Trial reportAbdominal radiology (New York)2026
Diagnostic accuracy and pitfalls of MRI for restaging locally advanced rectal cancer in patients following anti-PD1 therapy plus neoadjuvant chemoradiotherapy: a multicenter study.
Trial report in Abdominal radiology (New York), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
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Abstract
purposeEffectiveness 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.
methodsThis 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.
resultsA 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.
conclusionStandard 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.
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