Pathologic Implications of Radial Resection Margin and Perineural Invasion to Adjuvant Chemotherapy after Preoperative Chemoradiotherapy and Surgery for Rectal Cancer: A Multi-Institutional and Case-Matched Control Study

Sung, Soo-Yoon; Kim, Sung Hwan; Jang, Hong Seok; Song, Jin Ho; Jeong, Sungmoon; Jung, Joon-Yong; Lee, Jong Hoon

doi:10.3390/cancers14174112

Cited by 3 publications

(2 citation statements)

References 36 publications

(48 reference statements)

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“…Although the local recurrence rate is reduced to < 10%, the distant metastasis rate is still more than 20%-30%. Postoperative adjuvant chemotherapy is used to prevent distant metastasis, and the PNI status is an indicator of postoperative adjuvant chemotherapy[ 14 - 16 ]. However, nCRT can significantly reduce the incidence of PNI in patients with RC, promoting the downward phase of the tumor.…”

Section: Introductionmentioning

confidence: 99%

Preoperative prediction of perineural invasion of rectal cancer based on a magnetic resonance imaging radiomics model: A dual-center study

Liu,

Sun,

Zhang

et al. 2024

World J Gastroenterol

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BACKGROUND Perineural invasion (PNI) has been used as an important pathological indicator and independent prognostic factor for patients with rectal cancer (RC). Preoperative prediction of PNI status is helpful for individualized treatment of RC. Recently, several radiomics studies have been used to predict the PNI status in RC, demonstrating a good predictive effect, but the results lacked generalizability. The preoperative prediction of PNI status is still challenging and needs further study. AIM To establish and validate an optimal radiomics model for predicting PNI status preoperatively in RC patients. METHODS This retrospective study enrolled 244 postoperative patients with pathologically confirmed RC from two independent centers. The patients underwent pre-operative high-resolution magnetic resonance imaging (MRI) between May 2019 and August 2022. Quantitative radiomics features were extracted and selected from oblique axial T2-weighted imaging (T2WI) and contrast-enhanced T1WI (T1CE) sequences. The radiomics signatures were constructed using logistic regression analysis and the predictive potential of various sequences was compared (T2WI, T1CE and T2WI + T1CE fusion sequences). A clinical-radiomics (CR) model was established by combining the radiomics features and clinical risk factors. The internal and external validation groups were used to validate the proposed models. The area under the receiver operating characteristic curve (AUC), DeLong test, net reclassification improvement (NRI), integrated discrimination improvement (IDI), calibration curve, and decision curve analysis (DCA) were used to evaluate the model performance. RESULTS Among the radiomics models, the T2WI + T1CE fusion sequences model showed the best predictive performance, in the training and internal validation groups, the AUCs of the fusion sequence model were 0.839 [95% confidence interval (CI): 0.757-0.921] and 0.787 (95%CI: 0.650-0.923), which were higher than those of the T2WI and T1CE sequence models. The CR model constructed by combining clinical risk factors had the best predictive performance. In the training and internal and external validation groups, the AUCs of the CR model were 0.889 (95%CI: 0.824-0.954), 0.889 (95%CI: 0.803-0.976) and 0.894 (95%CI: 0.814-0.974). Delong test, NRI, and IDI showed that the CR model had significant differences from other models (P < 0.05). Calibration curves demonstrated good agreement, and DCA revealed significant benefits of the CR model. CONCLUSION The CR model based on preoperative MRI radiomics features and clinical risk factors can preoperatively predict the PNI status of RC noninvasively, which facilitates individualized treatment of RC patients.

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Section: Introductionmentioning

confidence: 99%

Preoperative prediction of perineural invasion of rectal cancer based on a magnetic resonance imaging radiomics model: A dual-center study

Liu,

Sun,

Zhang

et al. 2024

World J Gastroenterol

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“…Identifying which patients will benefit from adjuvant treatment after neoadjuvant chemoradiation, on the other hand, remains an unmet medical need. Sung et al shed light on this topic, demonstrating that adjuvant chemotherapy improves overall and recurrence-free survival in patients with perineural invasion and/or a positive surgical margin [9].…”

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confidence: 99%