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Purpose <p>Effectiveness of programmed cell death 1 blockade (anti-PD1) treatment plus neoadjuvant chemoradiotherapy (NCRT) in patients with locally advanced rectal cancer and proficient mismatch repair (pMMR-LARC) has been recently proven. However, the role of MRI in tumor restaging following anti-PD1 plus NCRT is less established. This study aims to evaluate the diagnostic performance and challenges of MRI for restaging pMMR-LARC patients after anti-PD1 plus NCRT treatment.</p> Methods <p>This prospective multicenter study involved pMMR-LARC patients exhibiting following anti-PD1 plus NCRT treatment from 2021 to 2022. The evaluation of preoperative treatment response included assessments of complete response and near complete response (CR/nCR), N category, extramural venous invasion (EMVI) and mesorectal fascia (MRF), all of which were analyzed using MRI. The diagnostic accuracy was assessed using pathology as the reference standard.</p> Results <p>A cohort of 44 patients (mean age, 60.5 years ± 10.4 [SD]; 15 females) was evaluated. The pathologic CR/nCR rate was 75.0%. MRI demonstrated an accuracy of 86.4% for identifying pathologic CR/nCR (pathologic tumor regression grade 0–1). The accuracy for involvement of ypN, circumferential resection margin (CRM) and ypEMVI were 86.4%, 100% and 90.9%, respectively. Minimal fibrosis (<i>p</i> = 0.022) and irregular fibrosis (<i>p</i> = 0.030) rather than oedema or mucin, contributed to misinterpretations in tumor treatment response assessment and ypEMVI using MRI, respectively.</p> Conclusion <p>Standard MRI restaging criteria was suitable for tumor restaging in pMMR-LARC patients following anti-PD1 plus NCRT therapy. Fibrotic-pattern-based interpretation methodology are needed in improving diagnostic accuracy of MRI.</p> Graphical abstract <p></p>

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Diagnostic accuracy and pitfalls of MRI for restaging locally advanced rectal cancer in patients following anti-PD1 therapy plus neoadjuvant chemoradiotherapy: a multicenter study

  • 期刊论文

  • 发表日期：

    2025年6月17日

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  • Lixue Xu,
  • Liting Sun,
  • Yuhuan Fu,
  • Guangyong Chen,
  • Hongwei Yao,
  • Zhenchang Wang,
  • Zhenghan Yang,
  • Jie Zhang

摘要

Purpose

Effectiveness of programmed cell death 1 blockade (anti-PD1) treatment plus neoadjuvant chemoradiotherapy (NCRT) in patients with locally advanced rectal cancer and proficient mismatch repair (pMMR-LARC) has been recently proven. However, the role of MRI in tumor restaging following anti-PD1 plus NCRT is less established. This study aims to evaluate the diagnostic performance and challenges of MRI for restaging pMMR-LARC patients after anti-PD1 plus NCRT treatment.

Methods

This prospective multicenter study involved pMMR-LARC patients exhibiting following anti-PD1 plus NCRT treatment from 2021 to 2022. The evaluation of preoperative treatment response included assessments of complete response and near complete response (CR/nCR), N category, extramural venous invasion (EMVI) and mesorectal fascia (MRF), all of which were analyzed using MRI. The diagnostic accuracy was assessed using pathology as the reference standard.

Results

A cohort of 44 patients (mean age, 60.5 years ± 10.4 [SD]; 15 females) was evaluated. The pathologic CR/nCR rate was 75.0%. MRI demonstrated an accuracy of 86.4% for identifying pathologic CR/nCR (pathologic tumor regression grade 0–1). The accuracy for involvement of ypN, circumferential resection margin (CRM) and ypEMVI were 86.4%, 100% and 90.9%, respectively. Minimal fibrosis (p = 0.022) and irregular fibrosis (p = 0.030) rather than oedema or mucin, contributed to misinterpretations in tumor treatment response assessment and ypEMVI using MRI, respectively.

Conclusion

Standard MRI restaging criteria was suitable for tumor restaging in pMMR-LARC patients following anti-PD1 plus NCRT therapy. Fibrotic-pattern-based interpretation methodology are needed in improving diagnostic accuracy of MRI.

Graphical abstract