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Extracellular volume fraction determined by equilibrium contrast-enhanced CT for the prediction of the pathological complete response to neoadjuvant chemoradiotherapy for locally advanced rectal cancer

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To determine the extracellular volume (ECV) fraction derived from equilibrium contrast-enhanced CT for predicting pathological complete response (pCR) after neoadjuvant chemoradiotherapy (NCRT) in locally advanced rectal cancer (LARC).

Methods

The ECV fraction before NCRT (ECVpre) and/or ECV after NCRT (ECVpost) of rectal tumors was assessed, and ECVΔ was calculated as ECVpost − ECVpre. The histopathologic tumor regression grading (TRG) was assessed. pCR (TRG 0 grade) was defined as the absence of viable tumor cells in the primary tumor and lymph nodes. Demographic and clinicopathological characteristics and ECV fraction were compared between the pCR and non-pCR groups. A mixed model was constructed by logistic regression. The performance for predicting pCR was assessed with the area under the receiver-operator curve (AUC). The AUCs of the different methods were compared by the method proposed by DeLong et al.

Results

Seventy-five patients were included; 17 achieved pCR, and 58 achieved non-pCR. The ECVpost (17.05 ± 2.36% vs. 29.94 ± 1.20%; p < 0.001) and ECVΔ (− 17.01 ± 3.01% vs. 0.44 ± 1.45%; p < 0.001) values in the pCR group were significantly lower than those in the non-pCR group. The mixed model that combined ECVpost with ECVΔ achieved an AUC of 0.92 (95% confidence interval (CI) = 0.81–0.98), which was higher than that of ECVpost (AUC, 0.91 (95% CI = 0.80–0.97); p = 0.60) or ECVΔ (AUC, 0.90 (95% CI = 0.79–0.97); p = 0.61).

Conclusions

ECVpost and ECVΔ determined by using equilibrium contrast-enhanced CT were useful in distinguishing between pCR and non-pCR patients with LARC who received NCRT.

Key Points

• ECV post and ECV Δ (ECV post − ECV pre ) differed significantly between the non-pCR and pCR groups.

• ECV pre cannot be used to predict the efficacy of neoadjuvant chemoradiotherapy.

• ECV post combined with ECV Δ had the best performance with an AUC of 0.92 for predicting pCR after NCRT in LARC.

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Abbreviations

AJCC:

American Joint Committee on Cancer

CA 19-9:

Carbohydrate antigen 19-9

CEA:

Carcinoma embryonic antigen

CTV:

Clinical target volume

ECV:

Extracellular volume

GTV:

Gross tumor volume

ICC:

Intra-class correlation coefficient

IMRT:

Intensity-modulated radiation therapy

LARC:

Locally advanced rectal cancer

NCRT:

Neoadjuvant chemoradiotherapy

OS:

Overall survival

pCR:

Pathological complete response

PFS:

Progression-free survival

TME:

Total mesorectal excision

TRG:

Tumor regression grading

UICC:

Union for International Cancer Control

W&W:

Watch and wait

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Acknowledgements

The authors thank Hesong Shen and Daihong Liu, who have been a source of encouragement and inspiration. We acknowledge the support of Xiaoyue Zhang from Siemens Healthineers.

Funding

This project was supported by the 2020 SKY Imaging Research Fund of the Chinese International Medical Foundation (Grant No. Z-2014-07-2003-24), the Natural Science Foundation of Chongqing municipality (No. cstc2021jcyj-msxmX0387), Medical Scientific Research Project of Chongqing Municipal Health Commission (No. 2022WSJK027), the Chongqing Medical Research Project of Combination of Science and Medicine (Grant No. 2021MSXM035), and the Chongqing Natural Science Foundation (Grant No. cstc2021jcyj-msxmX0313).

Author information

Author notes

  1. Yuesheng Luo and Leilei Liu are co-first authors and contributed equally to the study.

Authors and Affiliations

  1. Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, 400030, People’s Republic of China

    Yuesheng Luo, Leilei Liu, Daihong Liu, Hesong Shen, Xiaoxia Wang, Jing Zhang, Yong Tan & Jiuquan Zhang

  2. Cancer Radiotherapy Center, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, 400030, People’s Republic of China

    Chunbo Fan

  3. Department of Pathology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, 400030, People’s Republic of China

    Zhen Zeng

  4. Siemens Healthineers, Xi’an, 710000, People’s Republic of China

    Xiaoyue Zhang

  5. Siemens Healthineers, Shanghai, 200126, People’s Republic of China

    Jiaxing Wu

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  1. Yuesheng Luo
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Corresponding author

Correspondence to Jiuquan Zhang.

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Guarantor

The scientific guarantor of this publication is Jiuquan Zhang.

Conflict of interest

Two of the authors (Xiaoyue Zhang and Jiaxing Wu) are employees of Siemens Healthineers. The remaining authors declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Daihong Liu from Chongqing University Cancer Hospital kindly provided statistical advice for this manuscript, and he is one of the authors of this study.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Luo, Y., Liu, L., Liu, D. et al. Extracellular volume fraction determined by equilibrium contrast-enhanced CT for the prediction of the pathological complete response to neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Eur Radiol 33, 4042–4051 (2023). https://doi.org/10.1007/s00330-022-09307-z

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