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Comparison of tumor regression grade and clinical stage based on MRI image as a selection criterion for non-radical management after concurrent chemoradiotherapy in locally advanced rectal cancer: a multicenter, retrospective, cross-sectional study

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Abstract

Purpose

There has been no comparative study on the clinical value of magnetic resonance tumor regression grade (mrTRG)1–2 and ycT0–1N0 for the prediction of ypT0–1N0 after concurrent chemoradiotherapy (CCRT) for rectal cancer. We compared the diagnostic performance between mrTRG1–2 and ycT0–1N0 for predicting ypT0–1N0 as a selection criterion for non-radical management after CCRT in locally advanced rectal cancer.

Methods

This retrospective study enrolled 291 patients from three referral hospitals between January 2018 and March 2020. The diagnostic performance of ycT0–1N0 and mrTRG1–2 for the prediction of ypT0–1N0 was compared in terms of sensitivity, specificity, positive-predictive value, negative-predictive value, and area under the curve (AUC).

Results

Sixty-eight patients (23.4%) achieved ypT0–1N0. Nineteen patients (6.5%) had ycT0–1N0, and 91 patients (31.2%) had mrTRG1–2. For predicting ypT0–1N0, ycT0–1N0 had a sensitivity of 16.2% (95% confidence interval [CI]: 8.36‒27.10) and positive-predictive value of 57.9% (95% CI: 36.57‒76.63), while mrTRG1–2 had a sensitivity of 58.8% (95% CI: 46.23‒70.63) and positive-predictive value of 44.0% (95% CI: 36.46‒51.74). When predicting ypT0–1N0, mrTRG1–2 showed a higher AUC (0.680, 95% CI: 0.604‒0.756) than ycT0–1N0 (0.563, 95% CI: 0.481‒0.645) (P < 0.001).

Conclusion

mrTRG1–2 might be a better indicator than ycT0–1N0 for the selection of non-radical management of advanced rectal cancer post-CCRT. However, additional diagnostic tools are required for predicting ypT0–1N0 because mrTRG1–2 or yc stage on MRI has insufficient evidence for diagnosing ypT0–1N0.

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Data availability

The authors confirm that the data supporting the findings of this study are available within the article (and/or) its supplementary materials.

Code availability

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Authors and Affiliations

  1. Department of Surgery, Seoul National University Bundang Hospital, Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea

    In Jun Yang, Jung Wook Suh, Jeehye Lee, Hong-min Ahn, Heung-Kwon Oh, Duck-Woo Kim & Sung-Bum Kang

  2. Department of Surgery, Seoul National University Hospital, Seoul, Korea

    Min Jung Kim, Seung-Bum Ryoo, Seung-Yong Jeong & Kyu Joo Park

  3. Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Gyeonggi-do, Korea

    Dong Woon Lee, Sung-Chan Park, Hyung Chul Park & Jae Hwan Oh

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  1. In Jun Yang
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Contributions

Conceptualization and guided writing and performing study design: SBK, KJP, and JHO. Data collecting: HKO, DWK, MJK, SBR, SYJ, DWL, SCP, HCP, and HMA. Data analysis: JHL, JWS, and IJY. Data collecting and writing final manuscript: IJY.

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Correspondence to Sung-Bum Kang.

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Yang, I.J., Suh, J.W., Lee, J. et al. Comparison of tumor regression grade and clinical stage based on MRI image as a selection criterion for non-radical management after concurrent chemoradiotherapy in locally advanced rectal cancer: a multicenter, retrospective, cross-sectional study. Int J Colorectal Dis 37, 1561–1568 (2022). https://doi.org/10.1007/s00384-022-04193-9

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