Comparison of T and N Staging on Preoperative Magnetic Resonance Imaging and Postoperative Histopathologic Specimens in Rectum Cancer

Yılmaz, Eyüp Murat; Cartı, Erdem Barış; Gök, Mustafa; Özgün, Hedef

doi:10.4274/tjcd.32767

Cited by 1 publication

(1 citation statement)

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“…In particular, (1) the initial staging method pre-nCRT by MRI is notably inaccurate compared with the final staging method, with histopathological examination of the resected rectum remaining the gold standard for ypT-staging and ypN-staging post-nCRT). While MRI accuracy for mT3-staging compared with final histopathology is estimated to be 60%−80%, [17][18][19] accuracy for staging N-negative tumours is only 38%−54% and 48%−71% for N-positive tumours 17,19 (notably, this inaccuracy is particularly relevant in watch-and-wait studies where a definitive histopathology result may be unavailable) and ( 2) methods to assess tumour regression grade (TRG) are not consistent across studies and are scored subjectively. 2,[20][21][22] Further, assessment of nodal regression and downstaging is notoriously difficult, with nodal categorisation often simplified to ypN+ve or ypN-ve.…”

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confidence: 99%

T‐stage downstaging of locally advanced rectal cancer after neoadjuvant chemoradiotherapy is not associated with reduced recurrence after adjusting for tumour characteristics

Hayes

Milanzi

Pelly

et al. 2022

Journal of Surgical Oncology

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Background and Objectives: Prior studies examining prognostic outcomes of locally advanced rectal adenocarcinomas achieving a complete pathological response following neoadjuvant chemoradiotherapy (nCRT) did not adjust for adverse prognostic factors in multivariate analyses and account for magnetic resonance imaging tumour staging inaccuracy pre-nCRT. We aimed to clarify prognostic outcomes in mT3 rectal adenocarcinomas with ypT-downstaging post-nCRT in robust adjusted analyses.Methods: Retrospective analysis of prospectively-collected clinical data from 528 mT3 rectal adenocarcinomas ≤12 cm from the anal verge, any N-stage, no metastases, post-nCRT following total mesorectal excision (TME). Recurrence outcomes (local and distant combined) of tumours with complete ypT-downstaging (ypT0) post-nCRT before TME compared with no ypT-downstaging (≥ypT3) were examined using multivariate Cox regression, adjusting for confounders and accounting for pre-nCRT mT3-staging inaccuracy using bootstrapping.Results: Complete ypT-downstaging was achieved in of 17.6% tumours and correlated strongly with complete pathological response. Complete ypTdownstaging was not associated with reduced recurrence hazards compared with no ypT-downstaging (hazard ratio = 0.60; 95% confidence interval [CI]: 0.23−1.56; p = 0.30). Lymphovascular invasion (LVI) and ypN+ve increased recurrence hazards by 1.8-fold (95% CI: 1.10−2.79; p = 0.02) and 2.3-fold (95% CI: 1.48−3.54; p = 0.0002), respectively. Conclusion:Complete ypT-downstaging was not associated with reduced recurrence after adjusting for confounders and accounting for mT3-staging inaccuracy, even in the absence of adverse prognostic factors (ypN+, LVI).

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