Pre-treatment magnetic resonance imaging in anal cancer: large-scale evaluation of mrT, mrN and novel staging parameters.
Journal
British journal of cancer
ISSN: 1532-1827
Titre abrégé: Br J Cancer
Pays: England
ID NLM: 0370635
Informations de publication
Date de publication:
21 Aug 2024
21 Aug 2024
Historique:
received:
05
10
2023
accepted:
10
06
2024
revised:
23
05
2024
medline:
22
8
2024
pubmed:
22
8
2024
entrez:
21
8
2024
Statut:
aheadofprint
Résumé
In patients with squamous cell carcinoma of the anus (SCCA), magnetic resonance (MR) imaging is recommended for pre-treatment staging prior to chemo-radiotherapy (CRT), but large-scale evaluation of its staging performance is lacking. We re-characterised pre-treatment MRs from 228 patients with non-metastatic SCCA treated consecutively by CRT (2006-2015) at one UK cancer centre. We derived TN staging from tumour size (mrTr) and nodal involvement (mrN), and additionally characterised novel beyond TN features such as extramural vascular invasion (mrEMVI) and tumour signal heterogeneity (mrTSH). Primary outcomes were 5-year overall survival (OS) and 3-year loco-regional failure (LRF). Time-to-event analyses used Kaplan-Meier estimates; Hazard Ratios (HRs) with confidence intervals (CIs) were derived from Cox models. With a median follow up of 60.9 months, 5-year OS was 74%. Poor OS was associated with increasing mrT (HR: 1.12 per cm [95% CI: 1.07-1.33]), nodal positivity (HR 2.08 [95% CI 1.23-3.52]) and mrEMVI (HR 3.66 [95% CI: 1.88-7.41]). 3-year LRF rate was 16.5%. Increased LRF was associated with increasing mrT (HR: 1.43 per cm [95% CI: 1.26-1.63]), nodal positivity (HR 2.70 [95% CI 1.39-5.24]) and mrTSH (HR 2.66 [95% CI 1.29-5.48]). In SCCA, the study demonstrates that mrT and mrN stages are prognostic, while mrEMVI and mrTSH may be novel prognostic factors.
Sections du résumé
BACKGROUND
BACKGROUND
In patients with squamous cell carcinoma of the anus (SCCA), magnetic resonance (MR) imaging is recommended for pre-treatment staging prior to chemo-radiotherapy (CRT), but large-scale evaluation of its staging performance is lacking.
METHODS
METHODS
We re-characterised pre-treatment MRs from 228 patients with non-metastatic SCCA treated consecutively by CRT (2006-2015) at one UK cancer centre. We derived TN staging from tumour size (mrTr) and nodal involvement (mrN), and additionally characterised novel beyond TN features such as extramural vascular invasion (mrEMVI) and tumour signal heterogeneity (mrTSH). Primary outcomes were 5-year overall survival (OS) and 3-year loco-regional failure (LRF). Time-to-event analyses used Kaplan-Meier estimates; Hazard Ratios (HRs) with confidence intervals (CIs) were derived from Cox models.
RESULTS
RESULTS
With a median follow up of 60.9 months, 5-year OS was 74%. Poor OS was associated with increasing mrT (HR: 1.12 per cm [95% CI: 1.07-1.33]), nodal positivity (HR 2.08 [95% CI 1.23-3.52]) and mrEMVI (HR 3.66 [95% CI: 1.88-7.41]). 3-year LRF rate was 16.5%. Increased LRF was associated with increasing mrT (HR: 1.43 per cm [95% CI: 1.26-1.63]), nodal positivity (HR 2.70 [95% CI 1.39-5.24]) and mrTSH (HR 2.66 [95% CI 1.29-5.48]).
CONCLUSIONS
CONCLUSIONS
In SCCA, the study demonstrates that mrT and mrN stages are prognostic, while mrEMVI and mrTSH may be novel prognostic factors.
Identifiants
pubmed: 39169173
doi: 10.1038/s41416-024-02759-8
pii: 10.1038/s41416-024-02759-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Bowel Disease Research Foundation (BDRF)
ID : none
Organisme : Bowel Disease Research Foundation (BDRF)
ID : None
Organisme : Royal College of Surgeons of England (RCS)
ID : none
Organisme : Royal College of Surgeons of England (RCS)
ID : None
Informations de copyright
© 2024. The Author(s).
Références
Clark MA, Hartley A, Geh JI. Cancer of the anal canal. Lancet Oncol. 2004;5:149–57.
pubmed: 15003197
Fish R, Sanders C, Adams R, Brewer J, Brookes ST, DeNardo J, et al. A core outcome set for clinical trials of chemoradiotherapy interventions for anal cancer (CORMAC): a patient and health-care professional consensus. Lancet Gastroenterol Hepatol. 2018;3:865–73.
pubmed: 30507470
Sekhar H, Malcomson L, Kochhar R, Sperrin M, Alam N, Chakrbarty B, et al. Temporal improvements in loco-regional failure and survival in patients with anal cancer treated with chemo-radiotherapy: treatment cohort study (1990-2014). Br J Cancer. 2020;122:749–58.
pubmed: 31932755
pmcid: 7078229
Sekhar H, Zwahlen M, Trelle S, Malcomson L, Kochhar R, Saunders MP, et al. Nodal stage migration and prognosis in anal cancer: a systematic review, meta-regression, and simulation study. Lancet Oncol. 2017;18:1348–59.
pubmed: 28802802
Geh I, Gollins S, Renehan A, Scholefield J, Goh V, Prezzi D, et al. Association of Coloproctology of Great Britain & Ireland (ACPGBI): Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017)–Anal Cancer. Colorectal Dis. 2017;19(Suppl 1):82–97.
pubmed: 28632308
Rao, S, Guren, MG, Khan, K, Brown, G, Renehan, A, Steigen, S et al. Anal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. On behalf of the ESMO Guidelines Committee. Ann Oncol. 2021;32:1087–1100.
Ng M, Leong T, Chander S, Chu J, Kneebone A, Carroll S, et al. Australasian Gastrointestinal Trials Group (AGITG) contouring atlas and planning guidelines for intensity-modulated radiotherapy in anal cancer. Int J Radiat Oncol Biol Phys. 2012;83:1455–62.
pubmed: 22401917
Das P, Bhatia S, Eng C, Ajani JA, Skibber JM, Rodriguez-Bigas MA, et al. Predictors and patterns of recurrence after definitive chemoradiation for anal cancer. Int J Radiat Oncol Biol Phys. 2007;68:794–800.
pubmed: 17379452
Mai SK, Welzel G, Hermann B, Bohrer M, Wenz F. Long-term outcome after combined radiochemotherapy for anal cancer–retrospective analysis of efficacy, prognostic factors, and toxicity. Onkologie. 2008;31:251–7.
pubmed: 18497514
Olivatto LO, Cabral V, Rosa A, Bezerra M, Santarem E, Fassizoli A, et al. Mitomycin-C- or cisplatin-based chemoradiotherapy for anal canal carcinoma: long-term results. Int J Radiat Oncol Biol Phys. 2011;79:490–5.
pubmed: 20472349
Tomaszewski JM, Link E, Leong T, Heriot A, Vazquez M, Chander S, et al. Twenty-five-year experience with radical chemoradiation for anal cancer. Int J Radiat Oncol Biol Phys. 2012;83:552–8.
pubmed: 22019078
Bilimoria KY, Bentrem DJ, Rock CE, Stewart AK, Ko CY, Halverson A. Outcomes and prognostic factors for squamous-cell carcinoma of the anal canal: analysis of patients from the National Cancer Data Base. Dis Colon Rectum. 2009;52:624–31.
pubmed: 19404066
Ajani JA, Winter KA, Gunderson LL, Pedersen J, Benson AB 3rd, Thomas CR Jr., et al. Prognostic factors derived from a prospective database dictate clinical biology of anal cancer: the intergroup trial (RTOG 98-11). Cancer. 2010;116:4007–13.
pubmed: 20564111
Gunderson LL, Moughan J, Ajani JA, Pedersen JE, Winter KA, Benson AB 3rd, et al. Anal carcinoma: impact of TN category of disease on survival, disease relapse, and colostomy failure in US Gastrointestinal Intergroup RTOG 98-11 phase 3 trial. Int J Radiat Oncol Biol Phys. 2013;87:638–45.
pubmed: 24035327
pmcid: 3938865
Kochhar R, Renehan AG, Mullan D, Chakrabarty B, Saunders MP, Carrington BM. The assessment of local response using magnetic resonance imaging at 3- and 6-month post chemoradiotherapy in patients with anal cancer. Eur Radio. 2017;27:607–17.
Hocquelet A, Auriac T, Perier C, Dromain C, Meyer M, Pinaquy JB, et al. Pre-treatment magnetic resonance-based texture features as potential imaging biomarkers for predicting event free survival in anal cancer treated by chemoradiotherapy. Eur Radio. 2018;28:2801–11.
Owczarczyk K, Prezzi D, Cascino M, Kozarski R, Gaya A, Siddique M, et al. MRI heterogeneity analysis for prediction of recurrence and disease free survival in anal cancer. Radiother Oncol. 2019;134:119–26.
pubmed: 31005205
Muirhead R, Bulte D, Cooke R, Chu KY, Durrant L, Goh V, et al. A prospective study of diffusion-weighted magnetic resonance imaging as an early prognostic biomarker in chemoradiotherapy in squamous cell carcinomas of the anus. Clin Oncol (R Coll Radio). 2020;32:874–83.
Hanekamp BA, Viktil E, Slørdahl KS, Dormagen JB, Kløw NE, Malinen E, et al. Magnetic resonance imaging of anal cancer: tumor characteristics and early prediction of treatment outcome. Strahlenther Onkol. 2024;200:19–27.
pubmed: 37429949
Chandramohan A, Sathyakumar K, Augustine A, John R, Simon B, Issac R, et al. MRI staging of anorectal malignancy—a reporting dilemma: is it adenocarcinoma or squamous cell carcinoma? J Gastrointest Abdom Radiol. 2023;06:138–47.
Glynne-Jones R, Renehan A. Current treatment of anal squamous cell carcinoma. Hematol Oncol Clin North Am. 2012;26:1315–50.
pubmed: 23116582
PLATO - Personalising anal cancer radiotherapy dose. [Trial Registration] https://www.isrctn.com/ISRCTN88455282 [accessed 27th Dec 2022].
Radiochemotherapy +/− Durvalumab for locally-advanced anal carcinoma. a multicenter, randomized, phase II trial of the German Anal Cancer Study Group (RADIANCE) https://clinicaltrials.gov/ct2/show/NCT04230759?term=chemoradiotherapy&cond=NCT04230759&draw=2&rank=1 [accessed 28 Dec 2022].
Chemoradiotherapy combined with or without PD-1 blockade in anal canal squamous carcinoma patients https://clinicaltrials.gov/ct2/show/NCT05374252?cond=Anal+Cancer&cntry=CN&draw=2&rank=3 [accessed 28 Dec 2022].
Anus. In: ML Welton et al. (eds). AJCC cancer staging manual, 275–84 (Springer: Switzerland, 2017).
Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FI, Trotti AI. AJCC cancer staging manual (Springer: New York, 2009).
Kochhar R, Plumb AA, Carrington BM, Saunders M. Imaging of anal carcinoma. Am J Roentgenol. 2012;199:W335–344.
Brown G, Richards CJ, Bourne MW, Newcombe RG, Radcliffe AG, Dallimore NS, et al. Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology. 2003;227:371–7.
pubmed: 12732695
Muirhead R, Adams RA, Gilbert DC, Glynne-Jones R, Harrison M, Sebag-Montefiore D, et al. Anal cancer: developing an intensity-modulated radiotherapy solution for ACT2 fractionation. Clin Oncol (R Coll Radio). 2014;26:720–1.
Janczewski LM, Faski J, Nelson H, Gollub MJ, Eng C, Brierley JD, et al. Survival outcomes used to generate version 9 American Joint Committee on Cancer staging system for anal cancer. CA Cancer J Clin. 2023;73:516–23.
pubmed: 37114458
Brown G, Radcliffe AG, Newcombe RG, Dallimore NS, Bourne MW, Williams GT. Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging. Br J Surg. 2003;90:355–64.
pubmed: 12594673
McHugh ML. Interrater reliability: the kappa statistic. Biochem Med. 2012;22:276–82.
Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15:155–63.
pubmed: 27330520
pmcid: 4913118
Steyerberg EW, Vickers AJ, Cook NR, Gerds T, Gonen M, Obuchowski N, et al. Assessing the performance of prediction models: a framework for traditional and novel measures. Epidemiology. 2010;21:128–38.
pubmed: 20010215
pmcid: 3575184
Slørdahl KS, Klotz D, Olsen J, Skovlund E, Undseth C, Abildgaard HL, et al. Treatment outcomes and prognostic factors after chemoradiotherapy for anal cancer. Acta Oncol. 2021;60:921–30.
pubmed: 33966592
Dahl O, Myklebust MP, Dale JE, Leon O, Serup-Hansen E, Jakobsen A, et al. Evaluation of the stage classification of anal cancer by the TNM 8th version versus the TNM 7th version. Acta Oncol. 2020;59:1016–23.
pubmed: 32574087
Widder J, Kastenberger R, Fercher E, Schmid R, Langendijk JA, Dobrowsky W, et al. Radiation dose associated with local control in advanced anal cancer: retrospective analysis of 129 patients. Radiother Oncol. 2008;87:367–75.
pubmed: 18501453
Chand M, Bhangu A, Wotherspoon A, Stamp GWH, Swift RI, Chau I, et al. EMVI-positive stage II rectal cancer has similar clinical outcomes as stage III disease following pre-operative chemoradiotherapy. Ann Oncol. 2014;25:858–63.
pubmed: 24667718
Knudsen JB, Nilsson T, Sprechler M, Johansen A, Christensen N. Venous and nerve invasion as prognostic factors in postoperative survival of patients with resectable cancer of the rectum. Dis Colon Rectum. 1983;26:613–7.
pubmed: 6872793
Smith NJ, Barbachano Y, Norman AR, Swift RI, Abulafi AM, Brown G. Prognostic significance of magnetic resonance imaging-detected extramural vascular invasion in rectal cancer. Br J Surg. 2008;95:229–36.
pubmed: 17932879
Talbot IC, Ritchie S, Leighton M, Hughes AO, Bussey HJ, Morson BC. Invasion of veins by carcinoma of rectum: method of detection, histological features and significance. Histopathology. 1981;5:141–63.
pubmed: 7216178
Goh V, Gollub FK, Liaw J, Wellsted D, Przybytniak I, Padhani AR, et al. Magnetic resonance imaging assessment of squamous cell carcinoma of the anal canal before and after chemoradiation: can MRI predict for eventual clinical outcome? Int J Radiat Oncol Biol Phys. 2010;78:715–21.
pubmed: 20171812
Prezzi D, Muthuswamy K, Amlani A, Owczarczyk K, Elowaidy A, Mistry T, et al. Diffusion-weighted imaging complements T2-weighted MRI for tumour response assessment in squamous anal carcinoma. Eur Radio. 2023;33:7575–84.
Jones CM, Goh V, Sebag-Montefiore D, Gilbert DC. Biomarkers in anal cancer: from biological understanding to stratified treatment. Br J Cancer. 2017;116:156–62.
pubmed: 27923035