Comparison between MRI and pathology in the assessment of tumour regression grade in rectal cancer View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2017-09-21

AUTHORS

Francesco Sclafani, Gina Brown, David Cunningham, Andrew Wotherspoon, Larissa Sena Teixeira Mendes, Svetlana Balyasnikova, Jessica Evans, Clare Peckitt, Ruwaida Begum, Diana Tait, Josep Tabernero, Bengt Glimelius, Susana Roselló, Janet Thomas, Jacqui Oates, Ian Chau

ABSTRACT

Background:Limited data exist regarding the correlation between MRI tumour regression grade (mrTRG) and pathological TRG (pTRG) in rectal cancer.Methods:mrTRG and pTRG were compared in rectal cancer patients from two phase II trials (EXPERT and EXPERT-C). The agreement between radiologist and pathologist was assessed with the weighted κ test while the Kaplan–Meier method was used to estimate survival outcomes.Results:One hundred ninety-one patients were included. Median time from completion of neoadjuvant treatment to pre-operative MRI and surgery was 4.1 weeks (interquartile range (IQR): 3.7–4.7) and 6.6 weeks (IQR: 5.9–7.6), respectively. Fair agreement was found between mrTRG and pTRG when regression was classified according to standard five-tier systems (κ=0.24) or modified three-tier systems (κ=0.25). Sensitivity and specificity of mrTRG 1–2 (complete/good radiological regression) for the prediction of pathological complete response was 74.4% (95% CI: 58.8–86.5) and 62.8% (95% CI: 54.5–70.6), respectively. Survival outcomes of patients with intermediate pathological regression (pTRG 2) were numerically better if complete/good regression was also observed on imaging (mrTRG 1–2) compared to poor regression (mrTRG 3–5) (5-year recurrence-free survival 76.9% vs 65.9%, P=0.18; 5-year overall survival 80.6% vs 68.8%, P=0.22).Conclusions:The agreement between mrTRG and pTRG is low and mrTRG cannot be used as a surrogate of pTRG. Further studies are warranted to assess the ability of mrTRG to identify pathological complete responders for the adoption of non-operative management strategies and to provide complementary prognostic information to pTRG for better risk-stratification after surgery. More... »

PAGES

1478-1485

Journal

TITLE

British Journal of Cancer

ISSUE

10

VOLUME

117

Identifiers

URI

http://scigraph.springernature.com/pub.10.1038/bjc.2017.320

DOI

http://dx.doi.org/10.1038/bjc.2017.320

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1091882065

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/28934761


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27 schema:description Background:Limited data exist regarding the correlation between MRI tumour regression grade (mrTRG) and pathological TRG (pTRG) in rectal cancer.Methods:mrTRG and pTRG were compared in rectal cancer patients from two phase II trials (EXPERT and EXPERT-C). The agreement between radiologist and pathologist was assessed with the weighted κ test while the Kaplan–Meier method was used to estimate survival outcomes.Results:One hundred ninety-one patients were included. Median time from completion of neoadjuvant treatment to pre-operative MRI and surgery was 4.1 weeks (interquartile range (IQR): 3.7–4.7) and 6.6 weeks (IQR: 5.9–7.6), respectively. Fair agreement was found between mrTRG and pTRG when regression was classified according to standard five-tier systems (κ=0.24) or modified three-tier systems (κ=0.25). Sensitivity and specificity of mrTRG 1–2 (complete/good radiological regression) for the prediction of pathological complete response was 74.4% (95% CI: 58.8–86.5) and 62.8% (95% CI: 54.5–70.6), respectively. Survival outcomes of patients with intermediate pathological regression (pTRG 2) were numerically better if complete/good regression was also observed on imaging (mrTRG 1–2) compared to poor regression (mrTRG 3–5) (5-year recurrence-free survival 76.9% vs 65.9%, P=0.18; 5-year overall survival 80.6% vs 68.8%, P=0.22).Conclusions:The agreement between mrTRG and pTRG is low and mrTRG cannot be used as a surrogate of pTRG. Further studies are warranted to assess the ability of mrTRG to identify pathological complete responders for the adoption of non-operative management strategies and to provide complementary prognostic information to pTRG for better risk-stratification after surgery.
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34 II trial
35 Kaplan-Meier method
36 MRI
37 MRI tumor regression grade
38 TRG
39 ability
40 adoption
41 agreement
42 assessment
43 cancer
44 cancer patients
45 comparison
46 complementary prognostic information
47 complete responders
48 complete response
49 completion
50 correlation
51 data
52 fair agreement
53 five-tier system
54 good regression
55 grade
56 information
57 limited data
58 management strategies
59 median time
60 method
61 mrTRG
62 neoadjuvant treatment
63 non-operative management strategies
64 outcomes
65 pathological TRG
66 pathological complete responders
67 pathological complete response
68 pathological regression
69 pathologists
70 pathology
71 patients
72 phase II trial
73 poor regression
74 pre-operative MRI
75 prediction
76 prognostic information
77 radiologists
78 rectal cancer
79 rectal cancer patients
80 regression
81 regression grade
82 responders
83 response
84 sensitivity
85 specificity
86 strategies
87 study
88 surgery
89 surrogate
90 survival outcomes
91 system
92 test
93 three-tier system
94 time
95 treatment
96 trials
97 tumor regression grade
98 weeks
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