTS Regarding post-surgical T staging, eight patients had early tumor (T2 = 16 and T1 = 9) and thirty six were locally advanced (T3 = 36), while N staging, forty patients with negative nodes and 33 were positive (N1 = 22 and N2 = 11). Comparing EUS to MRI, it showed a higher sensitivity (95.7% vs. 78.7%), specificity (84.6% vs. 68.0%) and accuracy (91.8% vs. 75.3%) for staging early and locally advanced tumor. Also, it had a higher sensitivity (78.8% vs. 69.7%), specificity (75.0% vs. 65.0%) and accuracy (76.7% vs. 67.1%) for detection of lymph nodes. CONCLUSION EUS appears to be more accurate than MRI in loco-regional staging of rectal carcinoma after neo-adjuvant therapy.
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Affiliation(s)
- Elsayed Ghoneem
- grid.10251.370000000103426662Department of Internal Medicine, Hepatology and Gastroenterology Unit, Specialized Medical Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt ,Egyptian Liver Research Institute and Hospital, Sherbin, Mansoura, Egypt
| | - Ahmed Shekeib Abdein Shabana
- grid.10251.370000000103426662Department of Internal Medicine, Hepatology and Gastroenterology Unit, Specialized Medical Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed El Sherbini
- grid.10251.370000000103426662Department of Internal Medicine, Hepatology and Gastroenterology Unit, Specialized Medical Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohammad Zuhdy
- grid.10251.370000000103426662Department of Surgical Oncology, Oncology Center Mansoura University (OCMU), Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Osama Eldamshety
- grid.10251.370000000103426662Department of Surgical Oncology, Oncology Center Mansoura University (OCMU), Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Gouda
- grid.420091.e0000 0001 0165 571XTheodor Bilharz Research Institute, Cairo, Egypt
| | - Ahmed El Shamy
- grid.10251.370000000103426662Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Gehad Ahmad Saleh
- grid.10251.370000000103426662Department of Diagnostic Radiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Abdel Ghafar Saleh
- grid.10251.370000000103426662Department of Internal Medicine, Hepatology and Gastroenterology Unit, Specialized Medical Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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29
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Wadhwa V, Patel N, Grover D, Ali FS, Thosani N. Interventional gastroenterology in oncology. CA Cancer J Clin 2022; 73:286-319. [PMID: 36495087 DOI: 10.3322/caac.21766] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 10/12/2022] [Accepted: 10/17/2022] [Indexed: 12/14/2022] Open
Abstract
Cancer is one of the foremost health problems worldwide and is among the leading causes of death in the United States. Gastrointestinal tract cancers account for almost one third of the cancer-related mortality globally, making it one of the deadliest groups of cancers. Early diagnosis and prompt management are key to preventing cancer-related morbidity and mortality. With advancements in technology and endoscopic techniques, endoscopy has become the core in diagnosis and management of gastrointestinal tract cancers. In this extensive review, the authors discuss the role endoscopy plays in early detection, diagnosis, and management of esophageal, gastric, colorectal, pancreatic, ampullary, biliary tract, and small intestinal cancers.
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Affiliation(s)
- Vaibhav Wadhwa
- Center for Interventional Gastroenterology at UTHealth (iGUT), Division of Gastroenterology Hepatology and Nutrition, University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
| | - Nicole Patel
- Center for Interventional Gastroenterology at UTHealth (iGUT), Division of Gastroenterology Hepatology and Nutrition, University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
| | - Dheera Grover
- Center for Interventional Gastroenterology at UTHealth (iGUT), Division of Gastroenterology Hepatology and Nutrition, University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
| | - Faisal S Ali
- Center for Interventional Gastroenterology at UTHealth (iGUT), Division of Gastroenterology Hepatology and Nutrition, University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
| | - Nirav Thosani
- Center for Interventional Gastroenterology at UTHealth (iGUT), Division of Gastroenterology Hepatology and Nutrition, University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
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30
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Uttinger K, Mehdorn M, Gockel I. [82/f-Abdominal pain and no defecation for 10 days : Preparation for the medical specialist examination: part 6]. CHIRURGIE (HEIDELBERG, GERMANY) 2022; 93:25-29. [PMID: 36066594 DOI: 10.1007/s00104-022-01719-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Konstantin Uttinger
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstraße 20, Haus 4, 04103, Leipzig, Deutschland
| | - Matthias Mehdorn
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstraße 20, Haus 4, 04103, Leipzig, Deutschland.
| | - Ines Gockel
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstraße 20, Haus 4, 04103, Leipzig, Deutschland
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31
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Shi WK, Liu YX, Qiu XY, Zhou JY, Zhou JL, Lin GL. Construction and validation of a novel Ferroptosis-related gene signature predictive model in rectal Cancer. BMC Genomics 2022; 23:764. [DOI: 10.1186/s12864-022-08996-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022] Open
Abstract
Abstract
Background
Rectal cancer (RC) is one of the most common malignant tumors. Ferroptosis is an iron-dependent form of cell death, which plays an important role in various cancers. However, the correlation between ferroptosis-related genes (FRGs) and prognosis in RC remains unclear.
Methods
Gene expression data from The Cancer Genome Atlas Rectum adenocarcinoma (TCGA-READ) and GSE87211 were downloaded. Clustering and functional enrichment were evaluated. A FRGs risk score was established based on the univariate Cox analysis and the Least absolute shrinkage and selection operator (LASSO) analysis. K-M analysis and ROC analysis were conducted to determine prognostic values. qRT-PCR was performed to validate levels of mRNA expression. Multivariate Cox analysis was used to build a prognostic prediction model based on the risk score.
Results
Based on FRGs, RC patients were grouped into two clusters. In the functional enrichment of differentially expressed genes between the two clusters, immune-related pathways dominated. A novel FRGs signature with 14 genes related to the overall survival (OS) of RC was established. qRT-PCR of the 14 genes identified TP63, ISCU, PLIN4, MAP3K5, OXSR, FANCD2 and ATM were overexpressed in RC tissue; HSPB1, MAPK1, ABCC1, PANX1, MAPK9 and ATG7 were underexpressed; TUBE1 had no difference. The high-risk group had a significantly lower OS than the low-risk group (P < 0.001), and ROC curve analysis confirmed the signature’s predictive capacity. Multivariate analysis demonstrated that the risk score and age were independent prognostic factors.
Conclusion
A novel FRGs model can be used to predict the prognosis in RC, as well as to guide individual treatment.
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32
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Fang J, Sun W, Wu D, Pang P, Guo X, Yu C, Lu W, Tang G. Value of texture analysis based on dynamic contrast-enhanced magnetic resonance imaging in preoperative assessment of extramural venous invasion in rectal cancer. Insights Imaging 2022; 13:179. [DOI: 10.1186/s13244-022-01316-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 10/19/2022] [Indexed: 11/24/2022] Open
Abstract
Abstract
Objective
Accurate preoperative assessment of extramural vascular invasion (EMVI) is critical for the treatment and prognosis of rectal cancer. The aim of our research was to develop an assessment model by texture analysis for preoperative prediction of EMVI.
Materials and methods
This study enrolled 44 rectal patients as train cohort, 7 patients as validation cohort and 18 patients as test cohort. A total of 236 texture features from DCE MR imaging quantitative parameters were extracted for each patient (59 features of Ktrans, Kep, Ve and Vp), and key features were selected by least absolute shrinkage and selection operator regression (LASSO). Finally, clinical independent risk factors, conventional MRI assessment, and T-score were incorporated to construct an assessment model using multivariable logistic regression.
Results
The T-score calculated using the 4 selected key features were significantly correlated with EMVI (p < 0.010). The area under the receiver operating characteristic curve (AUC) was 0.797 for discriminating between EMVI-positive and EMVI-negative patients with a sensitivity of 88.2% and specificity of 70.4%. The conventional MRI assessment of EMVI had a sensitivity of 23.53% and a specificity of 96.30%. The assessment model showed a greatly improved performance with an AUC of 0.954 (sensitivity, 88.2%; specificity, 92.6%) in train cohort, 0.833 (sensitivity, 66.7%; specificity, 100%) in validation cohort and 0.877 in test cohort, respectively.
Conclusions
The assessment model showed an excellent performance in preoperative assessment of EMVI. It demonstrates strong potential for improving the accuracy of EMVI assessment and provide a reliable basis for individualized treatment decisions.
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33
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Carbonara R, Surgo A, Ciliberti MP, Gregucci F, Bonaparte I, Nicosia L, Meldolesi E, Caliandro M, Ferraro V, Inchingolo R, Memeo R, Ludovico E, Calbi R, Lavalle M, Gambacorta MA, Alongi F, Fiorentino A. Impact of preoperative chemoradiation with higher dose intensity modulated radiotherapy on pathological complete response for locally advanced rectal cancer: a systematic review. Expert Rev Anticancer Ther 2022; 22:1249-1259. [PMID: 36174658 DOI: 10.1080/14737140.2022.2130895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Neoadjuvant chemoradiation (CRT) followed by total mesorectal excision is the current standard-of-care for locally advanced UICC II-III stage rectal cancer (LARC). A pathological complete response (pCR) correlates with survival. Improvements of pCR, including dose escalation, should be explored. The aim of this explorative analysis is to assess the impact on pCR of intensity-modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB). AREAS COVERED A literature search via PICO (Population, Intervention, Comparison, Outcome) in MEDLINE/PubMed and EMBASE and a systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Metanalysis) methodology were performed. Studies that reported pCR rate in patients with LARC in clinical stage T2N+M0 or cT3/4 N0/+M0 treated with preoperative CRT with SIB-IMRT/VMAT (Volumetric Modulated Arc Therapy) were included. Sixty-two studies were identified, but only eight clinical trials with a total of 311 patients were included . Median follow-up was 16-61 months. pCR reached the value of 38%. Good survival outcomes were observed with a mild toxicity profile. EXPERT OPINION Radiotherapy dose intensification in LARC showed a slight increase of pCR compared to historical studies. Prospective evaluations are necessary to define which patients would benefit most.
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Affiliation(s)
- Roberta Carbonara
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Alessia Surgo
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Maria Paola Ciliberti
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Fabiana Gregucci
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Ilaria Bonaparte
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Luca Nicosia
- IRCCS, Advanced Radiation Oncology Department, Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Elisa Meldolesi
- Radiation Oncology Department, Fondazione Policlinico Universitario A.Gemelli, IRCCS, Rome, Italy
| | - Morena Caliandro
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Valentina Ferraro
- Hepatobiliary and Pancreatic Surgery Unit, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Riccardo Inchingolo
- Hepatobiliary and Pancreatic Surgery Unit, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Riccardo Memeo
- Hepatobiliary and Pancreatic Surgery Unit, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Elena Ludovico
- Radiology Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti (BA), Bari, Italy
| | - Roberto Calbi
- Radiology Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti (BA), Bari, Italy
| | - Mariadea Lavalle
- Nuclear Medicine Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti (BA), Bari, Italy
| | | | - Filippo Alongi
- IRCCS, Advanced Radiation Oncology Department, Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy.,Medicine Faculty, University of Brescia, Brescia, Italy
| | - Alba Fiorentino
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
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Opara CO, Khan FY, Kabiraj DG, Kauser H, Palakeel JJ, Ali M, Chaduvula P, Chhabra S, Lamsal Lamichhane S, Ramesh V, Mohammed L. The Value of Magnetic Resonance Imaging and Endorectal Ultrasound for the Accurate Preoperative T-staging of Rectal Cancer. Cureus 2022; 14:e30499. [DOI: 10.7759/cureus.30499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022] Open
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Somashekhar SP, Saklani A, Dixit J, Kothari J, Nayak S, Sudheer OV, Dabas S, Goud J, Munikrishnan V, Sugoor P, Penumadu P, Ramachandra C, Mehendale S, Dahiya A. Clinical Robotic Surgery Association (India Chapter) and Indian rectal cancer expert group’s practical consensus statements for surgical management of localized and locally advanced rectal cancer. Front Oncol 2022; 12:1002530. [PMID: 36267970 PMCID: PMC9577482 DOI: 10.3389/fonc.2022.1002530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction There are standard treatment guidelines for the surgical management of rectal cancer, that are advocated by recognized physician societies. But, owing to disparities in access and affordability of various treatment options, there remains an unmet need for personalizing these international guidelines to Indian settings. Methods Clinical Robotic Surgery Association (CRSA) set up the Indian rectal cancer expert group, with a pre-defined selection criterion and comprised of the leading surgical oncologists and gastrointestinal surgeons managing rectal cancer in India. Following the constitution of the expert Group, members identified three areas of focus and 12 clinical questions. A thorough review of the literature was performed, and the evidence was graded as per the levels of evidence by Oxford Centre for Evidence-Based Medicine. The consensus was built using the modified Delphi methodology of consensus development. A consensus statement was accepted only if ≥75% of the experts were in agreement. Results Using the results of the review of the literature and experts’ opinions; the expert group members drafted and agreed on the final consensus statements, and these were classified as “strong or weak”, based on the GRADE framework. Conclusion The expert group adapted international guidelines for the surgical management of localized and locally advanced rectal cancer to Indian settings. It will be vital to disseminate these to the wider surgical oncologists and gastrointestinal surgeons’ community in India.
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Affiliation(s)
- S. P. Somashekhar
- Department of Surgical Oncology, Manipal Hospital, Bengaluru, Karnataka, India
- *Correspondence: S. P. Somashekhar,
| | - Avanish Saklani
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Jagannath Dixit
- Department of GI Surgery, HCG Hospital, Bengaluru, Karnataka, India
| | - Jagdish Kothari
- Department of Surgical Oncology HCG Hospital, Ahmedabad, Gujarat, India
| | - Sandeep Nayak
- Department of Surgical Oncology, Fortis Hospital, Bengaluru, Karnataka, India
| | - O. V. Sudheer
- Department of GI Surgery and Surgical Oncology, Amrita Institute of Medical Science, Kochi, Kerala, India
| | - Surender Dabas
- Department of Surgical Oncology, BL Kapur-Max Superspeciality Hospital, Delhi, India
| | - Jagadishwar Goud
- Department of Surgical Oncology, AOI Hospital, Hyderabad, Telangana, India
| | | | - Pavan Sugoor
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | | | - C. Ramachandra
- Director and Head, Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Shilpa Mehendale
- Director and Head, Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Akhil Dahiya
- Department of Clinical and Medical Affairs, Intuitive Surgical, California, CA, United States
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Kahlert UD, Shi W, Strecker M, Scherpinski LA, Wartmann T, Dölling M, Perrakis A, Relja B, Mengoni M, Braun A, Croner RS. COL10A1 allows stratification of invasiveness of colon cancer and associates to extracellular matrix and immune cell enrichment in the tumor parenchyma. Front Oncol 2022; 12:1007514. [PMID: 36267978 PMCID: PMC9577326 DOI: 10.3389/fonc.2022.1007514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/06/2022] [Indexed: 11/25/2022] Open
Abstract
Background Treatment options for metastatic colorectal cancer (CRC) are mostly ineffective. We present new evidence that tumor tissue collagen type X alpha 1 (COL10A1) is a relevant candidate biomarker to improve this dilemma. Methods Several public databases had been screened to observe COL10A1 expression in transcriptome levels with cell lines and tissues. Protein interactions and alignment to changes in clinical parameters and immune cell invasion were performed, too. We also used algorithms to build a novel COL10A1-related immunomodulator signature. Various wet-lab experiments were conducted to quantify COL10A1 protein and transcript expression levels in disease and control cell models. Results COL10A1 mRNA levels in tumor material is clinical and molecular prognostic, featuring upregulation compared to non-cancer tissue, increase with histomorphological malignancy grading of the tumor, elevation in tumors that invade perineural areas, or lymph node invasion. Transcriptomic alignment noted a strong positive correlation of COL10A1 with transcriptomic signature of cancer-associated fibroblasts (CAFs) and populations of the immune compartment, namely, B cells and macrophages. We verified those findings in functional assays showing that COL10A1 are decreased in CRC cells compared to fibroblasts, with strongest signal in the cell supernatant of the cells. Conclusion COL10A1 abundance in CRC tissue predicts metastatic and immunogenic properties of the disease. COL10A1 transcription may mediate tumor cell interaction with its stromal microenvironment.
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Affiliation(s)
- Ulf D. Kahlert
- University Clinic for General, Visceral, Vascular and Transplantation Surgery, Faculty of Medicine, Otto-von-Guericke-University, Magdeburg, Germany
| | - Wenjie Shi
- University Clinic for General, Visceral, Vascular and Transplantation Surgery, Faculty of Medicine, Otto-von-Guericke-University, Magdeburg, Germany
- University Hospital for Gynecology, Pius-Hospital, University Medicine Oldenburg, Oldenburg, Germany
| | - Marco Strecker
- University Clinic for General, Visceral, Vascular and Transplantation Surgery, Faculty of Medicine, Otto-von-Guericke-University, Magdeburg, Germany
| | - Lorenz A. Scherpinski
- University Clinic for General, Visceral, Vascular and Transplantation Surgery, Faculty of Medicine, Otto-von-Guericke-University, Magdeburg, Germany
| | - Thomas Wartmann
- University Clinic for General, Visceral, Vascular and Transplantation Surgery, Faculty of Medicine, Otto-von-Guericke-University, Magdeburg, Germany
| | - Maximilian Dölling
- University Clinic for General, Visceral, Vascular and Transplantation Surgery, Faculty of Medicine, Otto-von-Guericke-University, Magdeburg, Germany
| | - Aristotelis Perrakis
- University Clinic for General, Visceral, Vascular and Transplantation Surgery, Faculty of Medicine, Otto-von-Guericke-University, Magdeburg, Germany
| | - Borna Relja
- Experimental Radiology, University Clinic of Radiology and Nuclear Medicine, Faculty of Medicine, Otto-von-Guericke-University, Magdeburg, Germany
| | - Miriam Mengoni
- University Clinic for Dermatology, Faculty of Medicine, Otto-von-Guericke-University, Magdeburg, Germany
| | - Andreas Braun
- University Clinic for Dermatology, Faculty of Medicine, Otto-von-Guericke-University, Magdeburg, Germany
| | - Roland S. Croner
- University Clinic for General, Visceral, Vascular and Transplantation Surgery, Faculty of Medicine, Otto-von-Guericke-University, Magdeburg, Germany
- *Correspondence: Roland S. Croner,
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Song G, Li P, Wu R, Jia Y, Hong Y, He R, Li J, Zhang R, Li A. Development and validation of a high-resolution T2WI-based radiomic signature for the diagnosis of lymph node status within the mesorectum in rectal cancer. Front Oncol 2022; 12:945559. [PMID: 36185279 PMCID: PMC9523667 DOI: 10.3389/fonc.2022.945559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose The aim of this study was to explore the feasibility of a high-resolution T2-weighted imaging (HR-T2WI)-based radiomics prediction model for diagnosing metastatic lymph nodes (LNs) within the mesorectum in rectal cancer. Method A total of 604 LNs (306 metastatic and 298 non-metastatic) from 166 patients were obtained. All patients underwent HR-T2WI examination and total mesorectal excision (TME) surgery. Four kinds of segmentation methods were used to select region of interest (ROI), including method 1 along the border of LNs; method 2 along the expanded border of LNs with an additional 2–3 mm; method 3 covering the border of LNs only; and method 4, a circle region only within LNs. A total of 1,409 features were extracted for each method. Variance threshold method, Select K Best, and Lasso algorithm were used to reduce the dimension. All LNs were divided into training and test sets. Fivefold cross-validation was used to build the logistic model, which was evaluated by the receiver operating characteristic (ROC) with four indicators, including area under the curve (AUC), accuracy (ACC), sensitivity (SE), and specificity (SP). Three radiologists with different working experience in diagnosing rectal diseases assessed LN metastasis respectively. The diagnostic efficiencies with each of four segmentation methods and three radiologists were compared to each other. Results For the test set, the AUCs of four segmentation methods were 0.820, 0.799, 0.764, and 0.741; the ACCs were 0.725, 0.704, 0.709, and 0.670; the SEs were 0.756, 0.634, 0.700, and 0.589; and the SPs were 0.696, 0.772, 0.717, and 0.750, respectively. There was no statistically significant difference in AUC between the four methods (p > 0.05). Method 1 had the highest values of AUC, ACC, and SE. For three radiologists, the overall diagnostic efficiency was moderate. The corresponding AUCs were 0.604, 0.634, and 0.671; the ACCs were 0.601, 0.632, and 0.667; the SEs were 0.366, 0.552, and 0.392; and the SPs were 0.842, 0.715, and 0.950, respectively. Conclusions The proposed HR-T2WI-based radiomic signature exhibited a robust performance on predicting mesorectal LN status and could potentially be used for clinicians in order to determine the status of metastatic LNs in rectal cancer patients.
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Affiliation(s)
- Gesheng Song
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Panpan Li
- Department of Radiology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Rui Wu
- Department of Radiology, Shandong University, Jinan, China
| | - Yuping Jia
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Yu Hong
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Rong He
- Department of Radiology, The Shandong First Medical University, Jinan, China
| | - Jinye Li
- Department of Radiology, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ran Zhang
- Marketing, Medical Technology Co., Ltd., Beijing, China
| | - Aiyin Li
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
- *Correspondence: Aiyin Li,
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Chang D, González APG, Migaly J. Management of neuroendocrine tumors of the rectum. SEMINARS IN COLON AND RECTAL SURGERY 2022. [DOI: 10.1016/j.scrs.2022.100901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Zhuang Z, Ma X, Zhang Y, Yang X, Wei M, Deng X, Wang Z. Establishment and validation of nomograms for predicting mesorectal lymph node staging and restaging. Int J Colorectal Dis 2022; 37:2069-2083. [PMID: 36028723 DOI: 10.1007/s00384-022-04244-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Preoperative determination of lymph node (LN) status is crucial in treatment planning for rectal cancer. This study prospectively evaluated the risk factors for lymph node metastasis (LNM) at staging and restaging based on a node-by-node pairing between MRI imaging findings and histopathology and constructed nomograms to evaluate its diagnostic value. METHODS From July 2021 to July 2022, patients with histopathologically verified rectal cancer who underwent MRI before surgery were prospectively enrolled. Histological examination of each LN status in the surgical specimens and anatomical matching with preoperative imaging. Taking histopathological results as the gold standard, federating clinical features from patients and LN imaging features on MRI-T2WI. Risk factors for LN metastasis were identified by multivariate logistic regression analysis and used to create a nomogram. The performance of the nomograms was assessed with calibration plots and bootstrapped-concordance index and validated using validation cohorts. RESULTS A total of 500 target LNs in 120 patients were successfully matched with node-by-node comparisons. A total of 353 LNs did not receive neoadjuvant therapy and 147 LNs received neoadjuvant chemoradiotherapy (neoCRT). Characterization of LNs not receiving neoadjuvant therapy and multivariate regression showed that the short diameter, preoperative CEA level, mrT-stage, border contour, and signal intensity were associated with a high risk of LN metastasis (P < 0.05). The nomogram predicted that the area under the curve was 0.855 (95% CI, 0.794-0.916) and 0.854 (95% CI, 0.727-0.980) in the training and validation cohorts, respectively. In the neoadjuvant therapy group, short diameter, ymrT-stage, internal signal, and MRI-EMVI were associated with LN positivity (P < 0.05), and the area under the curves using the nomogram was 0.912 (95% CI, 0.856-0.968) and 0.915 (95% CI, 0.817-1.000) in two cohorts. The calibration curves demonstrate good agreement between the predicted and actual probabilities for both the training and validation cohorts. CONCLUSION Our nomograms combined with preoperative clinical and imaging biomarkers have the potential to improve the prediction of nodal involvement, which can be used as an essential reference for preoperative N staging and restaging of rectal cancer.
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Affiliation(s)
- Zixuan Zhuang
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xueqin Ma
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Zhang
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xuyang Yang
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Mingtian Wei
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangbing Deng
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ziqiang Wang
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
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Zhuang Z, Ma X, Zhang Y, Yang X, Wei M, Deng X, Wang Z. Technique to match mesorectal lymph nodes imaging findings to histopathology: node-by-node comparison. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04305-6. [PMID: 36028725 DOI: 10.1007/s00432-022-04305-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/15/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lymph node status is critical for staging rectal cancer and determining neoadjuvant therapy regimens. Establishing a matching between imaging and histopathological lymph nodes is fundamental for predicting lymph node status. This study reports a technique to achieve node-by-node pairing of mesorectal lymph nodes between imaging findings and histopathology. METHODS Fifty-two patients with histopathologically verified rectal cancer underwent magnetic resonance imaging before surgery. The status of each lymph node in the surgical specimens was analyzed histopathologically and matched with preoperative imaging after the operation. RESULTS A total of 346 mesorectal lymph nodes were located on imaging evaluation, of which 313 were confirmed histopathologically, and 33 were unmatched. The total success rate of the technique was 90.5%. Node-by-node analysis revealed 280 benign and 33 malignant nodal structures. CONCLUSION The technique to match mesorectal lymph node imaging findings to histopathology was feasible and effective. It simplified the technical method and had a reasonable success matching rate, which could provide a standardized approach for obtaining a prospective correlation between imaging and histological findings, supporting all subsequent related studies at the level of mesorectal lymph nodes.
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Affiliation(s)
- Zixuan Zhuang
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan Province, China
| | - Xueqin Ma
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Zhang
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan Province, China
| | - Xuyang Yang
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan Province, China
| | - Mingtian Wei
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan Province, China
| | - Xiangbing Deng
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan Province, China
| | - Ziqiang Wang
- Department of General Surgery, Colorectal Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan Province, China.
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Sluckin TC, Hazen SMJA, Horsthuis K, Lambregts DMJ, Beets-Tan RGH, Tanis PJ, Kusters M. Significant improvement after training in the assessment of lateral compartments and short-axis measurements of lateral lymph nodes in rectal cancer. Eur Radiol 2022; 33:483-492. [PMID: 35802179 DOI: 10.1007/s00330-022-08968-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/06/2022] [Accepted: 06/14/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVES In patients with rectal cancer, the size and location of lateral lymph nodes (LLNs) are correlated to increased lateral local recurrence rates. Sufficient knowledge and accuracy when measuring these features are therefore essential. The objective of this study was to evaluate the variation in measurements and anatomical classifications of LLNs before and after training. METHODS Fifty-three Dutch radiologists examined three rectal MRI scans and completed a questionnaire. Presence, location, size, and suspiciousness of LLNs were reported. This assessment was repeated after a 2-hour online training by the same radiologists with the same three cases plus three additional cases. Three expert radiologists independently evaluated these 6 cases and served as the standard of reference. RESULTS Correct identification of the anatomical location improved in case 1 (62 to 77% (p = .077)) and in case 2 (46 to 72% (p = .007)) but decreased in case 3 (92 to 74%, p = .453). Compared to the first three cases, cases 4, 5, and 6 all had a higher initial consensus of 73%, 79%, and 85%, respectively. The mean absolute deviation of the short-axis measurements in cases 1-3 were closer-though not significantly-to the expert reference value after training with reduced ranges and standard deviations. Subjective determination of malignancy had a high consensus rate between participants and experts. CONCLUSION Though finding a high consensus rate for determining malignancy of LLNs, variation in short-axis measurements and anatomical location classifications were present and improved after training. Adequate training would support the challenges involved in evaluating LLNs appropriately. KEY POINTS • Variation was present in the assessment of the anatomical location and short-axis size of lateral lymph nodes. • In certain cases, the accuracy of short-axis measurements and anatomical location, when compared to an expert reference value, improved after a training session. • Consensus before and after training on whether an LLN was subjectively considered to be suspicious for malignancy was high.
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Affiliation(s)
- Tania C Sluckin
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, the Netherlands.,Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands.,Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Sanne-Marije J A Hazen
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, the Netherlands.,Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands.,Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Karin Horsthuis
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, the Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, the Netherlands.,GROW School for Oncology and Developmental Biology, University of Maastricht, Universiteitssingel 40, Maastricht, The Netherlands.,Department of Radiology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Campusvej 55, DK-5230, Odense, Denmark
| | - Pieter J Tanis
- Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands.,Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands.,Department of Surgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC, Doctor Molewaterplein 40, Rotterdam, the Netherlands
| | - Miranda Kusters
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, the Netherlands. .,Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands. .,Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands.
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Deep-learning-based 3D super-resolution MRI radiomics model: superior predictive performance in preoperative T-staging of rectal cancer. Eur Radiol 2022; 33:1-10. [PMID: 35726100 DOI: 10.1007/s00330-022-08952-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/30/2022] [Accepted: 06/08/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the feasibility and efficacy of a deep-learning (DL)-based three-dimensional (3D) super-resolution (SR) MRI radiomics model for preoperative T-staging prediction in rectal cancer (RC). METHODS Seven hundred six eligible RC patients (T1/2 = 287, T3/4 = 419) were retrospectively enrolled in this study and chronologically allocated into a training cohort (n = 565) and a validation cohort (n = 141). We conducted a deep-transfer-learning network on high-resolution (HR) T2-weighted imaging (T2WI) to enhance the z-resolution of the images and acquired the preoperative SRT2WI. The radiomics models named modelHRT2 and modelSRT2 were respectively constructed with high-dimensional quantitative features extracted from manually segmented volume of interests of HRT2WI and SRT2WI through the Least Absolute Shrinkage and Selection Operator method. The performances of the models were evaluated by ROC, calibration, and decision curves. RESULTS ModelSRT2 outperformed modelHRT2 (AUC 0.869, sensitivity 71.1%, specificity 93.1%, and accuracy 83.3% vs. AUC 0.810, sensitivity 89.5%, specificity 70.1%, and accuracy 77.3%) in distinguishing T1/2 and T3/4 RC with significant difference (p < 0.05). Both radiomics models achieved higher AUCs than the expert radiologists (0.685, 95% confidence interval 0.595-0.775, p < 0.05). The calibration curves confirmed high goodness of fit, and the decision curve analysis revealed the clinical value. CONCLUSIONS ModelSRT2 yielded superior predictive performance in preoperative RC T-staging by comparison with modelHRT2 and expert radiologists' visual assessments. KEY POINTS • For the first time, DL-based 3D SR images were applied in radiomics analysis for clinical utility. • Compared with the visual assessment of expert radiologists and the conventional radiomics model based on HRT2WI, the SR radiomics model showed a more favorable capability in helping clinicians assess the invasion depth of RC preoperatively. • This is the largest radiomics study for T-staging prediction in RC.
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Wang D, Zhuang Z, Wu S, Chen J, Fan X, Liu M, Zhu H, Wang M, Zou J, Zhou Q, Zhou P, Xue J, Meng X, Ju S, Zhang L. A Dual-Energy CT Radiomics of the Regional Largest Short-Axis Lymph Node Can Improve the Prediction of Lymph Node Metastasis in Patients With Rectal Cancer. Front Oncol 2022; 12:846840. [PMID: 35747803 PMCID: PMC9209707 DOI: 10.3389/fonc.2022.846840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 05/19/2022] [Indexed: 12/24/2022] Open
Abstract
ObjectiveTo explore the value of dual-energy computed tomography (DECT) radiomics of the regional largest short-axis lymph nodes for evaluating lymph node metastasis in patients with rectal cancer.Materials and MethodsOne hundred forty-one patients with rectal cancer (58 in LNM+ group, 83 in LNM- group) who underwent preoperative total abdominal DECT were divided into a training group and testing group (7:3 ratio). After post-processing DECT venous phase images, 120kVp-like images and iodine (water) images were obtained. The highest-risk lymph nodes were identified, and their long-axis and short-axis diameter and DECT quantitative parameters were measured manually by two experienced radiologists who were blind to the postoperative pathological results. Four DECT parameters were analyzed: arterial phase (AP) normalized iodine concentration, AP normalized effective atomic number, the venous phase (VP) normalized iodine concentration, and the venous phase normalized effective atomic number. The carcinoembryonic antigen (CEA) levels were recorded one week before surgery. Radiomics features of the largest lymph nodes were extracted, standardized, and reduced before modeling. Radomics signatures of 120kVp-like images (Rad-signature120kVp) and iodine map (Rad-signatureImap) were built based on Logistic Regression via Least Absolute Shrinkage and Selection Operator (LASSO).ResultsEight hundred thirty-three features were extracted from 120kVp-like and iodine images, respectively. In testing group, the radiomics features based on 120kVp-like images showed the best diagnostic performance (AUC=0.922) compared to other predictors [CT morphological indicators (short-axis diameter (AUC=0.779, IDI=0.262) and long-axis diameter alone (AUC=0.714, IDI=0.329)), CEA alone (AUC=0.540, IDI=0.414), and normalized DECT parameters alone (AUC=0.504-0.718, IDI=0.290-0.476)](P<0.05 in Delong test). Contrary, DECT iodine map-based radiomic signatures showed similar performance in predicting lymph node metastasis (AUC=0.866). The decision curve showed that the 120kVp-like-based radiomics signature has the highest net income.ConclusionPredictive model based on DECT and the largest short-axis diameter lymph nodes has the highest diagnostic value in predicting lymph node metastasis in patients with rectal cancer.
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Affiliation(s)
- Dongqing Wang
- Department of Medical Imaging, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Zijian Zhuang
- Department of Medical Imaging, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Shuting Wu
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Jixiang Chen
- Department of General Surgery, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Xin Fan
- Department of General Surgery, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Mengsi Liu
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Haitao Zhu
- Department of Medical Imaging, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Ming Wang
- Department of Medical Imaging, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Jinmei Zou
- Department of Medical Imaging, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Qun Zhou
- Department of Medical Imaging, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Peng Zhou
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Jing Xue
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Xiangpan Meng
- School of Medicine, Southeast University, Nanjing, China
- Department of Radiology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Shenghong Ju
- School of Medicine, Southeast University, Nanjing, China
- Department of Radiology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Lirong Zhang
- Department of Medical Imaging, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
- School of Medicine, Southeast University, Nanjing, China
- *Correspondence: Lirong Zhang,
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Wetzel A, Viswanath S, Gorgun E, Ozgur I, Allende D, Liska D, Purysko AS. Staging and Restaging of Rectal Cancer With MRI: A Pictorial Review. Semin Ultrasound CT MR 2022; 43:441-454. [DOI: 10.1053/j.sult.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Yan L, Weifeng Z, Qin W, Jinping W. A model based on endorectal ultrasonography predicts lateral lymph node metastasis in low and middle rectal cancer. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:705-712. [PMID: 35322883 PMCID: PMC9313894 DOI: 10.1002/jcu.23204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/04/2022] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE To investigate the risk factors for lymph node (LN) metastasis in low and middle rectal tumors, construct a predictive model and test the model's diagnostic efficacy. METHODS The clinical and pathological data of 172 patients with rectal cancer confirmed by surgery were retrospectively evaluated, among whom 61 patients were finally included in this study. Patients were divided into positive groups and negative groups based on LN metastasis, and risk factors that might affect LN metastasis were analyzed. Finally, a risk predictive model was constructed based on the weights of each risk factor. RESULTS Compared with pathology, the efficacy of diagnosing LN metastasis only according to conventional endorectal ultrasonography (ERUS) features of LN was not high, with sensitivity 67%, specificity 86%, positive predictive value 76%, negative predictive value 80%, and accuracy 79%. Univariate analysis showed that circumferential angle of the tumor, ultrasonic T- stage (UT stage), conventional ultrasound features diagnosis of LN metastasis, strain ratio (SR) of tumor were risk factors for LN metastasis, while vascular resistance index of rectal tumor was protective factor. Multivariate analysis showed that UT stage (OR = 7.188, p = 0.049), conventional ultrasound features diagnosis of LN metastasis (OR = 8.010, p = 0.025) and SR (OR = 5.022, p = 0.031) were independent risk factors for LN metastasis. These risk factors were included in logistic regression analysis and the model was established, Y = -7.3 + 1.9 X10 + 2.1 X11 + 1.6 X13 (Y = Logit[P], P: LN metastasis rate, X10: UT stage, X11: conventional ultrasound features diagnosis of LN metastasis, X13: SR). The receiver operating characteristic (ROC) curve was used to test the model's predictive efficacy, the area under the curve was 0.95, sensitivity: 95%, specificity: 87%. Hosmer-Lemeshow goodness of fit test showed X2 = 6.015, p = 0.65 (p > 0.05), indicating that the model had a high predictive value. CONCLUSION Evaluation of perirectal LN metastasis only based on conventional ERUS features of LN was not effective enough. UT stage of tumor, conventional ultrasound features diagnosis of LN metastasis and SR were independent risk factors for LN metastasis. The predictive model had good assessment efficacy and had certain clinical application value.
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Affiliation(s)
- Li Yan
- Department of UltrasoundThe first affiliated hospital of Anhui University of Traditional Chinese MedicineAnhuiChina
| | - Zhou Weifeng
- Department of UltrasoundThe first affiliated hospital of Anhui University of Traditional Chinese MedicineAnhuiChina
| | - Wang Qin
- Department of UltrasoundThe first affiliated hospital of Anhui University of Traditional Chinese MedicineAnhuiChina
| | - Wang Jinping
- Department of UltrasoundThe first affiliated hospital of Anhui University of Traditional Chinese MedicineAnhuiChina
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46
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Read M, Felder S. Transanal Approaches to Rectal Neoplasia. SEMINARS IN COLON AND RECTAL SURGERY 2022. [DOI: 10.1016/j.scrs.2022.100899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Zwart WH, Hotca A, Hospers GAP, Goodman KA, Garcia-Aguilar J. The Multimodal Management of Locally Advanced Rectal Cancer: Making Sense of the New Data. Am Soc Clin Oncol Educ Book 2022; 42:1-14. [PMID: 35561302 DOI: 10.1200/edbk_351411] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In the past 40 years, the treatment of locally advanced rectal cancer has evolved with the addition of radiotherapy or chemoradiotherapy and providing (neo)adjuvant systemic chemotherapy to major surgery. However, recent trends have focused on improving our ability to risk-stratify patients and tailoring treatment to achieve the best oncologic outcome while limiting the impact on long-term quality of life. Therefore, there has been increasing interest in pursuing a watch-and-wait approach to achieve organ preservation. Several retro- and prospective studies suggest safety of the watch-and-wait approach, though it is still considered controversial due to limited clinical evidence, concerns about tumor regrowth, and subsequent distant progression. To further reduce treatment, MRI risk stratification, together with patient characteristics and patient preferences, can guide personalized treatment and reserve radiation and chemotherapy for a select patient population. Ultimately, improved options for reassessment during neoadjuvant treatment may allow for more adaptive therapy options based on treatment response. This article provides an overview of some major developments in the multimodal treatment of locally advanced rectal cancer. It reviews some relevant, controversial issues of the watch-and-wait approach and opportunities to personally tailor and reduce treatment. It also reviews the overall neoadjuvant treatment, including total neoadjuvant therapy trials, and how to best optimize for a potential complete response. Finally, it provides an algorithm as an example of how such a personalized, tailored, adaptive, and reduced treatment could look like in the future.
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Affiliation(s)
- Wouter H Zwart
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Geke A P Hospers
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Borgheresi A, De Muzio F, Agostini A, Ottaviani L, Bruno A, Granata V, Fusco R, Danti G, Flammia F, Grassi R, Grassi F, Bruno F, Palumbo P, Barile A, Miele V, Giovagnoni A. Lymph Nodes Evaluation in Rectal Cancer: Where Do We Stand and Future Perspective. J Clin Med 2022; 11:jcm11092599. [PMID: 35566723 PMCID: PMC9104021 DOI: 10.3390/jcm11092599] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/25/2022] [Accepted: 05/03/2022] [Indexed: 12/12/2022] Open
Abstract
The assessment of nodal involvement in patients with rectal cancer (RC) is fundamental in disease management. Magnetic Resonance Imaging (MRI) is routinely used for local and nodal staging of RC by using morphological criteria. The actual dimensional and morphological criteria for nodal assessment present several limitations in terms of sensitivity and specificity. For these reasons, several different techniques, such as Diffusion Weighted Imaging (DWI), Intravoxel Incoherent Motion (IVIM), Diffusion Kurtosis Imaging (DKI), and Dynamic Contrast Enhancement (DCE) in MRI have been introduced but still not fully validated. Positron Emission Tomography (PET)/CT plays a pivotal role in the assessment of LNs; more recently PET/MRI has been introduced. The advantages and limitations of these imaging modalities will be provided in this narrative review. The second part of the review includes experimental techniques, such as iron-oxide particles (SPIO), and dual-energy CT (DECT). Radiomics analysis is an active field of research, and the evidence about LNs in RC will be discussed. The review also discusses the different recommendations between the European and North American guidelines for the evaluation of LNs in RC, from anatomical considerations to structured reporting.
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Affiliation(s)
- Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60121 Ancona, Italy; (A.B.); (A.A.); (A.B.); (A.G.)
| | - Federica De Muzio
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy;
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60121 Ancona, Italy; (A.B.); (A.A.); (A.B.); (A.G.)
- Department of Radiological Sciences, University Hospital Ospedali Riuniti, 60126 Ancona, Italy;
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
| | - Letizia Ottaviani
- Department of Radiological Sciences, University Hospital Ospedali Riuniti, 60126 Ancona, Italy;
| | - Alessandra Bruno
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60121 Ancona, Italy; (A.B.); (A.A.); (A.B.); (A.G.)
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale IRCCS di Napoli, 80131 Naples, Italy;
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Napoli, Italy
- Correspondence:
| | - Ginevra Danti
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy;
| | - Federica Flammia
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy;
| | - Roberta Grassi
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80128 Naples, Italy
| | - Francesca Grassi
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80128 Naples, Italy
| | - Federico Bruno
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Pierpaolo Palumbo
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
- Abruzzo Health Unit 1, Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, 67100 L’Aquila, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy; (G.D.); (R.G.); (F.G.); (F.B.); (P.P.); (V.M.)
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy;
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60121 Ancona, Italy; (A.B.); (A.A.); (A.B.); (A.G.)
- Department of Radiological Sciences, University Hospital Ospedali Riuniti, 60126 Ancona, Italy;
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Lambregts DMJ, Bogveradze N, Blomqvist LK, Fokas E, Garcia-Aguilar J, Glimelius B, Gollub MJ, Konishi T, Marijnen CAM, Nagtegaal ID, Nilsson PJ, Perez RO, Snaebjornsson P, Taylor SA, Tolan DJM, Valentini V, West NP, Wolthuis A, Lahaye MJ, Maas M, Beets GL, Beets-Tan RGH. Current controversies in TNM for the radiological staging of rectal cancer and how to deal with them: results of a global online survey and multidisciplinary expert consensus. Eur Radiol 2022; 32:4991-5003. [PMID: 35254485 PMCID: PMC9213337 DOI: 10.1007/s00330-022-08591-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/22/2021] [Accepted: 01/13/2022] [Indexed: 12/17/2022]
Abstract
Abstract
Objectives
To identify the main problem areas in the applicability of the current TNM staging system (8th ed.) for the radiological staging and reporting of rectal cancer and provide practice recommendations on how to handle them.
Methods
A global case-based online survey was conducted including 41 image-based rectal cancer cases focusing on various items included in the TNM system. Cases reaching < 80% agreement among survey respondents were identified as problem areas and discussed among an international expert panel, including 5 radiologists, 6 colorectal surgeons, 4 radiation oncologists, and 3 pathologists.
Results
Three hundred twenty-one respondents (from 32 countries) completed the survey. Sixteen problem areas were identified, related to cT staging in low-rectal cancers, definitions for cT4b and cM1a disease, definitions for mesorectal fascia (MRF) involvement, evaluation of lymph nodes versus tumor deposits, and staging of lateral lymph nodes. The expert panel recommended strategies on how to handle these, including advice on cT-stage categorization in case of involvement of different layers of the anal canal, specifications on which structures to include in the definition of cT4b disease, how to define MRF involvement by the primary tumor and other tumor-bearing structures, how to differentiate and report lymph nodes and tumor deposits on MRI, and how to anatomically localize and stage lateral lymph nodes.
Conclusions
The recommendations derived from this global survey and expert panel discussion may serve as a practice guide and support tool for radiologists (and other clinicians) involved in the staging of rectal cancer and may contribute to improved consistency in radiological staging and reporting.
Key Points
• Via a case-based online survey (incl. 321 respondents from 32 countries), we identified 16 problem areas related to the applicability of the TNM staging system for the radiological staging and reporting of rectal cancer.
• A multidisciplinary panel of experts recommended strategies on how to handle these problem areas, including advice on cT-stage categorization in case of involvement of different layers of the anal canal, specifications on which structures to include in the definition of cT4b disease, how to define mesorectal fascia involvement by the primary tumor and other tumor-bearing structures, how to differentiate and report lymph nodes and tumor deposits on MRI, and how to anatomically localize and stage lateral lymph nodes.
• These recommendations may serve as a practice guide and support tool for radiologists (and other clinicians) involved in the staging of rectal cancer and may contribute to improved consistency in radiological staging and reporting.
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Affiliation(s)
- Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands.
| | - Nino Bogveradze
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of Radiology, American Hospital Tbilisi, Tbilisi, Georgia
| | - Lennart K Blomqvist
- Department of Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Emmanouil Fokas
- Department of Radiooncology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
- Frankfurt Cancer Institute (FCI), University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Julio Garcia-Aguilar
- Department of Surgery, Colorectal Service, Benno C. Schmidt Chair in Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tsuyoshi Konishi
- Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Corrie A M Marijnen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Per J Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Division of Coloproctology, Pelvic Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | - Rodrigo O Perez
- Hospital Alemão Oswaldo Cruz & Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Petur Snaebjornsson
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London Hospital, London, UK
| | - Damian J M Tolan
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Vincenzo Valentini
- Department of Bioimaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica S. Cuore, Rome, Italy
| | - Nicholas P West
- Pathology & Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Albert Wolthuis
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Max J Lahaye
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
| | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
| | - Geerard L Beets
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands.
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
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Shi Z, Ma C, Huang X, Cao D. Magnetic Resonance Imaging Radiomics-Based Nomogram From Primary Tumor for Pretreatment Prediction of Peripancreatic Lymph Node Metastasis in Pancreatic Ductal Adenocarcinoma: A Multicenter Study. J Magn Reson Imaging 2022; 55:823-839. [PMID: 34997795 DOI: 10.1002/jmri.28048] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Determining the absence or presence of peripancreatic lymph nodal metastasis (PLNM) is important to the pathologic staging, prognostication, and guidance of treatment in pancreatic ductal adenocarcinoma (PDAC) patients. Computed tomography and MRI had a poor sensitivity and diagnostic accuracy in the assessment of PLNM. PURPOSES To develop and validate a 3 T MRI primary tumor radiomics-based nomogram from multicenter datasets for pretreatment prediction of the PLNM in PDAC patients. STUDY TYPE Retrospective. SUBJECTS A total of 251 patients (156 men and 95 women; mean age, 60.85 ± 8.23 years) with histologically confirmed pancreatic ductal adenocarcinoma from three hospitals. FIELD STRENGTH AND SEQUENCES A 3.0 T and fat-suppressed T1-weighted imaging. ASSESSMENT Quantitative imaging features were extracted from fat-suppressed T1-weighted (FS T1WI) images at the arterial phase. STATISTICAL TESTS Normally distributed data were compared by using t-tests, while the Mann-Whitney U test was used to evaluate non-normally distributed data. The diagnostic performances of the preoperative and postoperative nomograms were assessed in the external validation cohort with the area under receiver operating characteristics curve (AUC), calibration curve, and decision curve analysis (DCA). AUCs were compared with the De Long test. A p value below 0.05 was considered to be statistically significant. RESULTS The AUCs of magnetic resonance imaging (MRI) Rad-score were 0.868 (95% confidence level [CI]: 0.613-0.852) and 0.772 (95% CI: 0.659-0.879) in the training and internal validation cohort, respectively. The preoperative and postoperative nomograms could accurately predict PLNM in the training cohort (AUC = 0.909 and 0.851) and were validated in both the internal and external cohorts (AUC = 0.835 and 0.805, 0.808 and 0.733, respectively). DCA indicated that the two novel nomograms are of similar clinical usefulness. DATA CONCLUSION Pre-/postoperative nomograms and the constructed radiomics signature from primary tumor based on FS T1WI of arterial phase could serve as a potential tool to predict PLNM in patients with PDAC. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Zhenshan Shi
- Department of Radiology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, 350005, China
| | - Chengle Ma
- Department of Radiology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, 350005, China
| | - Xinming Huang
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, 350005, China
| | - Dairong Cao
- Department of Radiology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, 350005, China
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