| Shao Lingdong,Li Jinluan,Du Kaixin,He Junyan,Chen Shaohua,Liao Xuehong,Peng Qingqin,Wu Junxin.An evaluation of Mandard tumor regression grade system in patients with locally advanced rectal cancer treated with preoperative radiotherapy[J].Chinese Journal of Radiological Medicine and Protection,2017,37(8):587-593 |
| An evaluation of Mandard tumor regression grade system in patients with locally advanced rectal cancer treated with preoperative radiotherapy |
| Received:December 15, 2016 |
| DOI：10.3760/cma.j.issn.0254-5098.2017.08.005 |
| KeyWords:Locally advanced rectal carcinoma Preoperative radiotherapy Tumor regression grade ADC values |
| FundProject:福建省中青年骨干项目（2013-ZQN-ZD-8）；福建省自然科学基金（2016J01437，2017J01260） |
| Author Name | Affiliation | E-mail | | Shao Lingdong | Department of Radiation Oncology, Department of Pathology, Fuzhou 350014, China | | | Li Jinluan | Department of Radiation Oncology, Department of Pathology, Fuzhou 350014, China | | | Du Kaixin | Department of Radiation Oncology, Department of Pathology, Fuzhou 350014, China | | | He Junyan | Department of Radiation Oncology, Department of Pathology, Fuzhou 350014, China | | | Chen Shaohua | Department of Pathology, Second Affiliated Hospital of Fujian Medical University Cancer Hospital, Quanzhou 362000, China | | | Liao Xuehong | Fujian Cancer Hospital, Fujian Medical University, Fuzhou 350014, China | | | Peng Qingqin | Department of Radiation Oncology, Department of Pathology, Fuzhou 350014, China | | | Wu Junxin | Department of Radiation Oncology, Department of Pathology, Fuzhou 350014, China | junxinwu@126.com |
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| Abstract:: |
| Objective To explore the clinical and imaging factors influencing the patients' prognosis after preoperative radiotherapy for local advanced rectal cancer. Methods We retrospectively analyzed 106 locally advanced rectal cancer patients from June 2004 to September 2015 in our institution. All patients underwent preoperative radiotherapy. According to the Mandard score, patients were divided into 5 groups (TRG1-5). All patients were divided into two groups according to the TRG, which including good responder (TRG1+2) and poor responder (TRG3+4+5) groups. All of the tumor ADC values of post-RT were measured by Diffusion-weighted MRI technology, and the relationship between tumor ADC values of post-RT and TRG was analyzed. Results In univariate analysis, age, chemotherapy, pT, pN, differentiation degree, vascular invasion and TRG were significantly associated with overall survival (χ2=3.945-8.110, P<0.05). Multivariate analysis indicated that differentiation degree and TRG were the independent prognostic factors for OS (χ2=5.221, 6.563, P<0.05). No significant difference was found between long-course and short-course radiotherapy group (P>0.05) in OS. The good responder group had a favorable survival in 5-year OS compared to the poor responder group (χ2=8.110, P<0.05). Preoperative radiotherapy, preoperative chemotherapy, pathological type, differentiation degree and gross type, vascular tumor thrombus and tumor ADC values of post-RT were significantly associated with TRG (χ2=4.189-18.139, P<0.05). The best critical point of tumor ADC values of post-RT was 1.7×10-3 mm2/s by using ROC curve. The accuracy of tumor ADC values of post-RT in predicting TRG1+2 was 70%. Conclusions The TRG can predict the efficacy of preoperative radiotherapy in patients with locally advanced rectal cancer based on the Mandard score. There was no significant difference in OS between long-course radiotherapy group and short-course radiotherapy group. The tumor ADC values of post-RT might become a potential factor to predict TRG in patients with locally advanced rectal cancer after preoperative radiotherapy. |
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