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Comparative Study
. 2017 Nov 7;117(10):1478-1485.
doi: 10.1038/bjc.2017.320. Epub 2017 Sep 21.

Comparison between MRI and pathology in the assessment of tumour regression grade in rectal cancer

Francesco Sclafani  1 , Gina Brown  2 , David Cunningham  1 , Andrew Wotherspoon  3 , Larissa Sena Teixeira Mendes  3 , Svetlana Balyasnikova  2 , Jessica Evans  2 , Clare Peckitt  4 , Ruwaida Begum  1 , Diana Tait  1 , Josep Tabernero  5 , Bengt Glimelius  6 , Susana Roselló  7 , Janet Thomas  1 , Jacqui Oates  1 , Ian Chau  1
Affiliations
Comparative Study

Comparison between MRI and pathology in the assessment of tumour regression grade in rectal cancer

Francesco Sclafani et al. Br J Cancer. .

Abstract

Background: Limited data exist regarding the correlation between MRI tumour regression grade (mrTRG) and pathological TRG (pTRG) in rectal cancer.

Methods: mrTRG and pTRG were compared in rectal cancer patients from two phase II trials (EXPERT and EXPERT-C). The agreement between radiologist and pathologist was assessed with the weighted κ test while the Kaplan-Meier method was used to estimate survival outcomes.

Results: One hundred ninety-one patients were included. Median time from completion of neoadjuvant treatment to pre-operative MRI and surgery was 4.1 weeks (interquartile range (IQR): 3.7-4.7) and 6.6 weeks (IQR: 5.9-7.6), respectively. Fair agreement was found between mrTRG and pTRG when regression was classified according to standard five-tier systems (κ=0.24) or modified three-tier systems (κ=0.25). Sensitivity and specificity of mrTRG 1-2 (complete/good radiological regression) for the prediction of pathological complete response was 74.4% (95% CI: 58.8-86.5) and 62.8% (95% CI: 54.5-70.6), respectively. Survival outcomes of patients with intermediate pathological regression (pTRG 2) were numerically better if complete/good regression was also observed on imaging (mrTRG 1-2) compared to poor regression (mrTRG 3-5) (5-year recurrence-free survival 76.9% vs 65.9%, P=0.18; 5-year overall survival 80.6% vs 68.8%, P=0.22).

Conclusions: The agreement between mrTRG and pTRG is low and mrTRG cannot be used as a surrogate of pTRG. Further studies are warranted to assess the ability of mrTRG to identify pathological complete responders for the adoption of non-operative management strategies and to provide complementary prognostic information to pTRG for better risk-stratification after surgery.

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Conflict of interest statement

DC received research funding from: Roche, Amgen, Celgene, Sanofi, Merck Serono, Novartis, AstraZeneca, Bayer, Merrimack and MedImmune. CP has had advisory roles with Sanofi. JT has had advisory roles with Amgen, Roche, Sanofi-Aventis, and Merck. IC has had advisory roles with Merck Serono, Roche, Sanofi Oncology, Bristol Myers Squibb, Eli-Lilly, Novartis, Gilead Science. He has received research funding from Merck-Serono, Novartis, Roche and Sanofi Oncology, and honoraria from Roche, Sanofi-Oncology, Eli-Lilly, Taiho. All other authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier curves for recurrence-free survival (A) and overall survival (B) by combining mrTRG and pTRG.
See this image and copyright information in PMC

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