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

Jee Suk Chang, Youngin Lee, Joon Seok Lim, Namkyu Kim, Seung Hyuk Baik, Byung So Min, Hyuk Huh, Woong Sub Koom

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)293-298
Number of pages6
JournalAnnals of Surgery
Volume260
Issue number2
DOIs
Publication statusPublished - 2014 Jan 1

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Rectal Neoplasms
Magnetic Resonance Imaging
Recurrence
Adjuvant Radiotherapy
Chemoradiotherapy
Korea
Disease-Free Survival
Neoplasms
Multivariate Analysis
Databases

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Chang, Jee Suk ; Lee, Youngin ; Lim, Joon Seok ; Kim, Namkyu ; Baik, Seung Hyuk ; Min, Byung So ; Huh, Hyuk ; Koom, Woong Sub. / The magnetic resonance imaging-based approach for identification of high-risk patients with upper rectal cancer. In: Annals of Surgery. 2014 ; Vol. 260, No. 2. pp. 293-298.
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abstract = "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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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, Namkyu; Baik, Seung Hyuk; Min, Byung So; Huh, Hyuk; Koom, Woong Sub.

In: Annals of Surgery, Vol. 260, No. 2, 01.01.2014, p. 293-298.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The magnetic resonance imaging-based approach for identification of high-risk patients with upper rectal cancer

AU - Chang, Jee Suk

AU - Lee, Youngin

AU - Lim, Joon Seok

AU - Kim, Namkyu

AU - Baik, Seung Hyuk

AU - Min, Byung So

AU - Huh, Hyuk

AU - Koom, Woong Sub

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N2 - 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.

AB - 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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