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Войти в исследования International journal of colorectal disease · 2025
Predicting treatment response and survival in rectal cancer: insights from 18 FDG-PET/MRI post-neoadjuvant therapy.
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Ferri Valentina, Vicente Emilio, Quijano Yolanda, Duran Hipolito, Diaz Eduardo, Fabra Isabel, Malave Luis, Ruiz Pablo, Ballelli Luca, Broglio Alessandro, Cañamaque Lina Garcia, Segui Andrea Verdu, Dueñas Virginia Perez, Caruso Riccardo
Аннотация
INTRODUCTION: Accurate identification of patients with pathologic complete response (pCR) following neoadjuvant radiochemotherapy (RCT) for locally advanced rectal cancer (LARC) is essential. 18-FDG PET/MRI provides metabolic information that complements the morphological assessment of standard MRI, potentially enhancing the differentiation between fibrotic and tumorous tissues post-treatment. This study aims to evaluate the performance of 18-FDG PET/MRI in assessing treatment response compared to standard MRI.
MATERIALS AND METHODS: A prospective study was conducted at HM Sanchinarro University Hospital, Madrid, from 2018 to 2021. Patients with LARC undergoing RCT were included and staged at diagnosis and restaged 8-12 weeks post-neoadjuvant treatment using 18-FDG PET/MRI. The primary outcome was to compare the performance of PET/MRI and standard MRI in detecting pCR and tumor regression grade (TRG) confirmed via histopathological examination. Quantitative analysis assessed the apparent diffusion coefficient (ADC) and standardized uptake value (SUV). A secondary outcome included survival analysis using the Kaplan-Meier method and Cox regression analysis for radiological and pathological prognostic markers.
RESULTS: Among 33 patients, pCR was observed in 45% (14/33). PET/MRI demonstrated sensitivity, specificity, and accuracy values of 0.88, 0.80, and 0.84, respectively, for detecting pCR, compared to 0.82, 0.50, and 0.67 for standard MRI (p < 0.001). PET/MRI accurately identified TRG stages in 72% of cases, compared to 50% for standard MRI. Post-SUV, post-ADC, and delta-ADC were the most precise PET/MRI predictors for pCR, with AUC values of 0.81, 0.75, and 0.55, respectively. Patients with mrEMVI and mrTRG showed worse disease-free survival (DFS).
CONCLUSION: 18-FDG PET/MRI emerges as a promising imaging tool for predicting response to neoadjuvant treatment in rectal cancer, with superior diagnostic accuracy compared to standard MRI. Radiological findings, such as EMVI, can identify high-risk patients, offering valuable prognostic insights.
MATERIALS AND METHODS: A prospective study was conducted at HM Sanchinarro University Hospital, Madrid, from 2018 to 2021. Patients with LARC undergoing RCT were included and staged at diagnosis and restaged 8-12 weeks post-neoadjuvant treatment using 18-FDG PET/MRI. The primary outcome was to compare the performance of PET/MRI and standard MRI in detecting pCR and tumor regression grade (TRG) confirmed via histopathological examination. Quantitative analysis assessed the apparent diffusion coefficient (ADC) and standardized uptake value (SUV). A secondary outcome included survival analysis using the Kaplan-Meier method and Cox regression analysis for radiological and pathological prognostic markers.
RESULTS: Among 33 patients, pCR was observed in 45% (14/33). PET/MRI demonstrated sensitivity, specificity, and accuracy values of 0.88, 0.80, and 0.84, respectively, for detecting pCR, compared to 0.82, 0.50, and 0.67 for standard MRI (p < 0.001). PET/MRI accurately identified TRG stages in 72% of cases, compared to 50% for standard MRI. Post-SUV, post-ADC, and delta-ADC were the most precise PET/MRI predictors for pCR, with AUC values of 0.81, 0.75, and 0.55, respectively. Patients with mrEMVI and mrTRG showed worse disease-free survival (DFS).
CONCLUSION: 18-FDG PET/MRI emerges as a promising imaging tool for predicting response to neoadjuvant treatment in rectal cancer, with superior diagnostic accuracy compared to standard MRI. Radiological findings, such as EMVI, can identify high-risk patients, offering valuable prognostic insights.