MRI检查对MSS/pMMR型局部进展期直肠癌抗PD-1联合新辅助治疗效果的评估价值  

Application value of MRI in evaluating the efficacy of anti-PD-1 combined with neoadjuvant therapy for microsatellite stability/proficient mismatch repair locally advanced rectal cancer

作　　者：张洁[1] 许丽雪 杨正阳 孙丽婷 姚宏伟[2] 陈光勇[3] 杨正汉[1] Zhang Jie;Xu Lixue;Yang Zhengyang;Sun Liting;Yao Hongwei;Chen Guangyong;Yang Zhenghan(Department of Radiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Gastrointestinal Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Pathology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院放射科,北京100050 [2]首都医科大学附属北京友谊医院胃肠外科,北京100050 [3]首都医科大学附属北京友谊医院病理科,北京100050

出　　处：《中华消化外科杂志》2024年第6期859-867,共9页Chinese Journal of Digestive Surgery

基　　金：北京市医院管理中心重点医学专业发展计划(ZYLX202101)。

摘　　要：目的探讨磁共振成像(MRI)检查对微卫星稳定(MSS)/错配修复蛋白表达完整(pMMR)型局部进展期直肠癌抗程序性死亡受体1(PD-1)联合新辅助治疗效果的评估价值.方法采用前瞻性单臂Ⅱ期研究方法.选取2021年4月至2022年9月首都医科大学附属北京友谊医院收治的37例MSS/pMMR型局部进展期直肠癌患者的临床病理资料.患者均行抗PD-1联合新辅助治疗和全直肠系膜切除根治术.观察指标:(1)入组患者情况.(2)患者MRI及病理学检查情况.(3)MRI检查阅片的一致性分析.(4)MRI检查评估情况.正态分布的计量资料以(x)±s表示.计数资料以绝对数或百分比表示.采用线性加权κ值评价放射科医师评估的一致性.采用灵敏度、阴性预测值、准确率、分期过高率和分期不足率评价预测价值.结果(1)入组患者情况.筛选出符合条件的患者37例;男21例,女16例;年龄为(61±11)岁.患者联合治疗前后分别行MRI检查,根治术后行病理学检查.(2)患者MRI及病理学检查情况.37例患者中,联合治疗前MRI检查结果显示:T0期、T1期、T2期、T3期、T4期分别为0、0、5、24、8例,N0期、N1期、N2期分别为10、17、10例,壁外血管侵犯(EMVI)阳性、阴性分别为28、9例,系膜筋膜阳性、阴性分别为4、33例;联合治疗后MRI检查结果显示:T0期、T1期、T2期、T3期、T4期分别为15、4、7、10、1例,N0期、N1期、N2期分别为34、2、1例,EMVI阳性、阴性分别为9、28例,系膜筋膜阳性、阴性分别为1、36例.MRI检查肿瘤退缩分级(TRG)0级、1级、2级、3级分别为16、13、8、0例.术后病理学检查结果显示:T0期、T1期、T2期、T3期、T4期分别为18、4、3、11、1例,N0期、N1期、N2期分别为33、3、1例,EMVI阳性、阴性、未知分别为1、35、1例,环周切缘阳性、阴性分别为0、37例,美国癌症联合委员会标准TRG0级、1级、2级、3级分别为18、9、8、2例;病理学完全缓解率为48.6%(18/37),接近病理学完全Objective To investigate the application value of magnetic resonance imaging(MRI)in evaluating the efficacy of anti-PD-1 combined with neoadjuvant therapy for microsatellite stability(MSS)/proficient mismatch repair(pMMR)locally advanced rectal cancer(LARC).Methods The prospective single-arm phaseⅡstudy was conducted.The clinicopathological data of 37 patients with MSS/pMMR LARC who were admitted to Beijing Friendship Hospital of Capital Medical University from April 2021 to September 2022 were collected.All patients underwent anti-PD-1 combined with neoadjuvant therapy and radical total mesorectal excision.Observation indicators:(1)enrolled pati-ents;(2)MRI and pathological examination;(3)concordance analysis of MRI examination reading;(4)evaluation of MRI examination.Measurement data with normal distribution were represented as Mean±SD.Count data were expressed as absolute numbers or percentages.Linear weightedκvalue was used to evaluate the concordance of radiologist assessment.Sensitivity,negative predictive value,accuracy,overstaging rate and understaging rate were used to evaluate the predictive value.Results(1)Enrolled patients.A total of 37 eligible patients were screened out,including 21 males and 16 females,aged(61±11)years.MRI examination was performed before and after combined therapy,and pathological examination was performed after radical resection.(2)MRI and pathological exami-nation of patients.Among the 37 patients,MRI before combined therapy showed 0,0,5,24 and 8 cases in stage T0,T1,T2,T3 and T4,10,17 and 10 cases in stage N0,N1 and N2,28 and 9 cases of positive and negative extramural vascular invasion(EMVI),4 and 33 cases of positive and negative mesorectal fascia(MRF),respectively.MRI examination after combined therapy showed 15,4,7,10 and 1 cases in stage T0,T1,T2,T3 and T4,34,2 and 1 cases in stage N0,N1 and N2,9 and 28 cases of positive and negative EMVI,1 and 36 cases of positive and negative MRF.There were 16,13,8 and 0 cases of tumor regression grading(TRG)0,1,2 and 3,respectively

关 键 词：直肠肿瘤 进展期 磁共振成像 新辅助治疗 替雷利珠单克隆抗体 

分 类 号：R735.37[医药卫生—肿瘤]