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Structured Magnetic Resonance Imaging assessment improves diagnosis of pathological complete response in rectal cancer after neoadjuvant chemoradiation

Introduction: Precise prediction of pathological complete response (pCR) following neoadjuvant chemoradiotherapy (nCRT) in rectal cancer may identify candidates for non-operative management. The optimal selection of diagnostic tools is, therefore, of major clinical importance. Methods: Clinical, lab...

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Main Authors: Li, Moying (Author) , Dieckmann, Tobias (Author) , Herrle, Florian (Author) , Hofheinz, Ralf-Dieter (Author) , Hielscher, Thomas (Author) , Hertel, Alexander (Author) , Schweitzer, Sophia (Author) , Hetjens, Svetlana (Author) , Betge, Johannes (Author) , Belle, Sebastian (Author) , Schulte, Nadine (Author) , Reißfelder, Christoph (Author) , Boda-Heggemann, Judit (Author) , Dreher, Constantin (Author) , Brochhausen, Christoph (Author) , Ebert, Matthias (Author) , Froelich, Matthias F. (Author) , Zhan, Tianzuo (Author)
Format: Article (Journal)
Language:English
Published: September 5, 2025
In: Oncology research and treatment
Year: 2025, Pages: 1-13
ISSN:2296-5262
DOI:10.1159/000548042
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1159/000548042
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Author Notes:Moying Li, Tobias Dieckmann, Florian Herrle, Ralf-Dieter Hofheinz, Thomas Hielscher, Alexander Hertel, Sophia Schweitzer, Svetlana Hetjens, Johannes Betge, Sebastian Belle, Nadine Schulte, Christoph Reißfelder, Judit Boda-Heggemann, Constantin Dreher, Christoph Brochhausen, Matthias P. Ebert, Matthias F. Froelich, Tianzuo Zhan
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Summary:Introduction: Precise prediction of pathological complete response (pCR) following neoadjuvant chemoradiotherapy (nCRT) in rectal cancer may identify candidates for non-operative management. The optimal selection of diagnostic tools is, therefore, of major clinical importance. Methods: Clinical, laboratory, endoscopic, and radiological data of patients with rectal cancer treated with nCRT and surgery at an academic medical center from 2010 to 2020 were retrospectively collected. Pre- and post-nCRT magnetic resonance imaging (MRI) was reviewed with a structured report template and assessed by magnetic resonance imaging tumor regression grade (mrTRG). Two senior radiologists reviewed mrTRG independently to determine the inter-reader agreement. Univariate logistic regression was applied to identify parameters that predict pCR. A multivariate prediction model was developed using L1-penalized logistic regression, with performance assessed by area under the curve (AUC) in the total cohort (apparent AUC) and by cross-validation (CV-AUC). Results: A total of 261 patients were identified, of whom 36 achieved pCR. Univariate analysis showed a significant correlation between post-nCRT features with pCR, including radiological T-stage (odds ratio [OR] 0.05 [0.02-0.15], p < 0.001), mrTRG (OR 0.13 [0.05-0.31], p < 0.001), and endoscopic response (OR 0.17 [0.05-0.54], p = 0.032). Of those, mrTRG showed the highest AUC of 0.77 with a substantial inter-reader agreement (kappa = 0.71, 95% confidence interval: 0.61-0.81). The multivariate predictive model selected eight pre- and post-nCRT parameters with an apparent AUC of 0.84 and a CV-AUC of 0.73. Conclusion: Therapy response assessed by MRI, particularly by mrTRG, strongly predicted pCR. Therefore, mrTRG should be implemented in routine assessment of rectal cancer treated by nCRT.
Item Description:Gesehen am 24.11.2025
Physical Description:Online Resource
ISSN:2296-5262
DOI:10.1159/000548042

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