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Complementary value of pre-treatment apparent diffusion coefficient in rectal cancer for predicting tumor recurrence

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Abstract

Purpose

To assess the complementary prognostic value of pre-treatment tumor apparent diffusion coefficient (ADC) for the prediction of tumor recurrence in patients with rectal cancer.

Methods

From March 2012 to March 2013, a total of 128 patients with mid/lower rectal cancer who underwent pre-treatment rectal MRI were enrolled in this retrospective study. Two radiologists in consensus evaluated conventional imaging features (Cimg) in pre-treatment rectal MRI: tumor height from anal verge (≤5 cm vs. >5 cm), T stage (high vs. low), the presence or absence of lymph node metastasis, mesorectal fascia invasion, and extramural venous invasion. The mean tumor ADC values (TumorADC) based on high b-value (0, 1000 × 10−3 mm2/s) diffusion weight images were extracted. A multivariate Cox proportional hazard (CPH) regression was performed to evaluate the association of Cimg and TumorADC with the 3-year local recurrence (LR) rate. Predictive performance of two multivariate CPH models (Cimg only vs. Cimg + TumorADC) was compared using Harrell’s c index (HCI).

Results

TumorADC (Adjusted HR, 7.830; 95% CI 3.937–15.571) and high T stage (Adjusted HR, 8.039; 95% CI 2.405–26.874) were independently associated with the 3-year LR rate. The CPH model generated with T stage + TumorADC (HCI, 0.820; 95% CI 0.708–0.932) showed significantly higher HCI than that with T stage only (HCI, 0.742; 95% CI 0.594–0.889) (P = 0.009).

Conclusions

In patients with mid/lower rectal cancer, integrating TumorADC to Cimg increases predictive performance of the CPH model than that with Cimg alone for the prediction of LR within 3 years after surgery.

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Abbreviations

DWI:

Diffusion-weighted image

ADC:

Apparent diffusion coefficient

CR:

Complete remission

PCRT:

Preoperative chemoradiotherapy

MRI:

Magnetic resonance imaging

MRF:

Mesorectal fascia

ROI:

Region of interest

TumorADC :

Mean pre-treatment tumor ADC value

EMVI:

Extramural venous invasion

LN:

Lymph node

CT:

Computed tomography

dRFS:

Distant relapse-free survival

LR:

Local recurrence

Cimg :

Conventional imaging feature

CPH:

Cox proportional hazard

HR:

Hazard ratio

CI:

Confidence interval

HCI:

Harrell’s c index

AIC:

Akaike information criteria

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Authors and Affiliations

  1. Department of Radiology, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu, 702-210, Republic of Korea

    Sung Jun Moon, Seung Hyun Cho, Gab Chul Kim, Won Hwa Kim, Hye Jung Kim, Kyung-Min Shin & So Mi Lee

  2. Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu, 702-210, Republic of Korea

    Jun Seok Park & Gyu-Seog Choi

  3. Department of Radiology, Dongsan Hospital, College of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, 700-712, Republic of Korea

    See Hyung Kim

Authors
  1. Sung Jun Moon
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Corresponding author

Correspondence to Seung Hyun Cho.

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Funding

This study was not funded.

Conflicts of interest

All authors declare no existing conflict of interest.

Ethical approval

This retrospective study involving human was approved by the institutional research committee, complying with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was waived.

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Moon, S.J., Cho, S.H., Kim, G.C. et al. Complementary value of pre-treatment apparent diffusion coefficient in rectal cancer for predicting tumor recurrence. Abdom Radiol 41, 1237–1244 (2016). https://doi.org/10.1007/s00261-016-0648-4

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  • DOI: https://doi.org/10.1007/s00261-016-0648-4

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