J Cancer
2020; 11(1):168-176.
doi:10.7150/jca.38354 This issueCite
Research Paper
Value of intra-tumor heterogeneity evaluated by diffusion-weighted MRI for predicting pathological stages and therapeutic responses to chemoradiotherapy in lower rectal cancer
1. Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan; 2. Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan; 3. Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
✉ Corresponding author: Masayoshi Nakanishi MD, PhD, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan. Tel.: +81 752515527, Fax: +81 752515522, E-mail: mnakankpu-m.ac.jpMore
Citation:
Kudou M, Nakanishi M, Kuriu Y, Murayama Y, Arita T, Kishimoto M, Konishi E, Goto M, Yamada K, Otsuji E. Value of intra-tumor heterogeneity evaluated by diffusion-weighted MRI for predicting pathological stages and therapeutic responses to chemoradiotherapy in lower rectal cancer. J Cancer 2020; 11(1):168-176. doi:10.7150/jca.38354. https://www.jcancer.org/v11p0168.htm
Aim: Diffusion-weighted MRI (DWI) has the potential to reveal intra-tumor structural heterogeneity consisting of stroma through an evaluation of uniformity on DWI. In present study, we examined the diagnostic value of intra-tumor heterogeneity evaluated by DWI in lower rectal cancer (LRC).
Patients and Methods: A total of 172 LRC patients underwent radical surgery between 2009 and 2017. T1 tumors and cases without pre-operative MRI were excluded. Twenty-nine primary resection cases (PR) and 37 pre-operative chemoradiotherapy followed by radical surgery cases (pCRT) were targeted. Intra-tumor heterogeneity on DWI was quantified using a specific formula (HSD). Structural heterogeneity was objectively quantified by an image analysis of resected specimens using a digital microscope (HSP). The relationships between HSD and HSP, pathological factors, and tumor regression grades (TRG) of pCRT were evaluated.
Results: The relationship between HSD and HSP was analyzed by a linear regression model in PR cases, revealing a positive correlation (R2=0.43). PR cases were divided into HSD-high and HSD-low according to the median. There were more pT3 or N(+) cases in HSD-high (p=0.038, 0.095). HSD before pCRT correlated with TRG (grade 1 versus 2/3) in pCRT cases (p=0.001). The diagnostic accuracy of HSD for predicting T and N stages and therapeutic grades was evaluated by cut-off values calculated using a ROC curve and revealed that each factor may be accurately diagnosed.
Conclusion: Intra-tumor heterogeneity on DWI corresponded with stromal pathological heterogeneity. It is useful for predicting T3 or deeper tumor invasion, pathological N(+), and the therapeutic effects of pCRT.
Keywords: rectal cancer, chemoradiotherapy, magnetic resonance imaging, diffusion-weighted image, radiomics.
Citation styles
APA
Kudou, M., Nakanishi, M., Kuriu, Y., Murayama, Y., Arita, T., Kishimoto, M., Konishi, E., Goto, M., Yamada, K., Otsuji, E. (2020). Value of intra-tumor heterogeneity evaluated by diffusion-weighted MRI for predicting pathological stages and therapeutic responses to chemoradiotherapy in lower rectal cancer. Journal of Cancer, 11(1), 168-176. https://doi.org/10.7150/jca.38354.
ACS
Kudou, M.; Nakanishi, M.; Kuriu, Y.; Murayama, Y.; Arita, T.; Kishimoto, M.; Konishi, E.; Goto, M.; Yamada, K.; Otsuji, E. Value of intra-tumor heterogeneity evaluated by diffusion-weighted MRI for predicting pathological stages and therapeutic responses to chemoradiotherapy in lower rectal cancer. J. Cancer 2020, 11 (1), 168-176. DOI: 10.7150/jca.38354.
NLM
Kudou M, Nakanishi M, Kuriu Y, Murayama Y, Arita T, Kishimoto M, Konishi E, Goto M, Yamada K, Otsuji E. Value of intra-tumor heterogeneity evaluated by diffusion-weighted MRI for predicting pathological stages and therapeutic responses to chemoradiotherapy in lower rectal cancer. J Cancer 2020; 11(1):168-176. doi:10.7150/jca.38354. https://www.jcancer.org/v11p0168.htm
CSE
Kudou M, Nakanishi M, Kuriu Y, Murayama Y, Arita T, Kishimoto M, Konishi E, Goto M, Yamada K, Otsuji E. 2020. Value of intra-tumor heterogeneity evaluated by diffusion-weighted MRI for predicting pathological stages and therapeutic responses to chemoradiotherapy in lower rectal cancer. J Cancer. 11(1):168-176.
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