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Clinical Studies

A new magnetic resonance imaging tumour response grading scheme for locally advanced rectal cancer

British Journal of Cancer volume 127, pages 268–277 (2022)Cite this article

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Abstract

Background

The potential of using magnetic resonance image tumour-regression grading (MRI-TRG) system to predict pathological TRG is debatable for locally advanced rectal cancer treated by neoadjuvant radiochemotherapy.

Methods

Referring to the American Joint Committee on Cancer/College of American Pathologists (AJCC/CAP) TRG classification scheme, a new four-category MRI-TRG system based on the volumetric analysis of the residual tumour and radiochemotherapy induced anorectal fibrosis was established. The agreement between them was evaluated by Kendall’s tau-b test, while Kaplan–Meier analysis was used to calculate survival outcomes.

Results

In total, 1033 patients were included. Good agreement between MRI-TRG and AJCC/CAP TRG classifications was observed (k = 0.671). Particularly, as compared with other pairs, MRI-TRG 0 displayed the highest sensitivity [90.1% (95% CI: 84.3–93.9)] and specificity [92.8% (95% CI: 90.4–94.7)] in identifying AJCC/CAP TRG 0 category patients. Except for the survival ratios that were comparable between the MRI-TRG 0 and MRI-TRG 1 categories, any two of the four categories had distinguished 3-year prognosis (all P < 0.05). Cox regression analysis further proved that the MRI-TRG system was an independent prognostic factor (all P < 0.05).

Conclusion

The new MRI-TRG system might be a surrogate for AJCC/CAP TRG classification scheme. Importantly, the system is a reliable and non-invasive way to identify patients with complete pathological responses.

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Fig. 1: Representative images of the MRI-TRG categories.
Fig. 2: The Kaplan-Meier curve analysis of survival among patients with distinct MRI-TRG categories in the validation set.
Fig. 3: The ROC curve analysis of the four-category MRI-TRG system to predict the individual risk of disease progression in the validation set.

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Data availability

The datasets used during this study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank Dr. XinJuan Fan and Dr. Yan Huang for their professional assistance in the pathological analysis, and Dr. Lishuo Shi (the Clinical Research Center, the Sixth Affiliated Hospital of Sun Yat-Sen University) for providing valuable advice on statistical analyses.

Funding

This research was funded by the Sixth Affiliated Hospital of Sun Yat-Sen University Clinical Research 1010 Program, grant number 1010PY (2020)-09; Guangdong Science and Technology Project (2017B090901065); Natural Science Foundation of China (No. 81872188), and Beijing Bethune Charitable Foundation (flzh202102).

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Author notes

  1. These authors contributed equally: Xiaolin Pang, Peiyi Xie, Li Yu.

Authors and Affiliations

  1. Department of Radiation Oncology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

    Xiaolin Pang, Haiyang Chen, Jian Zheng & Xiangbo Wan

  2. Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China

    Xiaolin Pang, Peiyi Xie, Haiyang Chen, Jian Zheng, Xiaochun Meng & Xiangbo Wan

  3. Department of Radiology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

    Peiyi Xie & Xiaochun Meng

  4. Department of Medical Oncology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China

    Li Yu

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Contributions

XLP and XBW contributed to the study design. XBW, HYC, LY and JZ recruited study patients. XLP, PYX, LY, XCM and XBW collected, audited, and assembled these data. XLP and XBW wrote the initial draft. PYX and LY revised the draft. XBW supervised this study. All authors read and approved the final manuscript. All authors contributed to the article and approved the submitted version.

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Correspondence to Xiangbo Wan.

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The protocol was approved by the central ethics committee of The Sixth Affiliated Hospital, Sun Yat-sen University. (2021ZSLYEC-121).

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Pang, X., Xie, P., Yu, L. et al. A new magnetic resonance imaging tumour response grading scheme for locally advanced rectal cancer. Br J Cancer 127, 268–277 (2022). https://doi.org/10.1038/s41416-022-01801-x

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