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, Namkyu Kim, Myeong Jin Kim, Joong Bae Ahn, Hyuk Hur, Joon Seok Lim

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

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)wereassociated 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)ormrEMVI(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.

Original languageEnglish
Article numbere0146235
JournalPLoS One
Volume11
Issue number1
DOIs
Publication statusPublished - 2016 Jan 5

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Neoadjuvant Therapy
relapse
remission
resection
Magnetic resonance
Rectal Neoplasms
colorectal neoplasms
magnetic resonance imaging
Tumors
Magnetic Resonance Imaging
Imaging techniques
Recurrence
therapeutics
neoplasms
Neoplasms
fascia
Fascia
Therapeutics
Kaplan-Meier Estimate
Survival Analysis

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Kim, Honsoul ; Myoung, Sungmin ; Koom, Woong Sub ; Kim, Namkyu ; Kim, Myeong Jin ; Ahn, Joong Bae ; Hur, Hyuk ; Lim, Joon Seok. / MRI risk stratification for tumor relapse in rectal cancer achieving pathological complete remission after neoadjuvant chemoradiation therapy and curative resection. In: PLoS One. 2016 ; Vol. 11, No. 1.
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title = "MRI risk stratification for tumor relapse in rectal cancer achieving pathological complete remission after neoadjuvant chemoradiation therapy and curative resection",
abstract = "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)wereassociated 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)ormrEMVI(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.",
author = "Honsoul Kim and Sungmin Myoung and Koom, {Woong Sub} and Namkyu Kim and Kim, {Myeong Jin} and Ahn, {Joong Bae} and Hyuk Hur and Lim, {Joon Seok}",
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MRI risk stratification for tumor relapse in rectal cancer achieving pathological complete remission after neoadjuvant chemoradiation therapy and curative resection. / Kim, Honsoul; Myoung, Sungmin; Koom, Woong Sub; Kim, Namkyu; Kim, Myeong Jin; Ahn, Joong Bae; Hur, Hyuk; Lim, Joon Seok.

In: PLoS One, Vol. 11, No. 1, e0146235, 05.01.2016.

Research output: Contribution to journalArticle

TY - JOUR

T1 - MRI risk stratification for tumor relapse in rectal cancer achieving pathological complete remission after neoadjuvant chemoradiation therapy and curative resection

AU - Kim, Honsoul

AU - Myoung, Sungmin

AU - Koom, Woong Sub

AU - Kim, Namkyu

AU - Kim, Myeong Jin

AU - Ahn, Joong Bae

AU - Hur, Hyuk

AU - Lim, Joon Seok

PY - 2016/1/5

Y1 - 2016/1/5

N2 - 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)wereassociated 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)ormrEMVI(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.

AB - 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)wereassociated 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)ormrEMVI(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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