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Comparison between MRI and pathology in the assessment of tumour regression grade in rectal cancer
Royal Marsden NHS Fdn Trust, Dept Med, London, England.;Royal Marsden NHS Fdn Trust, Dept Med, Surrey, England..
Royal Marsden NHS Fdn Trust, Dept Radiol, London, England.;Royal Marsden NHS Fdn Trust, Dept Radiol, Surrey, England..
Royal Marsden NHS Fdn Trust, Dept Med, London, England.;Royal Marsden NHS Fdn Trust, Dept Med, Surrey, England..
Royal Marsden NHS Fdn Trust, Dept Histopathol, London, England.;Royal Marsden NHS Fdn Trust, Dept Histopathol, Surrey, England..
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2017 (English)In: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 117, no 10, p. 1478-1485Article in journal (Refereed) Published
Abstract [en]

Background: Limited data exist regarding the correlation between MRI tumour regression grade (mrTRG) and pathological TRG (pTRG) in rectal cancer. Methods: mrTRG and pTRG were compared in rectal cancer patients from two phase II trials (EXPERT and EXPERT-C). The agreement between radiologist and pathologist was assessed with the weighted k test while the Kaplan-Meier method was used to estimate survival outcomes. Results: One hundred ninety-one patients were included. Median time from completion of neoadjuvant treatment to pre-operative MRI and surgery was 4.1 weeks (interquartile range (IQR): 3.7-4.7) and 6.6 weeks (IQR: 5.9-7.6), respectively. Fair agreement was found between mrTRG and pTRG when regression was classified according to standard five-tier systems (kappa = 0.24) or modified three-tier systems (kappa = 0.25). Sensitivity and specificity of mrTRG 1-2 (complete/good radiological regression) for the prediction of pathological complete response was 74.4% (95% CI: 58.8-86.5) and 62.8% (95% CI: 54.5-70.6), respectively. Survival outcomes of patients with intermediate pathological regression (pTRG 2) were numerically better if complete/good regression was also observed on imaging (mrTRG 1-2) compared to poor regression (mrTRG 3-5) (5-year recurrence-free survival 76.9% vs 65.9%, P = 0.18; 5-year overall survival 80.6% vs 68.8%, P = 0.22). Conclusions: The agreement between mrTRG and pTRG is low and mrTRG cannot be used as a surrogate of pTRG. Further studies are warranted to assess the ability of mrTRG to identify pathological complete responders for the adoption of non-operative management strategies and to provide complementary prognostic information to pTRG for better risk-stratification after surgery.

Place, publisher, year, edition, pages
2017. Vol. 117, no 10, p. 1478-1485
Keywords [en]
pathological tumour regression grade, magnetic resonance tumour regression grade, rectal cancer
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:uu:diva-341935DOI: 10.1038/bjc.2017.320ISI: 000414550300010PubMedID: 28934761OAI: oai:DiVA.org:uu-341935DiVA, id: diva2:1183418
Available from: 2018-02-16 Created: 2018-02-16 Last updated: 2018-02-16Bibliographically approved

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