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Response Prediction after Neoadjuvant Chemotherapy for Colon Cancer Using CT Tumor Regression Grade: A Preliminary Study

대장암 환자의 수술 전 항암화학요법의 반응을 CT 종양퇴행등급을 이용한 반응 예측: 예비 연구

  • Hwan Ju Je (Department of Radiology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University) ;
  • Seung Hyun Cho (Department of Radiology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University) ;
  • Hyun Seok Oh (Department of Radiology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University) ;
  • An Na Seo (Department of Pathology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University) ;
  • Byung Geon Park (Department of Radiology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University) ;
  • So Mi Lee (Department of Radiology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University) ;
  • See Hyung Kim (Department of Radiology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University) ;
  • Gab Chul Kim (Department of Radiology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University) ;
  • Hunkyu Ryeom (Department of Radiology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University) ;
  • Gyu-Seog Choi (Department of Colorectal Cancer Centre, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University)
  • 제환주 (경북대학교 의과대학 칠곡경북대학교병원 영상의학과) ;
  • 조승현 (경북대학교 의과대학 칠곡경북대학교병원 영상의학과) ;
  • 오현석 (경북대학교 의과대학 칠곡경북대학교병원 영상의학과) ;
  • 서안나 (경북대학교 의과대학 칠곡경북대학교병원 병리학과) ;
  • 박병건 (경북대학교 의과대학 칠곡경북대학교병원 영상의학과) ;
  • 이소미 (경북대학교 의과대학 칠곡경북대학교병원 영상의학과) ;
  • 김시형 (경북대학교 의과대학 경북대학교병원 영상의학과) ;
  • 김갑철 (경북대학교 의과대학 칠곡경북대학교병원 영상의학과) ;
  • 염헌규 (경북대학교 의과대학 경북대학교병원 영상의학과) ;
  • 최규석 (경북대학교 의과대학 칠곡경북대학교병원 대장항문외과)
  • Received : 2022.08.30
  • Accepted : 2023.02.06
  • Published : 2023.09.01

Abstract

Purpose To investigate whether CT-based tumor regression grade (ctTRG) can be used to predict the response to neoadjuvant chemotherapy (NAC) in colon cancer. Materials and Methods A total of 53 patients were enrolled. Two radiologists independently assessed the ctTRG using the length, thickness, layer pattern, and luminal and extraluminal appearance of the tumor. Changes in tumor volume were also analyzed using the 3D Slicer software. We evaluated the association between pathologic TRG (pTRG) and ctTRG. Patients with Rödel's TRG of 2, 3, or 4 were classified as responders. In terms of predicting responder and pathologic complete remission (pCR), receiver operating characteristic was compared between ctTRG and tumor volume change. Results There was a moderate correlation between ctTRG and pTRG (ρ = -0.540, p < 0.001), and the interobserver agreement was substantial (weighted κ = 0.672). In the prediction of responder, there was no significant difference between ctTRG and volumetry (Az = 0.749, criterion: ctTRG ≤ 3 for ctTRG, Az = 0.794, criterion: ≤ -27.1% for volume, p = 0.53). Moreover, there was no significant difference between the two methods in predicting pCR (p = 0.447). Conclusion ctTRG might predict the response to NAC in colon cancer. The diagnostic performance of ctTRG was comparable to that of CT volumetry.

목적 대장암 환자에서 선행화학요법(neoadjuvant chemotherapy; 이하 NAC)의 반응을 CT를 이용한 종양퇴행등급(CT-based tumor regression grade; 이하 ctTRG)으로 예측할 수 있는지를 알아보고자 한 연구이다. 대상과 방법 총 53명을 대상으로 NAC 전후 종양의 길이, 두께, 장벽의 패턴과 모양으로 ctTRG를 정하고 부피도 측정했다. 병리 종양퇴행등급(pathologic TRG; 이하 pTRG)을 반응 평가의 기준으로 ctTRG와 연관성을 평가했다. Rödel's TRG 2, 3 그리고 4를 반응군으로 분류하였다. ctTRG와 부피변화로 반응군 및 병리완전퇴행(pathologic complete remission; 이하 pCR)을 예측하는 성능을 비교하였다. 결과 ctTRG와 pTRG는 moderate의 연관성을 보였다(ρ = -0.540). 관찰자간 신뢰도는 substantial으로 보였다(weighted κ = 0.672). 반응군을 예측하는데 ctTRG와 volume 변화의 성능은 유의미한 차이를 보이지 않았다(ctTRG의 Az = 0.749, 반응기준: ctTRG ≤ 3, volume 변화의 Az = 0.794, 반응기준: ≤ -27.1%, p = 0.53). pCR을 예측하는 두 방법 간의 성능도 차이가 없었다(p = 0.447). 결론 ctTRG는 대장암에 NAC 후 반응을 예측할 수 있었고, 그 성능은 종양부피변화 방법과 차이가 없었다.

Keywords

References

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