Staging Of Rectal Cancer Research Articles

Study on the Application of 1.5T Magnetic Resonance Imaging Image Fusion in the Staging of Rectal Cancer

Rectal cancer is a common gastric testicular malignancy, and surgical resection is the most effective treatment. The depth of local tumour filtration, lymph node metastasis and distant metastasis are all factors that influence the prognosis of rectal cancer surgery. MRI has the advantages of high-resolution, multidirectional, multi-angle, multiparameter imaging and zero radiation in soft tissue, so you can estimate the depth of tumour filtration and lymph node metastasis more accurately than ultrasound or CT. Today, it is a standard method for pre-operative imaging of rectal cancer. In this study, patients with rectal cancer have been studied from May 2020 to May 2021. 75 Patients were scanned at an arrow-shaped position and cross-sectional images, which are strictly vertical to the rectal wall, were designed after improvement at tumour level. The position of the coronal image is strictly vertical to the horizontal position. In this way, partial volume effects can be avoided and the depth of tumour filtration accurately evaluated. This helps surgeons determine the horizontal position of the tumor based on MRI images. To avoid the volume effect, the cross-section line must be vertical to the tumour axis. This study shows that in T3 tumours it is particularly important to measure the minimum level between the tumour and the rectal mesioma phase. The histology of the resected samples showed that if the distance between the tumor and the rectal mestrincular fascia exceeds 1 mm, the frequency of local recurrence is greatly reduced. If the distance between the tumor and the rectal mesiole fascia is less than 1 mm, the risk of local recurrence is greatly increased. Therefore, tumours with a straight mesosis of 1 mm or less margin-positive are called.

Correlation Among the Expression, Clinical Significance and Prognosis of DJ-1 and Runt-Related Transcription Factor 3 in Rectal Cancer

This study explored the correlation among the expression, clinical significance, and prognosis of DJ-1 and RUNX3 in rectal cancer. Eighty-five cases of resected rectal cancer tissue were obtained from patients treated from June 2014 to June 2015. The expression ofDJ-1 and RUNX3 mRNA was detected by reverse transcription-polymerase chain reaction (RT-PCR), and the expression of DJ-1 and RUNX3 protein was detected by immunohistochemistry. Their relationship to the clinicopathological features of the tumor was also analyzed. The correlation between the two proteins and survival prognosis [5-year disease-free survival(DFS)] was analyzed. RT-PCR results showed that the DJ-1 mRNA expression of cancer tissue increased, whereas that of RUNX3 decreased. Immunohistochemical results showed that the positive rate of DJ-1 protein of cancer tissue increased (69.41% vs. 21.18%), whereas that of RUNX3 decreased (40.00% vs. 77.65%). The positive expression of DJ-1 and RUNX3 was highly related to the cTNM staging of rectal cancer. Correlation analysis results showed a negative correlation between the genes in rectal cancer tissue. The follow-up records showed 5-year DFS data as follows: 50.00% for the DJ-1+/RUNX3− group, 57.14% for the DJ-1−/RUNX3− group, 71.43% for the DJ-1+/RUNX3+ group, and 82.50% for the DJ-1−/RUNX3+ group, suggesting that the 5-year DFS of the DJ-1+ group was lower, whereas that of the RUNX3+ group was higher. These results indicated that DJ-1 and RUNX3 were related to the occurrence, development, and progression of rectal cancer. Interestingly, there was a significant negative correlation between the genes, which was important for the treatment and prognosis of rectal cancer.

High expression of CD34 protein in stage IIA rectal cancer is independently associated with better prognosis

Abstract Objective Colorectal cancer (CRC) remains the third most common cause of death from malignancies, while 30% of all these tumors develop in the rectum. The proximity of the rectum to vital structures, and in some cases the use of neoadjuvant treatment, make the surgical resection of this tumor a great challenge even for highly qualified surgeons. Understanding the mechanisms of rectal cancer (RC) development could lead to new concepts in the approach of diagnosis, prognosis, and eventually treatment of this disease. Despite the fact that TNM classification represents the gold standard tool for the staging of RC, a significant number of studies has recently focused on the association between the tumor microenvironment and RC. CD34 is a transmembrane phosphoglycoprotein expressed on human hematopoietic progenitor and vascular endothelial cells, as well in malignant tissues. It has also been shown to be involved in tumor invasion and angiogenesis. Because of the controversial data , we examined the expression of CD34 protein in RC specimens after stratifying the patients according to their UICC stage. Methods In our retrospective study, we included 364 patients with unselected, clinically annotated primary RC specimens. We analyzed a tissue microarray (TMA) of these specimens by immunohistochemistry (IHC) for the expression of CD34 protein by tumor cells. Results After stratifying the patients in nodal negative and positive groups, we found that the patients with Stage IIA tumors and high expression of CD34 protein had a favorable 5-year overall survival rate (53%; 95%CI = 40.0 – 65.1%) compared to tumors without expression of CD34 protein (26%; 95%CI = 10.7 – 44.6%, p = 0.003). Univariate and multivariate Hazard Cox regression survival analysis revealed that the combined the expression of CD34 protein was an independent, favorable, prognostic marker for overall survival in the stage IIA RC (HR = 0.39, 95%CI = 0.19 – 0.79; p = 0.009). Conclusion Our data show that the expression of CD34 protein represents an independent, favorable, prognostic condition in nodal negative stage IIA RC. Thereby, we provide novel insights into the prognostic role of the tumor microenvironment in RC that might help in the development of novel treatment modalities by its modification.

Detailed incidence and mortality trends of early-onset colorectal cancer in Canada.

e15539 Background: There has been a consistent increase in the incidence of early-onset colorectal cancer (eoCRC), under the age of 50, in Canada since the late 1990s. Questions remain surrounding how these trends vary by topography, histology, and stage, and related trends with CRC-specific mortality. Methods: CRC incidence data were obtained from the Canadian Cancer Registry and CRC-specific mortality data from the Canadian Vital Statistics – Death Database for the years 2000 to 2017. Age-specific average annual percent changes (AAPC) in the incidence (by topography and histology) and mortality rates of CRC were estimated using the National Cancer Institute’s Joinpoint Regression Program. To determine age-specific differences (5-year age groups) in CRC diagnosis at late stage (III and IV) for years 2011 to 2017 combined, a logistic regression model adjusting for sex with the 50-54 age group as the referent was conducted. Results: AAPCs and 95% confidence intervals in the rates of incidence (topography and histology) and mortality of eoCRC from 2000 to 2017 in Canada are presented in Table. Different trends in topography were observed across sexes with the largest increases in the distal colon (splenic flexure, descending, and sigmoid) and rectum among males and rectum only among females. Significant increases were observed for non-mucinous adenocarcinomas, while significant decreases were observed for mucinous adenocarcinomas among the 40-49 age group. Compared to the 50-54 age group, only the 45-49 group had a significantly higher odds of developing late-stage colon cancer, while men and adults 25-49 had a higher odds of developing late stage rectal cancer. Despite increases in the incidence of eoCRC there has only been a significant increase in mortality for men aged 20-39. Trends in mortality vary by site, with significant decreases observed for colon cancer-specific mortality among the 40-49 age group and increases in rectal cancer-specific mortality for adults aged 20-49. Conclusions: These results indicate that the largest increases in incidence and mortality for eoCRC have occurred in the rectum and trends have varied by sex. Further research on the etiology and treatment outcomes of eoCRC patients are warranted for this patient population.[Table: see text]

CCTG CO.28 primary endpoint analysis: Neoadjuvant chemotherapy, excision and observation for early rectal cancer, the NEO trial.

3508 Background: CO.28 (NCT03259035) is a phase II study designed to determine if patients with cT1-T3a/bN0 rectal cancer can be treated with induction chemotherapy (FOLFOX/CAPOX) and organ-preserving surgery. Methods: Patients with MRI staged cT1-3a/bN0 tumors and no pathologic (p) high risk features received 6/4 cycles of FOLFOX/CAPOX, repeat sigmoidoscopy/pelvic MRI and subsequent Transanal Endoscopic Surgery (TES) in the absence of tumor progression. ypT0/T1N0 tumors were treated with observation while ypT2+ or ypN+ stage were recommended Total Mesorectal Excision (TME). The primary endpoint was protocol specified Organ Preservation Rate (psOPR = ypT0/T1N0, no p high risk features) and actual Organ Preservation Rate (aOPR = ypT0/T1N0 stage plus higher yp stage patients who declined TME surgery). The study would be considered negative with an psOPR of 50% or lower (H0) and as promising if it is 65% or higher (H1). Results: Between 08/2017 to 05/2020, 58 eligible patients were accrued in Canada and the United States, median age was 67 years, 71% male. All had well-moderately differentiated, non-mucinous rectal adenocarcinoma and median tumor height was 6 cm (range 0-18). Median follow-up was 15.4 months. Chemotherapy with FOLFOX (32) or CAPOX (26) was administered, 90% completed all planned cycles. A total of 56/58 (97%) proceeded to TES, while one patient was ineligible due to tumor progression (1.7%) and one declined. In the intention to treat analysis, the psOPR was 57% (95% CI 43-70%) while the aOPR was 79% (95% CI 67% to 89%) due to 13/23 declining recommended TME surgery. Of 10 patients who proceeded to recommended TME, a complete R0 TME was performed in 9/10, and no p residual carcinoma was found in 7/10. Crude loco-regional (LR) and distant recurrence rates were 3.5% (95% CI 0.4 to 12%) and 0%, respectively. A recurrence occurred in 1/13 patients who initially declined TME surgery. Conclusions: In select patients with early stage rectal cancer, three months of induction CAPOX/FOLFOX followed by TES resulted in a high OPR without the use of pelvic irradiation. The observed high rate of pathologic downstaging may point to high chemo-responsiveness in early rectal adenocarcinoma with no p high risk features. Further trials to evaluate this approach are justified and updated results will be presented. Clinical trial information: NCT03259035. [Table: see text]

Sex disparities in vitamin D status and the impact on systemic inflammation and survival in rectal cancer

BackgroundWe reported previously that rectal cancer patients given curative-intent chemotherapy, radiation, and surgery for non-metastatic disease had enhanced risk of metastatic progression and death if circulating levels of 25-hydroxyvitamin D [25(OH) D] were low. Here we investigated whether the association between the vitamin D status and prognosis pertains to the general, unselected population of rectal cancer patients.MethodsSerum 25(OH) D at the time of diagnosis was assessed in 129 patients, enrolled 2013–2017 and representing the entire range of rectal cancer stages, and analyzed with respect to season, sex, systemic inflammation, and survival.ResultsIn the population-based cohort residing at latitude 60°N, 25(OH) D varied according to season in men only, who were overrepresented among the vitamin D-deficient (< 50 nmol/L) patients. Consistent with our previous findings, the individuals presenting with T4 disease had significantly reduced 25(OH) D levels. Low vitamin D was associated with systemic inflammation, albeit with distinct modes of presentation. While men with low vitamin D showed circulating markers typical for the systemic inflammatory response (e.g., elevated erythrocyte sedimentation rate), the corresponding female patients had elevated serum levels of interleukin-6 and the chemokine (C-X-C motif) ligand 7. Despite disparities in vitamin D status and the potential effects on disease attributes, significantly shortened cancer-specific survival was observed in vitamin D-deficient patients irrespective of sex.ConclusionThis unselected rectal cancer cohort confirmed the interconnection of low vitamin D, more advanced disease presentation, and poor survival, and further suggested it may be conditional on disparate modes of adverse systemic inflammation in men and women.Trial registrationClinicalTrials.govNCT01816607; registration date: 22 March 2013.

Expert's advice on the surgical clinical application of rectal cancer staging recognition system based on artificial intelligence platform (2020 edition)

At present, preoperative assessment of rectal cancer stage mainly relies on imaging examination, and the results of imaging reading will directly determine the treatment. In order to alleviate the reading pressure of the radiologist and improve the efficiency and accuracy of imaging diagnosis, there are related studies on using artificial intelligence automatic recognition system to assist the imaging assessment of rectal cancer staging now. Colorectal Surgery Group, Chinese Society of Surgery of the Chinese Medical Association, along with Beihang University, proposed the expert's advice on the surgical clinical application of rectal cancer staging recognition system based on artificial intelligence platform, so as to guide the standard application of this technology and promote the automation and intelligence of imaging reading.

Accuracy of High Resolution Multidetector Computed Tomography in the Local Staging of Rectal Cancer

Abstract Background Magnetic resonance imaging (MRI) is the gold standard for local staging of rectal cancer. Advanced computed tomography (CT) machines are now capable of high-resolution images of rectal cancer and utilized for CT perfusion. The possibility of local staging of rectal cancer by CT needs to be explored. Purpose The aim of the study is to evaluate accuracy of high-resolution CT for local rectal cancer staging. Methods A high-resolution CT was performed for local staging of rectal cancer in our study group of 93 patients, where 64 underwent primary surgery and 29 underwent surgery post neoadjuvant chemoradiotherapy (NACRT). Results In differentiating stages T2-and-less than T2 from T3–T4 rectal cancer, accuracy, sensitivity, specificity, and kappa score in overall patients were 91%, 87%, 94%, and 0.8; in primary surgery group were 89%, 76%, 94%, and 0.7; in NACRT group were 97%, 100%, 94%, and 0.9; in low rectal group were 94%, 89%, 97%, and 0.82, respectively. Conclusion High resolution CT is an accurate tool for local staging of rectal cancer.

Structured Reporting of Rectal Cancer Staging and Restaging: A Consensus Proposal.

Simple SummaryStructured reporting in oncologic imaging is becoming necessary and has recently been recognized by major scientific societies. Structured reports collect all Patient Clinical Data, Clinical Evaluations and relevant key findings of Rectal Cancer, both in staging and restaging, and can facilitate clinical decision-making.Background: Structured reporting (SR) in oncologic imaging is becoming necessary and has recently been recognized by major scientific societies. The aim of this study was to build MRI-based structured reports for rectal cancer (RC) staging and restaging in order to provide clinicians all critical tumor information. Materials and Methods: A panel of radiologist experts in abdominal imaging, called the members of the Italian Society of Medical and Interventional Radiology, was established. The modified Delphi process was used to build the SR and to assess the level of agreement in all sections. The Cronbach’s alpha (Cα) correlation coefficient was used to assess the internal consistency of each section and to measure the quality analysis according to the average inter-item correlation. The intraclass correlation coefficient (ICC) was also evaluated. Results: After the second Delphi round of the SR RC staging, the panelists’ single scores and sum of scores were 3.8 (range 2–4) and 169, and the SR RC restaging panelists’ single scores and sum of scores were 3.7 (range 2–4) and 148, respectively. The Cα correlation coefficient was 0.79 for SR staging and 0.81 for SR restaging. The ICCs for the SR RC staging and restaging were 0.78 (p < 0.01) and 0.82 (p < 0.01), respectively. The final SR version was built and included 53 items for RC staging and 50 items for RC restaging. Conclusions: The final version of the structured reports of MRI-based RC staging and restaging should be a helpful and promising tool for clinicians in managing cancer patients properly. Structured reports collect all Patient Clinical Data, Clinical Evaluations and relevant key findings of Rectal Cancer, both in staging and restaging, and can facilitate clinical decision-making.

Temporal improvements noted in life expectancy of patients with colorectal cancer; a Dutch population-based study

ObjectiveSpecific survival estimates are needed for the increasing number of colorectal cancer (CRC) survivors. The aim of this population-based study was to determine conditional loss in expectation of life (LEL) due to CRC. Study Design and SettingAll surgically treated patients with CRC registered in the Netherlands Cancer Registry with stage I–III between 1990–2016, were included (N = 203,216). Estimates of conditional LEL were predicted using flexible parametric models and the total life years lost due to cancer were estimated. ResultsLEL decreased with older age and patients with rectal cancer or higher disease stage had highest LEL. In 2010, LEL for sixty-year old male and female patients was 2 vs. 2, 4 vs. 4, and 7 vs. 8 years for colon cancer, and 2 vs. 2, 4 vs. 5 and 7 vs. 8 years for rectal cancer, respectively. Conditional LEL in patients with CRC decreased during follow-up. Patients with combined stage I–III colon and rectal cancer in 2010 lost an estimated 18,628 and 11,336 life years. ConclusionThis study quantified the impact of CRC on patient's life expectancy, both on individual and population level and demonstrated temporal improvements in CRC survival. These results provide meaningful information that can be used during follow-up.

Histogram Analysis of Diffusion-Weighted Magnetic Resonance Imaging as a Biomarker to Predict Lymph Node Metastasis in T3 Stage Rectal Carcinoma.

PurposeThis study investigated the predictive value of apparent diffusion coefficient (ADC) histogram parameters of the primary tumor for regional lymph node metastasis (LNM) in pathological T3 stage rectal cancer.Patients and MethodsWe retrospectively studied 175 patients with T3 stage rectal cancer who underwent preoperative MRI, including diffusion-weighted imaging, between January 2015 and October 2017. Based on pathological analysis of surgical specimens, 113 patients were classified into the LN− group and 62 in the LN+ group. We analyzed clinical data, radiological characteristics and histogram parameters derived from ADC maps. Then, receiver operating characteristic curve (ROC) analyses were generated to determine the best diagnostic performance.ResultsThe mean (p=0.002, cutoff=1.08×10–3 s/mm2), coefficient of variation (CV) (p=0.040, cutoff=0.249) of the ADC map, carbohydrate antigen 199, and N stage with magnetic resonance (mrN stage) were independent factors for LNM. Combining these factors yielded the best diagnostic performance, with the area under the ROC curve of 0.838, 72.9% sensitivity, 79.1% specificity, 65.2% positive predictive value, and 84.5% negative predictive value.ConclusionWith the mean >1.08×10–3 s/mm2 and CV <0.249, the ADC improved the diagnostic performance of LNM in T3 stage rectal cancer, which could assist surgeons with neoadjuvant chemoradiotherapy.

Relationship between inferior mesenteric artery diameter and rectal cancer.

A dilated inferior mesenteric vein has been reported in rectal cancer patients. However, no study has yet reported inferior mesenteric artery (IMA) enlargement in rectal cancer. We aimed to assess the relationship between the IMA diameter and rectal cancer. Patients diagnosed with rectal cancer and a control group of 42 patients in our hospital from July 2017 to June 2019 were evaluated. The IMA diameter was independently measured by two observers on axial computed tomography images. The mean IMA diameter was wider in rectal cancer patients (2.49 ±0.53 mm) than in the control group (2.20 ±0.47 mm, p < 0.001). The IMA diameter of patients with stage I, stage II, stage III, and stage IV cancers was 2.24 ±0.36 mm, 2.45 ±0.39 mm, 2.80 ±0.55 mm, and 2.85 ±0.51 mm, respectively (p < 0.001). The IMA diameter correlated positively and moderately with TNM stage (r = 0.519, p < 0.001). The IMA diameter of patients with T1, T2, T3, and T4 tumors was 2.18 ±0.31 mm, 2.39 ±0.50 mm, 2.55 ±0.48 mm, and 2.73 ±0.51 mm, respectively (p < 0.001). The IMA diameter also correlated positively and moderately with T stage (r = 0.457, p < 0.001). The IMA diameter of patients with N0, N1, and N2 tumors was 2.37 ±0.39 mm, 2.83 ±0.60 mm, and 2.71 ±0.40 mm, respectively (p < 0.001); however, the IMA diameter did not correlate with N stage (r = 0.166, p = 0.077). Patients with M1 tumors had a wider IMA diameter than patients with M0 tumors (p = 0.011). The IMA in rectal cancer patients enlarges as the TNM stage gets higher. The IMA diameter can be accepted as a possibly important marker for the staging of rectal cancer.

Robotic Transanal Surgery: A Novel Approach for Full-Thickness Rectal Excision.

Transanal excision of rectal lesions is a full thickness excision that is indicated in selected cases of early stage rectal cancer and in cases that have shown a major or complete clinical response after neoadjuvant chemoradiation. Complete clinical response includes also flat scar or teleangiectasia along with non palpable mass at digital exam and non visible lymphnodes at MRI.1 Full thickness excision is considered primarily as a radical excisionaI biopsy and it has the advantage (vs watch and wait approach) to provide a hystologic confirmation of the complete response. The excision of the tumor/scar and the suture of the rectal defect are technically demanding if performed with standard laparoscopic instruments because of the narrow working space. In order to overcome these difficulties we propose to use the daVinci® robotic platform. The robotic instruments are fully articulated at their tip and they allow the surgeon to easily operate within the lumen of the rectum and perform wrist like movements despite the narrow surgical space. The one limitation is represented by the cost of these procedures, so they should be reserved to selected, challenging cases (i.e. lesions of the mid-upper rectum and lesions that require extensive suture). The patients are either in lithotomy or prone position, depending on the site of the lesion. A gelpoint® system is inserted transanally in order to place the robotic trocars and the daVinci® system is then connected. The purpose of this video is to show the many advantages of the robotic platform in performing full thickness excisions and how the wrist like movements allow to perform transversal sutures thus minimizing the risk of stenosis of the rectum. See Video at http://links.lww.com/DCR/B515 .

18F FDG PET/MRI with hepatocyte-specific contrast agent for M staging of rectal cancer: a primary economic evaluation

PurposeRectal cancer is one of the most frequent causes of cancer-related morbidity and mortality in the world. Correct identification of the TNM state in primary staging of rectal cancer has critical implications on patient management. Initial evaluations revealed a high sensitivity and specificity for whole-body PET/MRI in the detection of metastases allowing for metastasis-directed therapy regimens. Nevertheless, its cost-effectiveness compared with that of standard-of-care imaging (SCI) using pelvic MRI + chest and abdominopelvic CT is yet to be investigated. Therefore, the aim of this study was to analyze the cost-effectiveness of whole-body 18F FDG PET/MRI as an alternative imaging method to standard diagnostic workup for initial staging of rectal cancer.MethodsFor estimation of quality-adjusted life years (QALYs) and lifetime costs of diagnostic modalities, a decision model including whole-body 18F FDG PET/MRI with a hepatocyte-specific contrast agent and pelvic MRI + chest and abdominopelvic CT was created based on Markov simulations. For obtaining model input parameters, review of recent literature was performed. Willingness to pay (WTP) was set to $100,000/QALY. Deterministic sensitivity analysis of diagnostic parameters and costs was applied, and probabilistic sensitivity was determined using Monte Carlo modeling.ResultsIn the base-case scenario, the strategy whole-body 18F FDG PET/MRI resulted in total costs of $52,186 whereas total costs of SCI were at $51,672. Whole-body 18F FDG PET/MRI resulted in an expected effectiveness of 3.542 QALYs versus 3.535 QALYs for SCI. This resulted in an incremental cost-effectiveness ratio of $70,291 per QALY for PET/MRI. Thus, from an economic point of view, whole-body 18F FDG PET/MRI was identified as an adequate diagnostic alternative to SCI with high robustness of results to variation of input parameters.ConclusionBased on the results of the analysis, use of whole-body 18F FDG PET/MRI was identified as a feasible diagnostic strategy for initial staging of rectal cancer from a cost-effectiveness perspective.

Metastatic lymph node calcification in rectal cancer: comparison of CT and high-resolution MRI.

Calcification causes mixed signal intensity in the lymph node (LN) on high-resolution magnetic resonance imaging (MRI), which is a strong indicator of regional LN metastasis in rectal cancer. Calcified metastatic LNs in rectal cancer commonly display scattered fine punctate calcifications to varying degrees on computed tomography (CT). On high-resolution MRI, the calcifications manifest a patchy area of signal loss in corresponding calcified area that is larger than on CT. It is necessary to recognize the appearance of metastatic LN calcifications on high-resolution MRI in rectal cancer because it is the primary imaging method for local staging in rectal cancer. This pictorial essay aims to introduce an important imaging finding that can contribute to the diagnosis of LN metastasis by illustrating features and differences between CT and high-resolution MRI of metastatic LN calcifications in rectal cancer.

Preliminary Study on Predicting Pathological Staging and Immunohistochemical Markers of Rectal Cancer Based on ADC Histogram Analysis

To analyze the correlation between histogram parameters of ADC and pathological staging of rectal cancer and CD31, CD2-40, S-100, and to explore its predictive value. MRI findings of 60 patients with surgically and pathologically proved rectal cancer were analyzed retrospectively. Patients were divided into pT1-2, pT3-4, pN0, pN1-2, G1-2 and G3 groups according to TNM staging of UICC tumors (2019) and WHO classification of digestive system tumors (2019). Cases were divided into CD31 (+) and CD31 (-), CD2-40 (+) and CD4-20 (-), S-100 (+) and S-100 (-) groups according to the expression of immunohistochemical markers. The ROI was delineated layer by layer on the ADC images by Firevoxel software, and the histogram parameters were extracted. The histogram parameters (ADC mean, ADC minimum, ADC maximum, ADC mode, ADC quartile), skewness, kurtosis and entropy were compared between each group. The bivariate logistic regression model was used to predict the tumor staging and immunohistochemical results. 1. ADC10th, ADC mean and Entropy were higher than pT3-4, ADC mean was higher than pT1-2, Entropy was lower than pT1-2, ADC10th, ADC25th, ADC50th, ADC mean and ADC mode were lower than pT3-40 (-) in CD2-40 (+) group, and the difference was statistically significant (p < 0.05); 2. The lower area of the curve (AUC) of rectal cancer pT, pN and CD2-40 (+) is 0.952 (0.892-1.000), 0.882 (0.791-0.972), 0.913 (0.840-0.985); 3. In the logistic regression model, higher ADC, Ropy and higher pN stages are independent predictors of tumor pT stages (OR = 1.156, 1.144,111.528); p = 0.045, 0.048, 0.002); higher Ropy and lower pT stages are independent predictors of tumor pN stages in the model (OR = 73.939, 0.024; p = 0.019, 0.001); higher ADC and lower differentiation are independent predictors of tumor CD2-40 stages in the model (ADC = 1.17, 0.048, 0.011); and higher Ropy and lower pT stages are independent predictors of tumor CD2-40 stages in the model (ADC = 1.096, 0.094, 0.044). Histogram analysis based on ADC images has potential value in predicting the pathologic stage and immunohistochemical markers of rectal cancer, and logistic regression model has better diagnostic efficacy than single parameter.

MRI associated biomarker analysis for diagnosis of lymph node metastasis in T1-2 stage rectal cancer

Objective: To explore the diagnostic accuracy improved by magnetic resonance imaging (MRI) biomarkers for lymph node metastasis in T1-2 stage rectal cancer before treatment. Methods: Medical records of 327 patients with T1-2 rectal cancer who underwent pretreatment MRI and rectal tumor resection between January 2015 and November 2019 were retrospectively analyzed. Fifty-seven cases were divided into the lymph node metastasis group (N+ group) while other 270 cases in the non-lymph node metastasis group (N-group) according to the pathologic diagnosis. Two radiologist evaluated the tumor characteristics of MRI images. The relationship of the clinical and imaging characteristics of lymph node metastasis was assessed by using univariate analysis and multivariable logistic regression analysis. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic abilities for the differentiation of N- from N+ tumors. Results: Among the 327 patients, MR-N evaluation was positive in 67 cases, which was statistically different from the pathological diagnosis (P<0.001). The sensitivity, specificity and accuracy of MRI for lymph node metastasis were 45.6%, 84.8% and 78.0%, respectively. Multivariate regression analysis showed that tumor morphology (P=0.002), including mucus or not (P<0.001), and MR-N evaluation (P<0.001) were independent influencing factors for stage T1-2 rectal cancer with lymph node metastasis. The area under the ROC curve of rectal cancer with lymph node metastasis analyzed by the logistic regression model was 0.786 (95%CI: 0.720~0.852). Conclusions: Tumor morphology, including mucus or not, and MR-N evaluation can serve as independent biomarkers for differentiation of N- and N+ tumors. The model combined with these biomarkers facilitates to improve the diagnostic accuracy of lymph node metastasis in T1-2 rectal cancers by using MRI.

Endorectal Ultrasound and Magnetic Resonance Imaging for Rectal Cancer Staging: A Modern Multimodality Approach

Preoperative staging represents a crucial point for the management, type of surgery, and candidacy for neoadjuvant therapy in patient with rectal cancer. The most recent clinical guidelines in oncology recommend an accurate preoperative evaluation in order to address early and advanced tumors to different therapeutic options. In particular, potential pitfalls may occur in the assessment of T3 tumors, which represents the most common stage at diagnosis. The depth of tumor invasion is known to be an important prognostic factor in rectal carcinoma; as a consequence, the T3 imaging classification has a substantial importance for treatment strategy and patient survival. However, the differentiation between tumor invasion of perirectal fat and mesorectal desmoplastic reactions remains a main goal for radiologists. Magnetic resonance imaging (MRI) is actually considered as the best imaging modality for rectal cancer staging. Although the endorectal ultrasound (ERUS) is the preferred staging method for early tumors, it could also be useful in identifying perirectal fat invasion. Moreover, the addiction of diffusion weighted imaging (DWI) improves the diagnostic performance of MRI in rectal cancer staging by adding functional information about rectal tumor and adjacent mesorectal tissues. This study investigated the diagnostic performance of conventional MRI alone, in combination with the DWI technique and ERUS in order to assess the best diagnostic imaging combination for rectal cancer staging.

Oncological outcome after local treatment for early stage rectal cancer

BackgroundTreatment of early rectal cancer is evolving towards organ-preserving therapy which includes endoscopic resection and transanal approaches. We aimed to explore the role of local treatments such as endoscopic polypectomy (Endoscopic Mucosal Resection (EMR) or Endoscopic submucosal dissection (ESD)) and transanal endoscopic microsurgery/ transanal minimal invasive surgery (TEM/TAMIS) in patients who had early rectal cancer. We considered these outcomes alongside conventional major surgery using total mesorectal excision (TME) for early stage disease.MethodsAll patients identified at MDT with early stage rectal cancer at our institution between 2010 and 2019 were included. Long-term outcomes in terms of local recurrence, survival and procedure-specific morbidity were analysed.ResultsIn total, 536 patients with rectal cancer were identified, of which 112 were included based on their pre-operative identification at the MDT on the basis that they had node-negative early rectal cancer. Among these, 30 patients (27%) had the lesion excised by flexible endoscopic polypectomy techniques (EMR/ESD), 67 (60%) underwent TEM/TAMIS and 15 (13%) had major surgery. There were no differences in patient demographics between the three groups except for TEM/TAMIS patients being more likely to be referred from another hospital (p < 0.001) and they were less active (WHO performance status p = 0.04). There were no significant differences in overall survival rates and cancer-specific survival between the three treatment groups. The 5-year overall survival rate for endoscopic polypectomy, TEM/TAMIS or major resection was 96% versus 90% and 88%, respectively (p = 0.89). The 5- year cancer-specific survival rate was 96%, versus 96% and 100%, respectively (p = 0.74).ConclusionEndoscopic polypectomy by EMR/ESD is an appropriate local treatment for early stage rectal cancer in selected patients. It is possible to achieve good oncological outcomes with a polypectomy similar to TEM/TAMIS and major surgery; however, a multidisciplinary approach is necessary enabling close surveillance and the use of adjuvant radiotherapy.

Injection of Carbon Nanoparticles for Lymph Node Detection After Laparoscopic Colorectal Cancer Surgery.

Colorectal cancer is the third most common cause of cancer-related death in the world because of its poor prognosis and many related complications. In clinical practice, lymph node metastasis is an important index to evaluate the recurrence and survival rate of patients with rectal cancer, it also the main method to determine the treatment plan of patients with rectal cancer. Nano carbon tracer can guide surgeons to clear regional lymph nodes accurately, improve the number of lymph nodes detected, and then improve the accuracy of pathological staging of rectal cancer. It has an important clinical significance in the removal of lymph nodes of middle and low rectal cancer, and provides an important basis for the development of postoperative adjuvant treatment plan. The purpose of this study is to explore the application value of this method in improving the detection rate of lymph nodes in laparoscopic colorectal cancer. According to the research results, the total number of lymphatic gland, the number of small lymphatic gland, the rate of lymph node metastasis, the number of black stained lymphatic gland and the number of lymphatic gland confirmed by pathology in the two groups were better than those in the traditional surgical treatment, which had better application value in the radical operation of colorectal cancer.