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Comparison between MRI and pathology in the assessment of tumour regression grade in rectal cancer.

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Date
2017-11
ICR Author
Cunningham, David
Chau, Ian
Marsden,
Author
Sclafani, F
Brown, G
Cunningham, D
Wotherspoon, A
Mendes, LST
Balyasnikova, S
Evans, J
Peckitt, C
Begum, R
Tait, D
Tabernero, J
Glimelius, B
Roselló, S
Thomas, J
Oates, J
Chau, I
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Type
Journal Article
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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.
URI
https://repository.icr.ac.uk/handle/internal/860
DOI
https://doi.org/10.1038/bjc.2017.320
Collections
  • Clinical Studies
Subject
Humans
Rectal Neoplasms
Magnetic Resonance Imaging
Neoplasm Staging
Cytodiagnosis
Disease-Free Survival
Neoadjuvant Therapy
Adult
Aged
Aged, 80 and over
Middle Aged
Female
Male
Clinical Trials, Phase II as Topic
Kaplan-Meier Estimate
Chemoradiotherapy, Adjuvant
Research team
Medicine (RMH Smith Cunningham)
Language
eng
Date accepted
2017-08-22
License start date
2017-11
Citation
British journal of cancer, 2017, 117 (10), pp. 1478 - 1485

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