Complementary value of pre-treatment apparent diffusion coefficient in rectal cancer for predicting tumor recurrence

PurposeTo assess the complementary prognostic value of pre-treatment tumor apparent diffusion coefficient (ADC) for the prediction of tumor recurrence in patients with rectal cancer.MethodsFrom March 2012 to March 2013, a total of 128 patients with mid/lower rectal cancer who underwent pre-treatment rectal MRI were enrolled in this retrospective study. Two radiologists in consensus evaluated conventional imaging features (Cimg) in pre-treatment rectal MRI: tumor height from anal verge (≤5 cm vs. >5 cm), T stage (high vs. low), the presence or absence of lymph node metastasis, mesorectal fascia invasion, and extramural venous invasion. The mean tumor ADC values (TumorADC) based on high b-value (0, 1000 × 10−3 mm2/s) diffusion weight images were extracted. A multivariate Cox proportional hazard (CPH) regression was performed to evaluate the association of Cimg and TumorADC with the 3-year local recurrence (LR) rate. Predictive performance of two multivariate CPH models (Cimg only vs. Cimg + TumorADC) was compared using Harrell’s c index (HCI).ResultsTumorADC (Adjusted HR, 7.830; 95% CI 3.937–15.571) and high T stage (Adjusted HR, 8.039; 95% CI 2.405–26.874) were independently associated with the 3-year LR rate. The CPH model generated with T stage + TumorADC (HCI, 0.820; 95% CI 0.708–0.932) showed significantly higher HCI than that with T stage only (HCI, 0.742; 95% CI 0.594–0.889) (P = 0.009).ConclusionsIn patients with mid/lower rectal cancer, integrating TumorADC to Cimg increases predictive performance of the CPH model than that with Cimg alone for the prediction of LR within 3 years after surgery.

[1]  G. Beets,et al.  Diffusion‐weighted MRI in rectal cancer: Apparent diffusion coefficient as a potential noninvasive marker of tumor aggressiveness , 2012, Journal of magnetic resonance imaging : JMRI.

[2]  Gina Brown,et al.  Preoperative magnetic resonance imaging assessment of circumferential resection margin predicts disease-free survival and local recurrence: 5-year follow-up results of the MERCURY study. , 2014, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[3]  Myeong-Jin Kim,et al.  High-resolution MR imaging for nodal staging in rectal cancer: are there any criteria in addition to the size? , 2004, European journal of radiology.

[4]  K. Haustermans,et al.  Diffusion-Weighted MRI for Selection of Complete Responders After Chemoradiation for Locally Advanced Rectal Cancer: A Multicenter Study , 2011, Annals of Surgical Oncology.

[5]  Myeong-Jin Kim,et al.  MRI-detected extramural vascular invasion is an independent prognostic factor for synchronous metastasis in patients with rectal cancer , 2015, European Radiology.

[6]  N. deSouza,et al.  A literature review of the association between diffusion-weighted MRI derived apparent diffusion coefficient and tumour aggressiveness in pelvic cancer. , 2015, Cancer treatment reviews.

[7]  Derya Yakar,et al.  Complementary Prognostic Value of Pelvic Magnetic Resonance Imaging and Whole-Body Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Pretreatment Assessment of Patients With Cervical Cancer , 2015, International Journal of Gynecologic Cancer.

[8]  Osama Mawlawi,et al.  Stage III Non-Small Cell Lung Cancer: Prognostic Value of FDG PET Quantitative Imaging Features Combined with Clinical Prognostic Factors. , 2016, Radiology.

[9]  M. Minami,et al.  Diffusion-weighted imaging findings of mucinous carcinoma arising in the ano-rectal region: comparison of apparent diffusion coefficient with that of tubular adenocarcinoma , 2012, Japanese Journal of Radiology.

[10]  S. Galimberti,et al.  Locally advanced rectal cancer: value of ADC mapping in prediction of tumor response to radiochemotherapy. , 2013, European journal of radiology.

[11]  Q. Chan,et al.  Quantitative Assessment of Diffusion-Weighted MR Imaging in Patients with Primary Rectal Cancer: Correlation with FDG-PET/CT , 2010, Molecular Imaging and Biology.

[12]  M. Weiser,et al.  Does gadolinium-based contrast material improve diagnostic accuracy of local invasion in rectal cancer MRI? A multireader study. , 2015, AJR. American journal of roentgenology.

[13]  Rui Bi,et al.  Apparent Diffusion Coefficient (ADC) Value: A Potential Imaging Biomarker That Reflects the Biological Features of Rectal Cancer , 2014, PloS one.

[14]  B. Stieltjes,et al.  The role of perfusion effects in monitoring of chemoradiotherapy of rectal carcinoma using diffusion-weighted imaging , 2013, Cancer imaging : the official publication of the International Cancer Imaging Society.

[15]  Roger Newson,et al.  Comparing the Predictive Powers of Survival Models Using Harrell's C or Somers’ D , 2010 .

[16]  G. Choi,et al.  Locally advanced rectal cancer: post-chemoradiotherapy ADC histogram analysis for predicting a complete response , 2015, Acta radiologica.

[17]  L. Guerra,et al.  Response to neoadjuvant therapy in locally advanced rectal cancer: assessment with diffusion-weighted MR imaging and 18FDG PET/CT , 2012, Abdominal Imaging.

[18]  B. van Calster,et al.  Integrating pretreatment diffusion weighted MRI into a multivariable prognostic model for head and neck squamous cell carcinoma. , 2014, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[19]  F. Giganti,et al.  Prognostic Role of Diffusion-weighted MR Imaging for Resectable Gastric Cancer. , 2015, Radiology.

[20]  Lei Tang,et al.  Locally advanced rectal carcinoma treated with preoperative chemotherapy and radiation therapy: preliminary analysis of diffusion-weighted MR imaging for early detection of tumor histopathologic downstaging. , 2010, Radiology.

[21]  M. Miyazaki,et al.  Prognostic relevance of apparent diffusion coefficient obtained by diffusion‐weighted MRI in pancreatic cancer , 2015, Journal of magnetic resonance imaging : JMRI.

[22]  Y. Mao,et al.  Prognostic value of the primary lesion apparent diffusion coefficient (ADC) in nasopharyngeal carcinoma: a retrospective study of 541 cases , 2015, Scientific Reports.

[23]  A. Crucitti,et al.  Diffusion-weighted magnetic resonance imaging in monitoring rectal cancer response to neoadjuvant chemoradiotherapy. , 2012, International journal of radiation oncology, biology, physics.

[24]  Caroline Reinhold,et al.  The use of MR imaging in treatment planning for patients with rectal carcinoma: have you checked the "DISTANCE"? , 2013, Radiology.

[25]  Markus Abt,et al.  Capecitabine as adjuvant treatment for stage III colon cancer. , 2005, The New England journal of medicine.

[26]  Stuart A. Taylor,et al.  Magnetic resonance imaging for the clinical management of rectal cancer patients: recommendations from the 2012 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting , 2018, European Radiology.

[27]  R. Newcombe,et al.  Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. , 2003, Radiology.

[28]  Hao Wang,et al.  Effectiveness of the Apparent Diffusion Coefficient for Predicting the Response to Chemoradiation Therapy in Locally Advanced Rectal Cancer , 2015, Medicine.

[29]  M. Harisinghani,et al.  Apparent diffusion coefficient as a non-invasive predictor of treatment response and recurrence in locally advanced rectal cancer. , 2013, Clinical radiology.

[30]  Gina Brown,et al.  MRI for detection of extramural vascular invasion in rectal cancer. , 2008, AJR. American journal of roentgenology.

[31]  R. Newson.  Comparing the predictive power of survival models using Harrell ’ s c or , 2010 .

[32]  Jae Young Lee,et al.  Locally advanced rectal cancer: added value of diffusion-weighted MR imaging in the evaluation of tumor response to neoadjuvant chemo- and radiation therapy. , 2009, Radiology.

[33]  K. Miyazaki,et al.  Assessment of aggressiveness of rectal cancer using 3-T MRI: correlation between the apparent diffusion coefficient as a potential imaging biomarker and histologic prognostic factors , 2014, Acta radiologica.