Có lợi ích gì khi sử dụng hình ảnh cộng hưởng từ trong việc dự đoán phản ứng điều trị bổ trợ trước phẫu thuật ở bệnh nhân ung thư trực tràng tiến triển tại chỗ?

Lian-Ming Wu1, Jiong Zhu1, Jiani Hu2, Yan Yin1, Hai-Yan Gu1, Jia Hua1, Jie Chen1, Jian-Rong Xu1
1Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
2Department of Radiology, Wayne State University, Detroit, USA

Tóm tắt

Phân tích tổng hợp này nhằm đánh giá độ chính xác của hình ảnh cộng hưởng từ (MRI) trong việc dự đoán phản ứng ở bệnh nhân ung thư trực tràng tiến triển tại chỗ sau điều trị bổ trợ trước phẫu thuật. Các bài báo bằng tiếng Anh liên quan đến độ chính xác của MRI cho mục đích này đã được thu thập. Chất lượng phương pháp được đánh giá bằng công cụ Đánh giá Chất lượng Nghiên cứu Độ chính xác Chẩn đoán. Dữ liệu ước lượng tổng hợp và phân tích nhóm được thu thập bằng phân tích thống kê. Mười bốn nghiên cứu có 751 bệnh nhân được xác nhận bằng bệnh lý đã đáp ứng tiêu chí bao gồm. Chất lượng phương pháp tương đối cao. Để dự đoán phản ứng mô bệnh học ở ung thư trực tràng tiến triển tại chỗ bằng MRI, độ nhạy và độ đặc hiệu tổng hợp lần lượt là 0.78 [Khoảng tin cậy (CI) 95%, 0.65, 0.87] và 0.81 (CI 95%, 0.72, 0.87). Tỷ lệ khả năng dương tính và tỷ lệ khả năng âm tính lần lượt là 4.1 (CI 95%, 2.9, 5.8) và 0.27 (CI 95%, 0.17, 0.43). Phân tích nhóm cho thấy rằng việc chụp hình ở các thiết bị MRI 3.0 T có độ nhạy tổng hợp cao hơn (0.92, CI 95%, 0.84, 1.00) so với nhóm MRI với ≤1.5 T (0.68, CI 95%, 0.53, 0.82) (p < 0.05). Độ nhạy và độ đặc hiệu của hình ảnh T2-weighted (T2WI) kết hợp với hình ảnh khuếch tán (DWI) lần lượt là 0.92 (CI 95%, 0.81, 1.00) và 0.75 (CI 95%, 0.54, 0.95); trong khi đó, của T2WI đơn độc là 0.64 (CI 95%, 0.47, 0.82) và 0.88 (CI 95%, 0.81, 0.94) (p > 0.05). Phân tích tổng hợp này chỉ ra rằng MRI là một công cụ chính xác trong việc dự đoán phản ứng mô bệnh học sau điều trị trước phẫu thuật ở bệnh nhân ung thư trực tràng tiến triển tại chỗ. Đề xuất thực hiện MRI bằng các thiết bị 3.0 T, có thể nhạy cảm hơn trong việc xác định người đáp ứng. Sự bổ sung DWI vào T2WI cho thấy sự cải thiện không đáng kể về độ nhạy, điều này đáng được nghiên cứu thêm.

Từ khóa

#hình ảnh cộng hưởng từ #ung thư trực tràng tiến triển tại chỗ #điều trị bổ trợ trước phẫu thuật #độ chính xác chẩn đoán #phân tích tổng hợp

Tài liệu tham khảo

Govindarajan A, Coburn NG, Kiss A, Rabeneck L, Smith AJ, Law CH (2006) Population-based assessment of the surgical management of locally advanced colorectal cancer. J Natl Cancer Inst 98:1474–1481 Lehnert T, Methner M, Pollok A, Schaible A, Hinz U, Herfarth C (2002) Multivisceral resection for locally advanced primary colon and rectal cancer: an analysis of prognostic factors in 201 patients. Ann Surg 235:217–225 Theodoropoulos G, Wise WE, Padmanabhan A et al (2002) T-level downstaging and complete pathologic response after preoperative chemoradiation for advanced rectal cancer result in decreased recurrence and improved disease-free survival. Dis Colon Rectum 45(7):895–903 Hartley A, Ho KF, McConkey C, Geh JI (2005) Pathological complete response following preoperative chemoradiotherapy in rectal cancer: analysis of phase II/III trials. Br J Radiol 78(934):934–938 Bonnen M, Crane C, Vauthey JN et al (2004) Long-term results using local excision after preoperative chemoradiation among selected T3 rectal cancer patients. Int J Radiat Oncol Biol Phys 60(4):1098–1105 Habr-Gama A, Perez RO, Nadalin W et al (2004) Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg 240(4):711–717, discussion 717–718 Feliu J, Calvilio J, Escribano A et al (2002) Neoadjuvant therapy of rectal carcinoma with UFT-leucovorin plus radiotherapy. Ann Oncol 13(5):730–736 Fernandez-Martos C, Aparicio J, Bosch C et al (2004) Preoperative uracil, tegafur, and concomitant radiotherapy in operable rectal cancer: a phase II multicenter study with 3 years’ follow-up. J Clin Oncol 22(15):3016–3022 Thoeny HC, Ross BD (2010) Predicting and monitoring cancer treatment response with diffusion-weighted MRI. J Magn Reson Imaging 32(1):2–16 Lambrecht M, Vandecaveye V, De Keyzer F et al (2012) Value of diffusion-weighted magnetic resonance imaging for prediction and early assessment of response to neoadjuvant radiochemotherapy in rectal cancer: preliminary results. Int J Radiat Oncol Biol Phys 82(2):863–870 Torkzad MR, Lindholm J, Martling A et al (2007) MRI after preoperative radiotherapy for rectal cancer; correlation with histopathology and the role of volumetry. Eur Radiol 17(6):1566–1573 Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J (2003) The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 3:25 Rutter CM, Gatsonis CA (2001) A hierarchical regression approach to meta-analysis of diagnostic test accuracy evaluations. Stat Med 20(19):2865–2884 Harbord RM, Deeks JJ, Egger M, Whiting P, Sterne JA (2007) A unification of models for meta-analysis of diagnostic accuracy studies. Biostatistics 8(2):239–251 Swets JA (1988) Measuring the accuracy of diagnostic systems. Science 240(4857):1285–1293 Huedo-Medina TB, Sanchez-Meca J, Marin-Martinez F, Botella J (2006) Assessing heterogeneity in meta-analysis: Q statistic or I2 index? Psychol Methods 11(2):193–206 Vliegen RF, Beets GL, Lammering G et al (2008) Mesorectal fascia invasion after neoadjuvant chemotherapy and radiation therapy for locally advanced rectal cancer: accuracy of MR imaging for prediction. Radiology 246(2):454–462 Kremser C, Trieb T, Rudisch A, Judmaier W, de Vries A (2007) Dynamic T(1) mapping predicts outcome of chemoradiation therapy in primary rectal carcinoma: sequence implementation and data analysis. J Magn Reson Imaging 26(3):662–671 Sun YS, Zhang XP, Tang L et al (2010) Locally advanced rectal carcinoma treated with preoperative chemotherapy and radiation therapy: preliminary analysis of diffusion-weighted MR imaging for early detection of tumor histopathologic downstaging. Radiology 254(1):170–178 Allen SD, Padhani AR, Dzik-Jurasz AS, Glynne-Jones R (2007) Rectal carcinoma: MRI with histologic correlation before and after chemoradiation therapy. AJR Am J Roentgenol 188(2):442–451 Kuo LJ, Chern MC, Tsou MH et al (2005) Interpretation of magnetic resonance imaging for locally advanced rectal carcinoma after preoperative chemoradiation therapy. Dis Colon Rectum 48(1):23–28 Dinter DJ, Horisberger K, Zechmann C et al (2009) Can dynamic MR imaging predict response in patients with rectal cancer undergoing cetuximab-based neoadjuvant chemoradiation? Onkologie 32(3):86–93 DeVries A, Griebel J, Judmaier W et al (2000) Perfusion-index values evaluated by dynamic magnetic resonance imaging in advanced rectal carcinoma. A new predictor of response to preoperative radiochemotherapy? Strahlenther Onkol 176(12):567–572 Lorente Garin JA, Arango Toro O, Bielsa Gali O, Cortadellas Angel R, Gelabert-Mas A (2000) Predictive factors of locally advanced disease in patients with prostatic cancer treated with neoadjuvant hormone therapy and radical prostatectomy. Actas Urol Esp 24(5):393–399 Sun YS, Cui Y, Tang L et al (2011) Early evaluation of cancer response by a new functional biomarker: apparent diffusion coefficient. AJR Am J Roentgenol 197(1):W23–W29 Bratland A, Vetrhus T, Grøholt KK, Ree AH (2010) Preoperative radiotherapy in rectal signet-ring cell carcinoma—magnetic resonance imaging and treatment outcome: report of six cases. Acta Oncol 49(1):42–49 Lambrecht M, Deroose C, Roels S et al (2010) The use of FDG-PET/CT and diffusion-weighted magnetic resonance imaging for response prediction before, during and after preoperative chemoradiotherapy for rectal cancer. Acta Oncol 49(7):956–963 Kim SH, Lee JM, Hong SH et al (2009) Locally advanced rectal cancer: added value of diffusion-weighted MR imaging in the evaluation of tumor response to neoadjuvant chemo- and radiation therapy. Radiology 253(1):116–125 Torkzad MR, Suzuki C, Tanaka S, Palmer G, Holm T, Blomqvist L (2008) Morphological assessment of the interface between tumor and neighboring tissues, by magnetic resonance imaging, before and after radiotherapy in patients with locally advanced rectal cancer. Acta Radiol 49(10):1099–1103 Park MJ, Kim SH, Lee SJ, Jang KM, Rhim H (2011) Locally advanced rectal cancer: added value of diffusion-weighted MR imaging for predicting tumor clearance of the mesorectal fascia after neoadjuvant chemotherapy and radiation therapy. Radiology 260(3):771–780 Lambregts DM, Vandecaveye V, Barbaro B et al (2011) Diffusion-weighted MRI for selection of complete responders after chemoradiation for locally advanced rectal cancer: a multicenter study. Ann Surg Oncol 18(8):2224–2231 Kim YC, Lim JS, Keum KC et al (2011) Comparison of diffusion-weighted MRI and MR volumetry in the evaluation of early treatment outcomes after preoperative chemoradiotherapy for locally advanced rectal cancer. J Magn Reson Imaging 34(3):570–576 Kim SH, Lee JY, Lee JM, Han JK, Choi BI (2011) Apparent diffusion coefficient for evaluating tumour response to neoadjuvant chemoradiation therapy for locally advanced rectal cancer. Eur Radiol 21(5):987–995 Jung SH, Heo SH, Kim JW et al (2012) Predicting response to neoadjuvant chemoradiation therapy in locally advanced rectal cancer: diffusion-weighted 3 Tesla MR imaging. J Magn Reson Imaging 35(1):110–116 Curvo-Semedo L, Lambregts DM, Maas M et al (2011) Rectal cancer: assessment of complete response to preoperative combined radiation therapy with chemotherapy—conventional MR volumetry versus diffusion-weighted MR imaging. Radiology 260(3):734–743 Song I, Kim SH, Lee SJ, Choi JY, Kim MJ, Rhim H (2012) Value of diffusion-weighted imaging in the detection of viable tumour after neoadjuvant chemoradiation therapy in patients with locally advanced rectal cancer: comparison with T2-weighted and PET/CT imaging. Br J Radiol 85(1013):577–586 Kim SH, Lee JM, Park HS, Eun HW, Han JK, Choi BI (2009) Accuracy of MRI for predicting the circumferential resection margin, mesorectal fascia invasion, and tumor response to neoadjuvant chemoradiotherapy for locally advanced rectal cancer. J Magn Reson Imaging 29(5):1093–1101 Dresen RC, Beets GL, Rutten HJ et al (2009) Locally advanced rectal cancer: MR imaging for restaging after neoadjuvant radiation therapy with concomitant chemotherapy. Part I. Are we able to predict tumor confined to the rectal wall? Radiology 252(1):71–80 Barbaro B, Fiorucci C, Tebala C et al (2009) Locally advanced rectal cancer: MR imaging in prediction of response after preoperative chemotherapy and radiation therapy. Radiology 250(3):730–739 Kulkarni T, Gollins S, Maw A, Hobson P, Byrne R, Widdowson D (2008) Magnetic resonance imaging in rectal cancer downstaged using neoadjuvant chemoradiation: accuracy of prediction of tumour stage and circumferential resection margin status. Color Dis 10(5):479–489 Denecke T, Rau B, Hoffmann KT et al (2005) Comparison of CT, MRI and FDG-PET in response prediction of patients with locally advanced rectal cancer after multimodal preoperative therapy: is there a benefit in using functional imaging? Eur Radiol 15(8):1658–1666 Jones CM, Athanasiou T (2005) Summary receiver operating characteristic curve analysis techniques in the evaluation of diagnostic tests. Ann Thorac Surg 79(1):16–20 Petitti DB (2001) Approaches to heterogeneity in meta-analysis. Stat Med 20:3625–3633 Miao H, Fukatsu H, Ishigaki T (2007) Prostate cancer detection with 3 T MRI: comparison of diffusion-weighted and T2-weighted imaging. Eur J Radiol 61:297–302 Maas M, Lambregts DM, Lahaye MJ et al (2012) T-staging of rectal cancer: accuracy of 3.0 Tesla MRI compared with 1.5 Tesla. Abdom Imaging 37(3):475–481 Rao SX, Zeng MS, Chen CZ et al (2008) The value of diffusion-weighted imaging in combination with T2-weighted imaging for rectal cancer detection. Eur J Radiol 65(2):299–303 Koh DM, Collins DJ (2007) Diffusion-weighted MRI in the body: applications and challenges in oncology. AJR Am J Roentgenol 188(6):1622–1635 Woodhams R, Kakita S, Hata H et al (2009) Diffusion weighted imaging of mucinous carcinoma of the breast: evaluation of apparent diffusion coefficient and signal intensity in correlation with histologic findings. AJR Am J Roentgenol 193(1):260–266 Allen SD, Padhani AR, Dzik-Jurasz AS, Glynne-Jones R (2007) Rectal carcinoma: MRI with histologic correlation before and after chemoradiation therapy. Am J Roentgenol 188:442–451 Beets-Tan RG, Beets GL (2004) Rectal cancer: review with emphasis on MR imaging. Radiology 232(2):335–346 Beets-Tan RG, Beets GL (2003) Rectal cancer: how accurate can imaging predict the T stage and the circumferential resection margin? Int J Color Dis 18(5):385–391 Brown G, Radcliffe AG, Newcombe RG, Dallimore NS, Bourne MW, Williams GT (2003) Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging. Br J Surg 90(3):355–364 Mandard AM, Dalibard F, Mandard JC et al (1994) Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma: clinicopathologic correlations. Cancer 73(11):2680–2686