Objective: To evaluate the predictive value of MRI features and pathological parameters on local recurrence, metastasis and progression free survival (PFS) for locally advanced rectal cancer after neoadjuvant chemoradiotherapy and subsequent total mesorectal excision surgery. Methods: A retrospective analysis of 95 patients with locally advanced rectal adenocarcinoma who underwent total mesorectal excision after neoadjuvant chemoradiotherapy was performed. Univariate and multivariate analyses were performed to evaluate the predictive value of MRI features before chemoradiation and postoperative pathological parameters on progression free survival. Results: Among the 95 cases, 5 cases occured local recurrence, 21 cases developed, 3 cases including both locally recurrence and distant metastasis, 19 died and 47 had no recurrence or metastasis at the last of follow-up. Univariant analysis showed that MRI signs before chemoradiation, namely, mr circumferential resection margin, mr levator ani muscle invasion, mr lymphatic vessel invasion, mr tumor deposition and postoperative pathological parameters, yp circumferential resection margin, yp lymphatic vessel invasion were related to PFS (P<0.05). Multivariate analysis of Cox proportional hazard model showed that mr lymphatic vessel invasion and mr tumor deposition were independent factors for PFS (OR=2.774 and 3.029, P<0.05). Conclusions: Lymphatic vessel invasion and tumor deposition on MRI are independent prognostic factors for progression free survival of locally advanced rectal cancer after neoadjuvant chemoradiotherapy and TME surgery. To some extent, MRI signs can assess local recurrence and distant metastasis in locally advanced rectal cancer patients after neoadjuvant chemoradiotherapy and mesorectal excision.
目的： 评价MRI特征及术后病理指标对评估局部晚期直肠癌新辅助放化疗及手术后局部复发、转移及无进展生存期(PFS)的价值。 方法： 回顾性分析95例新辅助放化疗后行全直肠系膜切除术的局部晚期直肠腺癌患者的临床资料，通过单因素和多因素分析，评价放化疗前MRI特征和术后病理指标对无进展生存情况的预测价值。 结果： 到随访截止日期，95例患者中，局部复发5例，转移21例，局部复发合并远处转移3例，死亡19例，47例未出现复发及转移。单因素分析结果显示，放化疗前MRI指标mr环周切缘状态、mr肛提肌受侵、mr淋巴管血管侵犯、mr肿瘤沉积，术后病理指标yp环周切缘状态、yp淋巴管血管侵犯与患者PFS有关(均P<0.05)。Cox比例风险模型多因素分析表明，mr淋巴管血管侵犯、mr肿瘤沉积是患者PFS的独立影响因素(OR分别为2.774和3.029, 均P<0.05)。 结论： MRI图像上的淋巴管血管侵犯、肿瘤沉积是局部晚期直肠癌患者新辅助放化疗及全直肠系膜切除术后无进展生存期的独立影响因素。在一定程度上，MRI征象可以评估局部晚期直肠癌患者接受新辅助放化疗及全直肠系膜切除术后的局部复发和远处转移。.
Keywords: Adenocarcinoma; Chemoradiotherapy, neoadjuvant; Magnetic resonance imaging; Progression-free survival; Rectal neoplasms.