磁共振肿瘤退缩分级在经新辅助治疗后的局部进展期直肠癌中的应用

Application of magnetic resonance tumor regression gradingin locally advanced rectal cancer after neoadjuvant therapy

目的评估磁共振肿瘤退缩分级(mrTRG)在经新辅助治疗后的局部进展期直肠癌中的肿瘤消退程度的诊断性能,分析其与病理退缩分级(pTRG)的一致性。方法回顾性分析2015年1月至2019年9月于重庆医科大学附属第一医院行新辅助放、化疗联合直肠全系膜切除术的患者57例,利用Kappa和χ2检验分析患者mrTRG与pTRG一致性及准确性,探讨不同时间间隔对一致性的影响。结果mrTRG与pTRG一致性为中等偏低,κ=0.245(0.133~0.356),准确性为64.9%(52.5%~77.3%),当将pTRG1+2合并为一组时,一致性为中等,κ=0.526(0.397~0.656),准确性为75.4%(64.3%~86.6%)。mrTRG1对pCR患者预测为25.0%,mrTRG1+2为87.5%。时间间隔大于或等于9周具有更高一致性,差异有统计学意义(P<0.05)。结论mrTRG与pTRG一致性较差,临床应用中尚不能代替pTRG,进一步延长磁共振再评估时间有利于提高二者间的一致性。

Objective To evaluate the diagnostic performance of mrTRG in locally advanced rectal cancer after neoadjuvant therapy,and to analyze its correlation with pTRG,so as to provide relevant referencefor clinical application.Methods A retrospective analysis was made on 57 patients who underwent neoadjuvant therapy combined with total mesorectal resection in the first affiliated Hospital of Chongqing Medical University from January 2015 to September 2019.The Kappa and Chi-square tests were used to analyze the inter-test agreement in TRG between MRI and pathology,and to explore the effect of different time intervals on the consistency rate.Results The consistency between mrTRG and pTRG is moderately low,κ=0.245(0.133-0.356),accuracy is 64.9%(52.5%-77.3%),when TRG1+2 is separated from other groups,the consistency is medium,κ=0.526(0.397-0.656),accuracy is 75.4%(64.3%-86.6%).25.0%of pCR patients belong to mrTRG1 and 87.5%pCR patients belong to mrTRG1+2.The group time interval≥9 weeks has higher consistency,and the difference is statistically significant(P<0.05).Conclusion The application of mrTRG still has controversy,the consistency between mrTRG and pTRG is poor,and it can not replace pTRG.Further prolonging the time of MRI reevaluation is beneficial to improve the consistency between the mrTRG and pTRG.