Carcinoembryonic Antigen Improves the Performance of Magnetic Resonance Imaging in the Prediction of Pathologic Response after Neoadjuvant Chemoradiation for Patients with Rectal Cancer
1
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
Purpose The purpose of this study was to investigate the role of carcinoembryonic antigen (CEA) levels in improving the performance of magnetic resonance imaging (MRI) for the prediction of pathologic response after the neoadjuvant chemoradiation (NCRT) for patients with rectal cancer. Materials and Methods We retrospectively reviewed the medical records of 524 rectal cancer patients who underwent NCRT and total mesorectal excision between January 2009 and December 2014. The performances of MRI with or without CEA parameters (initial CEA and CEA dynamics) for prediction of pathologic tumor response grade (pTRG) were compared by receiver-operating characteristic analysis with DeLong’s method. Cox regression was used to identify the independent factors associated to pTRG and disease-free survival (DFS) after NCRT. Results The median follow-up was 64.0 months (range, 3.0 to 113.0 months). On multivariate analysis, poor tumor regression grade on MRI (mrTRG; p < 0.001), initial CEA (p < 0.001) and the mesorectal fascia involvement on MRI before NCRT (mrMFI; p=0.054) showed association with poor pTRG. The mrTRG plus CEA parameters showed significantly improved performances in the prediction of pTRG than mrTRG alone. All of mrTRG, mrMFI, and initial CEA were also identified as independent factors associated with DFS. The initial CEA further discriminated DFS in the subgroups with good mrTRG or that without mrMFI. Conclusion The CEA parameters significantly improved the performance of MRI in the prediction of pTRG after NCRT for patients with rectal cancer. The DFS was further discriminated by initial CEA level in the groups with favorable MRI parameters.
Abstract
Purpose The purpose of this study was to investigate the role of carcinoembryonic antigen (CEA) levels in improving the performance of magnetic resonance imaging (MRI) for the prediction of pathologic response after the neoadjuvant chemoradiation (NCRT) for patients with rectal cancer. Materials and Methods We retrospectively reviewed the medical records of 524 rectal cancer patients who underwent NCRT and total mesorectal excision between January 2009 and December 2014. The performances of MRI with or without CEA parameters (initial CEA and CEA dynamics) for prediction of pathologic tumor response grade (pTRG) were compared by receiver-operating characteristic analysis with DeLong’s method. Cox regression was used to identify the independent factors associated to pTRG and disease-free survival (DFS) after NCRT. Results The median follow-up was 64.0 months (range, 3.0 to 113.0 months). On multivariate analysis, poor tumor regression grade on MRI (mrTRG; p < 0.001), initial CEA (p < 0.001) and the mesorectal fascia involvement on MRI before NCRT (mrMFI; p=0.054) showed association with poor pTRG. The mrTRG plus CEA parameters showed significantly improved performances in the prediction of pTRG than mrTRG alone. All of mrTRG, mrMFI, and initial CEA were also identified as independent factors associated with DFS. The initial CEA further discriminated DFS in the subgroups with good mrTRG or that without mrMFI. Conclusion The CEA parameters significantly improved the performance of MRI in the prediction of pTRG after NCRT for patients with rectal cancer. The DFS was further discriminated by initial CEA level in the groups with favorable MRI parameters.
참고문헌 (35)
- Sauer R, "Preoperative versus postoperative chemoradiotherapy for rectal cancer", N Engl J Med, 351, pp.1731~1740 (2004)
- 송진호, "Preoperative chemoradiotherapy versus postoperative chemoradiotherapy for stage II–III resectable rectal cancer: a meta-analysis of randomized controlled trials", Radiation oncology journal, 35(3), pp.198~207 (2017), 대한방사선종양학회
- Rodel C, "Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer", J Clin Oncol, 23, pp.8688~8696 (2005)
- Losi L, "Prognostic value of Dworak grade of regression(GR)in patients with rectal carcinoma treated with preoperative radiochemotherapy", Int J Colorectal Dis, 21, pp.645~651 (2006)
- Maas M, "Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer : a pooled analysis of individual patient data", Lancet Oncol, 11, pp.835~844 (2010)
- Capirci C, "Prognostic value of pathologic complete response after neoadjuvant therapy in locally advanced rectal cancer : long-term analysis of 566 ypCR patients", Int J Radiat Oncol Biol Phys, 72, pp.99~107 (2008)
- Kennedy GD, "Hot topics in colorectal surgery", Clin Colon Rectal Surg, 29, pp.183~184 (2016)
- Huang M, "Erectile and urinary function in men with rectal cancer treated by neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy alone : a randomized trial report", Int J Colorectal Dis, 31, pp.1349~1357 (2016)
- Park SY, "Urinary and erectile function in men after total mesorectal excision by laparoscopic or robot-assisted methods for the treatment of rectal cancer : a case-matched comparison", World J Surg, 38, pp.1834~1842 (2014)
- van der Valk MJM, "Long-term outcomes of clinical complete responders after neoadjuvant treatment for rectal cancer in the International Watch & Wait Database(IWWD) : an international multicentre registry study", Lancet, 391, pp.2537~2545 (2018)
- Dossa F, "A watch-andwait approach for locally advanced rectal cancer after a clinical complete response following neoadjuvant chemoradiation : a systematic review and meta-analysis", Lancet Gastroenterol Hepatol, 2, pp.501~513 (2017)
- Renehan AG, "Watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer(the OnCoRe project) : a propensity-score matched cohort analysis", Lancet Oncol, 17, pp.174~183 (2016)
- 김종훈, "Controversial issues in radiotherapy for rectal cancer: a systematic review", Radiation oncology journal, 35(4), pp.295~305 (2017), 대한방사선종양학회
- Goodman KA, "Definitive chemoradiotherapy("Watch-and-Wait"approach)", Semin Radiat Oncol, 26, pp.205~210 (2016)
- Patel UB, "Magnetic resonance imaging-detected tumor response for locally advanced rectal cancer predicts survival outcomes : MERCURY experience", J Clin Oncol, 29, pp.3753~3760 (2011)
- Patel UB, "Comparison of magnetic resonance imaging and histopathological response to chemoradiotherapy in locally advanced rectal cancer", Ann Surg Oncol, 19, pp.2842~2852 (2012)
- Lee JH, "Carcinoembryonic antigen has prognostic value for tumor downstaging and recurrence in rectal cancer after preoperative chemoradiotherapy and curative surgery : a multi-institutional and case-matched control study of KROG 14-12", Radiother Oncol, 116, pp.202~208 (2015)
- Kim CW, "Clinical significance of pre-to post-chemoradiotherapy s-CEA reduction ratio in rectal cancer patients treated with preoperative chemoradiotherapy and curative resection", Ann Surg Oncol, 18, pp.3271~3277 (2011)
- Chung MJ, "Can serum dynamics of carcinoembryonic antigen level during neoadjuvant chemoradiotherapy in rectal cancer predict tumor response and recurrence? A multi-institutional retrospective study", Int J Colorectal Dis, 31, pp.1595~1601 (2016)
- Edge SB, "The American Joint Committee on Cancer : the 7th edition of the AJCC cancer staging manual and the future of TNM", Ann Surg Oncol, 17, pp.1471~1474 (2010)
- Dworak O, "Pathological features of rectal cancer after preoperative radiochemotherapy", Int J Colorectal Dis, 12, pp.19~23 (1997)
- Song I, "Value of diffusion-weighted imaging in the detection of viable tumour after neoadjuvant chemoradiation therapy in patients with locally advanced rectal cancer : comparison with T2 weighted and PET", CT imaging, 2012, pp.85, 577~586
- Greiner M, "Principles and practical application of the receiver-operating characteristic analysis for diagnostic tests", Prev Vet Med, 45, pp.23~41 (2000)
- Bulens P, "Development and validation of an MRI-based model to predict response to chemoradiotherapy for rectal cancer", Radiother Oncol, 126, pp.437~442 (2018)
- Lambrecht M, "Value of diffusion-weighted magnetic resonance imaging for prediction and early assessment of response to neoadjuvant radiochemotherapy in rectal cancer : preliminary results", Int J Radiat Oncol Biol Phys, 82, pp.863~870 (2012)
- Barbaro B, "Diffusion-weighted magnetic resonance imaging in monitoring rectal cancer response to neoadjuvant chemoradiotherapy", Int J Radiat Oncol Biol Phys, 83, pp.594~599 (2012)
- Joye I, "The role of diffusion-weighted MRI and(18)F-FDG PET", CT in the prediction of pathologic complete response after radiochemotherapy for rectal cancer : a systematic review, 2014, pp.113, 158~165
- Lee SJ, "Clinical implications of initial FDG-PET", CT in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy, 2013, pp.71, 1201~1207
- Hindie E, "Predicting response to chemoradiotherapy in rectal and oesophageal cancer with 18FFDG : prognostic value and possible role in patient management", Eur J Nucl Med Mol Imaging, 34, pp.1576~1582 (2007)
- Leccisotti L, "The predictive value of 18F-FDG PET", CT for assessing pathological response and survival in locally advanced rectal cancer after neoadjuvant radiochemotherapy, 2015, pp.42, 657~666
- Murcia Durendez MJ, "The value of 18F-FDG PET", CT for assessing the response to neoadjuvant therapy in locally advanced rectal cancer, 2013, pp.40, 91~97
- Koc M, "The value of liver-based standardized uptake value and other quantitative 18F-FDG PET-CT parameters in neoadjuvant therapy response in patients with locally advanced rectal cancer : correlation with histopathology", Nucl Med Commun, 36, pp.898~907 (2015)
- Aiba T, "MRI and FDG-PET for assessment of response to neoadjuvant chemotherapy in locally advanced rectal cancer", Ann Surg Oncol, 21, pp.1801~1808 (2014)
- Taylor FG, "Preoperative magnetic resonance imaging assessment of circumferential resection margin predicts disease-free survival and local recurrence : 5-year follow-up results of the MERCURY study", J Clin Oncol, 32, pp.34~43 (2014)
- Kim H, "MRI risk stratification for tumor relapse in rectal cancer achieving pathological complete remission after neoadjuvant chemoradiation therapy and curative resection", PLoS One, 11, pp.e0146235~ (2016)