Abstract
PurposeTo explore the clinical feasibility of predicting the efficacy of neoadjuvant chemoradiotherapy (nCRT) for rectal cancer on the basis of texture analysis (TA) of T2-weighted imaging (T2WI).MethodsThe cohort for this prospective study comprised 136 patients with rectal cancer to be treated with nCRT, all of whom underwent three MR scans (pre-, early, and post-nCRT). Treatment efficacy was assessed on the basis of the outcomes of pathologic complete response (pCR) and non-pCR as determined by postoperative pathological examination. Extraction and analysis of texture features in T2WI of defined tumor regions were performed by AK software. Pre- and early-nCRT texture features were selected as potential predictors of outcomes by logistic regression analysis, and a prediction model for pCR was developed. A receiver operating characteristic (ROC) curve was used to assess the predictive power of texture features in pre- and early-nCRT images.ResultsUnivariate logistic regression analysis demonstrated that the pre-nCRT features of energy, entropy, and skewness, and early-nCRT features of variance, kurtosis, energy, and entropy were independent predictors of pCR. A prediction model incorporating these predictors was constructed by multivariate logistic regression, The AUCs of pre-nCRT, early, and combined models were 0.751, 0.831, and 0.873, respectively; the sensitivities 66, 71, and 75%, respectively; and the specificities 87.22, 86.11, and 91.67%, respectively.ConclusionsTA of T2WI images can predict the efficacy of nCRT for rectal cancer, possibly providing a new marker of tumor biological response in clinical practice.
Highlights
Rectal cancer, one of the commonest malignant tumors of the digestive tract, has caused increasing morbidity in the past few years [1]
Our results show that texture analysis based on T2-weighted imaging (T2WI) images can predict sensitivity to neoadjuvant chemoradiotherapy (nCRT) of patients with rectal cancer
A combination of pre- and early-treatment texture features were identified as the best independent predictors for distinguishing between the pathologic complete response (pCR) and non-pCR groups, potentially enabling adjustment of treatment and timely planning
Summary
One of the commonest malignant tumors of the digestive tract, has caused increasing morbidity in the past few years [1]. Its treatment outcomes have been significantly improved by neoadjuvant chemoradiotherapy (nCRT) [2], which can result in pathological complete remission (pCR) [3]. It greatly reduces rates of local recurrence and distant metastasis of rectal cancer [4]. American cancer network guidelines state that concurrent preoperative nCRT and not surgical treatment alone should be the first choice for advanced rectal cancer [5]. There are significant individual variations in response to preoperative nCRT, and ineffective treatment may result in unjustified toxicity and a delay in more effective treatment [6, 7]. Early identification (before treatment or 2–3 weeks after starting nCRT) of patients who may benefit from nCRT is vital [8]
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