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Developing a prediction model based on MRI for pathological complete response after neoadjuvant chemoradiotherapy in locally advanced rectal cancer

  • Special Section: Rectal Cancer
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to build an appropriate diagnostic model for predicting pathological complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer (LARC), by combining magnetic resonance imaging (MRI) parameters with clinical factors.

Methods

Eighty-four patients with LARC who underwent MR examination before and after nCRT were enrolled in this study. MRI parameters including cylindrical approximated tumor volume (CATV) and relative signal intensity of tumor (rT2wSI) were measured; corresponding reduction rates (RR) were calculated; and MR tumor regression grade (mrTRG) and other conventional MRI parameters were assessed. Logistic regression with lasso regularization was performed and the appropriate prediction model for pCR was built up. An external cohort of thirty-six patients was used as the validation group for testing the model. Receiver-operating characteristic (ROC) analysis was used to assess the diagnostic performance.

Results

In the development and the validation group, 17 patients (20.2%) and 11 patients (30.6%), respectively, achieved pCR. Two CATV-related parameters (CATVpost, which is the CATV measured after nCRT and CATVRR), one rT2wSI-related parameter (rT2wSIRR), and mrTRG were the most important parameters for predicting pCR and were retained in the diagnostic model. In the development group, the area under the receiver-operating characteristic curve (AUC) for predicting pCR is 0.88 [95% confidence interval (CI) 0.78–0.97, p < 0.001], with a sensitivity of 82.4% and a specificity of 83.6%. In the validation group, the AUC is 0.84 (95% CI 0.70–0.98, p = 0.001), with a sensitivity of 81.8% and a specificity of 76.0%.

Conclusion

A diagnostic model including CATVpost, CATVRR, rT2wSIRR, and mrTRG was useful for predicting pCR after nCRT in patients with LARC and may be used as an effective organ-preservation strategy.

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Abbreviations

ADC:

Apparent diffusion coefficient

CP:

Circumferential percentage

CATV:

Cylindrical approximated tumor volume

CATVRR:

The reduction rate of cylindrical approximated tumor volume

DTA:

Distance from tumor to anal verge

EMVI:

Extramural venous invasion

LARC:

Locally advanced rectal cancer

MRF:

Mesorectal fascia

mrTRG:

Magnetic resonance tumor regression grading

nCRT:

Neoadjuvant chemoradiotherapy

pCR:

Pathological complete response

rT2wSI:

Relative signal intensity of tumor

rT2wSIRR:

The reduction rate of relative signal intensity of tumor

TME:

Total mesorectal excision

TP:

Tumor position

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Acknowledgements

The authors acknowledge Sainan Cheng and Shunan Che for their assistance with statistical analyses.

Conflict of interest

All authors (Lijuan Wan, Chongda Zhang, Qing Zhao, Yankai Meng, Shuangmei Zou, Yang Yang, Yuan Liu, Jun Jiang, Feng Ye, Han Ouyang, Xinming Zhao, and Hongmei Zhang) have no conflicts of interest to be disclosed related to this article.

Funding

This research is supported by the Special scientific research projects of Beijing science and technology project [Grant Number Z16110000051610]; Beijing hope marathon special fund [Grant Number LC2016A05]; Peking Union Medical College Youth Fund, the Fundamental Research Funds for the Central Universities [Grant Number 3332018078]; Beijing Hope Run Special Fund of the Cancer Foundation of China [Grant Number LC2017B18].

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Author notes

  1. Lijuan Wan and Chongda Zhang have contributed equally to this study.

Authors and Affiliations

  1. Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China

    Lijuan Wan, Chongda Zhang, Qing Zhao, Yankai Meng, Yang Yang, Yuan Liu, Jun Jiang, Feng Ye, Han Ouyang, Xinming Zhao & Hongmei Zhang

  2. Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China

    Shuangmei Zou

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Contributions

Study concepts/study design, data acquisition or data analysis/interpretation, all authors; quality control of date and algorithms, Jun Jiang, Feng Ye, Han Ouyang, Hongmei Zhang; statistical analysis, Lijuan Wan, Chongda Zhang, Hongmei Zhang. drafting the article or revising it critically for important intellectual content, all author; final approval of the version to be submitted, all author.

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Correspondence to Hongmei Zhang.

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Wan, L., Zhang, C., Zhao, Q. et al. Developing a prediction model based on MRI for pathological complete response after neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Abdom Radiol 44, 2978–2987 (2019). https://doi.org/10.1007/s00261-019-02129-6

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