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MRI Risk Stratification for Tumor Relapse in Rectal Cancer Achieving Pathological Complete Remission after Neoadjuvant Chemoradiation Therapy and Curative Resection

 Honsoul Kim  ;  Sungmin Myoung  ;  Woong Sub Koom  ;  Nam Kyu Kim  ;  Myeong-Jin Kim  ;  Joong Bae Ahn  ;  Hyuk Hur  ;  Joon Seok Lim 
 PLoS One, Vol.11(1) : e0146235, 2016 
Journal Title
 PLoS One 
Issue Date
Adult ; Aged ; Analysis of Variance ; Chemoradiotherapy ; Female ; Humans ; Kaplan-Meier Estimate ; Magnetic Resonance Imaging/methods* ; Male ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Recurrence, Local ; Postoperative Care/methods* ; Rectal Neoplasms/pathology* ; Rectal Neoplasms/therapy* ; Rectum/drug effects ; Rectum/radiation effects ; Rectum/surgery ; Remission Induction ; Retrospective Studies ; Risk Assessment/methods ; Risk Factors
PURPOSE: Rectal cancer patients achieving pCR are known to have an excellent prognosis, yet no widely accepted consensus on risk stratification and post-operative management (e.g., adjuvant therapy) has been established. This study aimed to identify magnetic resonance imaging (MRI) high-risk factors for tumor relapse in pathological complete remission (pCR) achieved by rectal cancer patients who have undergone neoadjuvant concurrent chemoradiation therapy (CRT) and curative resection. MATERIALS AND METHODS: We analyzed 88 (male/female = 55/33, median age, 59.5 years [range 34-78]) pCR-proven rectal cancer patients who had undergone pre-CRT MRI, CRT, post-CRT MRI and curative surgery between July 2005 and December 2012. Patients were observed for post-operative tumor relapse. We analyzed the pre/post-CRT MRIs for parameters including mrT stage, mesorectal fascia (mrMRF) status, tumor volume, tumor regression grade (mrTRG), nodal status (mrN), and extramural vessel invasion (mrEMVI). We performed univariate analysis and Kaplan-Meier survival analysis. RESULTS: Post-operative tumor relapse occurred in seven patients (8.0%, n = 7/88) between 5.7 and 50.7 (median 16.8) months. No significant relevance was observed between tumor volume, volume reduction rate, mrTRG, mrT, or mrN status. Meanwhile, positive mrMRF (Ppre-CRT = 0.018, Ppre/post-CRT = 0.006) and mrEMVI (Ppre-CRT = 0.026, Ppre-/post-CRT = 0.008) were associated with higher incidence of post-operative tumor relapse. Kaplan-Meier survival analysis revealed a higher risk of tumor relapse in patients with positive mrMRF (Ppre-CRT = 0.029, Ppre-/post-CRT = 0.009) or mrEMVI (Ppre-CRT = 0.024, Ppre-/post-CRT = 0.003). CONCLUSION: Positive mrMRF and mrEMVI status was associated with a higher risk of post-operative tumor relapse of pCR achieved by rectal cancer patients, and therefore, can be applied for risk stratification and to individualize treatment plans.
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
금웅섭(Koom, Woong Sub) ORCID logo https://orcid.org/0000-0002-9435-7750
김남규(Kim, Nam Kyu) ORCID logo https://orcid.org/0000-0003-0639-5632
김명진(Kim, Myeong Jin) ORCID logo https://orcid.org/0000-0001-7949-5402
김한솔(Kim, Hon Soul)
안중배(Ahn, Joong Bae) ORCID logo https://orcid.org/0000-0001-6787-1503
임준석(Lim, Joon Seok) ORCID logo https://orcid.org/0000-0002-0334-5042
허혁(Hur, Hyuk) ORCID logo https://orcid.org/0000-0002-9864-7229
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