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The magnetic resonance imaging-based approach for identification of high-risk patients with upper rectal cancer

 Chang, Jee Suk  ;  Lee, Youngin  ;  Lim, Joon Seok  ;  Kim, Nam Kyu  ;  Baik, Seung Hyuk  ;  Min, Byung So  ;  Huh, Hyuk  ;  Koom, Woong Sub 
 ANNALS OF SURGERY, Vol.260(2) : 293-298, 2014 
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Adult ; Aged ; Aged, 80 and over ; Contrast Media ; Follow-Up Studies ; Gadolinium DTPA ; Humans ; Magnetic Resonance Imaging/methods* ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Prognosis ; Rectal Neoplasms/pathology* ; Rectal Neoplasms/surgery ; Republic of Korea ; Retrospective Studies ; Risk Assessment
OBJECTIVE: To assess the efficacy of preoperative magnetic resonance imaging (MRI) in identifying upper rectal cancer patients who are at high risk for local recurrence. METHODS: 110 upper rectal cancer patients with locally advanced (pT3-4N0 or pTanyN+) tumors treated with tumor-specific mesorectal excision and no adjuvant radiotherapy were identified from an institutional database at a large academic medical center in Korea. Information on the extent of mesorectal invasion, sacral-side involvement was collected from preoperative MRI. RESULTS: At a median follow-up of 47 months, 5 patients (4.5%) experienced local recurrence (LR). LR rates for patients with intermediate risk (T1-2/N1, T3N0), moderately high risk (T1-2/N2, T3N1, T4N0), and high risk (T3N2, T4/N1-2) were 3%, 4.8%, and 8.7%, respectively. Patients who did not have sacral-side involvement or mesorectal invasion of 5 mm or less did not experience LR. The patients with sacral-side involvement and intermediate risk, moderately high risk, and high risk had an LR rate of 4.2%, 5.6%, and 10%, respectively, or 11.1%, 33.3%, and 18.2%, respectively, when combined with those with mesorectal invasion of greater than 5 mm. Multivariate analyses demonstrated the presence of both sacral-side location and mesorectal invasion of greater than 5 mm was significantly associated with adverse disease-free and overall survival (P < 0.05). CONCLUSIONS: Patients with mesorectal invasion of greater than 5 mm and sacral-side involvement identified on MRI were at an increased risk of local recurrence. The detection of these features on MRI provides prognostic information that is not available in conventional risk classification systems. Improved identification of a high-risk subset of upper rectal cancer patients may guide indications for preoperative chemoradiotherapy in this subset.
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Koom, Woong Sub(금웅섭) ORCID logo https://orcid.org/0000-0002-9435-7750
Kim, Nam Kyu(김남규) ORCID logo https://orcid.org/0000-0003-0639-5632
Min, Byung Soh(민병소) ORCID logo https://orcid.org/0000-0003-0180-8565
Baik, Seung Hyuk(백승혁) ORCID logo https://orcid.org/0000-0003-4183-2332
Lim, Joon Seok(임준석) ORCID logo https://orcid.org/0000-0002-0334-5042
Chang, Jee Suk Paul(장지석) ORCID logo https://orcid.org/0000-0001-7685-3382
Hur, Hyuk(허혁) ORCID logo https://orcid.org/0000-0002-9864-7229
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