Pre-treatment magnetic resonance imaging in anal cancer: large-scale evaluation of mrT, mrN and novel staging parameters

Hema Sekhar; Rohit Kochhar; Bernadette Carrington; Thomas Kaye; Damian Tolan; Lee Malcomson; Mark P Saunders; Matthew Sperrin; David Sebag-Montefiore; Marcel van Herk; Andrew G Renehan

doi:10.1038/s41416-024-02759-8

Pre-treatment magnetic resonance imaging in anal cancer: large-scale evaluation of mrT, mrN and novel staging parameters

Hema Sekhar, Rohit Kochhar, Bernadette Carrington, Thomas Kaye, Damian Tolan, Lee Malcomson, Mark P Saunders, Matthew Sperrin, David Sebag-Montefiore, Marcel van Herk, Andrew G Renehan

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: In patients with squamous cell carcinoma of the anus (SCCA), magnetic resonance (MR) imaging is recommended for pre-treatment staging prior to chemo-radiotherapy (CRT), but large-scale evaluation of its staging performance is lacking.

METHODS: We re-characterised pre-treatment MRs from 228 patients with non-metastatic SCCA treated consecutively by CRT (2006-2015) at one UK cancer centre. We derived TN staging from tumour size (mrTr) and nodal involvement (mrN), and additionally characterised novel beyond TN features such as extramural vascular invasion (mrEMVI) and tumour signal heterogeneity (mrTSH). Primary outcomes were 5-year overall survival (OS) and 3-year loco-regional failure (LRF). Time-to-event analyses used Kaplan-Meier estimates; Hazard Ratios (HRs) with confidence intervals (CIs) were derived from Cox models.

RESULTS: With a median follow up of 60.9 months, 5-year OS was 74%. Poor OS was associated with increasing mrT (HR: 1.12 per cm [95% CI: 1.07-1.33]), nodal positivity (HR 2.08 [95% CI 1.23-3.52]) and mrEMVI (HR 3.66 [95% CI: 1.88-7.41]). 3-year LRF rate was 16.5%. Increased LRF was associated with increasing mrT (HR: 1.43 per cm [95% CI: 1.26-1.63]), nodal positivity (HR 2.70 [95% CI 1.39-5.24]) and mrTSH (HR 2.66 [95% CI 1.29-5.48]).

CONCLUSIONS: In SCCA, the study demonstrates that mrT and mrN stages are prognostic, while mrEMVI and mrTSH may be novel prognostic factors.

Original language	English
Pages (from-to)	1137-1146
Number of pages	10
Journal	British Journal of Cancer
Volume	131
Issue number	7
DOIs	https://doi.org/10.1038/s41416-024-02759-8
Publication status	Published - Oct 2024

Keywords

Humans
Anus Neoplasms/therapy
Male
Magnetic Resonance Imaging/methods
Female
Middle Aged
Aged
Neoplasm Staging
Carcinoma, Squamous Cell/diagnostic imaging
Chemoradiotherapy
Adult
Aged, 80 and over
Prognosis

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1038/s41416-024-02759-8

Cite this

Sekhar, H., Kochhar, R., Carrington, B., Kaye, T., Tolan, D., Malcomson, L., Saunders, M. P., Sperrin, M., Sebag-Montefiore, D., van Herk, M., & Renehan, A. G. (2024). Pre-treatment magnetic resonance imaging in anal cancer: large-scale evaluation of mrT, mrN and novel staging parameters. British Journal of Cancer, 131(7), 1137-1146. https://doi.org/10.1038/s41416-024-02759-8

@article{ca4b75742ebe4159af04bd61fb38bde2,

title = "Pre-treatment magnetic resonance imaging in anal cancer: large-scale evaluation of mrT, mrN and novel staging parameters",

abstract = "BACKGROUND: In patients with squamous cell carcinoma of the anus (SCCA), magnetic resonance (MR) imaging is recommended for pre-treatment staging prior to chemo-radiotherapy (CRT), but large-scale evaluation of its staging performance is lacking.METHODS: We re-characterised pre-treatment MRs from 228 patients with non-metastatic SCCA treated consecutively by CRT (2006-2015) at one UK cancer centre. We derived TN staging from tumour size (mrTr) and nodal involvement (mrN), and additionally characterised novel beyond TN features such as extramural vascular invasion (mrEMVI) and tumour signal heterogeneity (mrTSH). Primary outcomes were 5-year overall survival (OS) and 3-year loco-regional failure (LRF). Time-to-event analyses used Kaplan-Meier estimates; Hazard Ratios (HRs) with confidence intervals (CIs) were derived from Cox models.RESULTS: With a median follow up of 60.9 months, 5-year OS was 74%. Poor OS was associated with increasing mrT (HR: 1.12 per cm [95% CI: 1.07-1.33]), nodal positivity (HR 2.08 [95% CI 1.23-3.52]) and mrEMVI (HR 3.66 [95% CI: 1.88-7.41]). 3-year LRF rate was 16.5%. Increased LRF was associated with increasing mrT (HR: 1.43 per cm [95% CI: 1.26-1.63]), nodal positivity (HR 2.70 [95% CI 1.39-5.24]) and mrTSH (HR 2.66 [95% CI 1.29-5.48]).CONCLUSIONS: In SCCA, the study demonstrates that mrT and mrN stages are prognostic, while mrEMVI and mrTSH may be novel prognostic factors.",

keywords = "Humans, Anus Neoplasms/therapy, Male, Magnetic Resonance Imaging/methods, Female, Middle Aged, Aged, Neoplasm Staging, Carcinoma, Squamous Cell/diagnostic imaging, Chemoradiotherapy, Adult, Aged, 80 and over, Prognosis",

author = "Hema Sekhar and Rohit Kochhar and Bernadette Carrington and Thomas Kaye and Damian Tolan and Lee Malcomson and Saunders, {Mark P} and Matthew Sperrin and David Sebag-Montefiore and {van Herk}, Marcel and Renehan, {Andrew G}",

note = "{\textcopyright} 2024. The Author(s).",

year = "2024",

month = oct,

doi = "10.1038/s41416-024-02759-8",

language = "English",

volume = "131",

pages = "1137--1146",

journal = "British Journal of Cancer",

issn = "0007-0920",

publisher = "Springer Nature",

number = "7",

}

Sekhar, H, Kochhar, R, Carrington, B, Kaye, T, Tolan, D, Malcomson, L, Saunders, MP, Sperrin, M, Sebag-Montefiore, D, van Herk, M & Renehan, AG 2024, 'Pre-treatment magnetic resonance imaging in anal cancer: large-scale evaluation of mrT, mrN and novel staging parameters', British Journal of Cancer, vol. 131, no. 7, pp. 1137-1146. https://doi.org/10.1038/s41416-024-02759-8

TY - JOUR

T1 - Pre-treatment magnetic resonance imaging in anal cancer

T2 - large-scale evaluation of mrT, mrN and novel staging parameters

AU - Sekhar, Hema

AU - Kochhar, Rohit

AU - Carrington, Bernadette

AU - Kaye, Thomas

AU - Tolan, Damian

AU - Malcomson, Lee

AU - Saunders, Mark P

AU - Sperrin, Matthew

AU - Sebag-Montefiore, David

AU - van Herk, Marcel

AU - Renehan, Andrew G

PY - 2024/10

Y1 - 2024/10

N2 - BACKGROUND: In patients with squamous cell carcinoma of the anus (SCCA), magnetic resonance (MR) imaging is recommended for pre-treatment staging prior to chemo-radiotherapy (CRT), but large-scale evaluation of its staging performance is lacking.METHODS: We re-characterised pre-treatment MRs from 228 patients with non-metastatic SCCA treated consecutively by CRT (2006-2015) at one UK cancer centre. We derived TN staging from tumour size (mrTr) and nodal involvement (mrN), and additionally characterised novel beyond TN features such as extramural vascular invasion (mrEMVI) and tumour signal heterogeneity (mrTSH). Primary outcomes were 5-year overall survival (OS) and 3-year loco-regional failure (LRF). Time-to-event analyses used Kaplan-Meier estimates; Hazard Ratios (HRs) with confidence intervals (CIs) were derived from Cox models.RESULTS: With a median follow up of 60.9 months, 5-year OS was 74%. Poor OS was associated with increasing mrT (HR: 1.12 per cm [95% CI: 1.07-1.33]), nodal positivity (HR 2.08 [95% CI 1.23-3.52]) and mrEMVI (HR 3.66 [95% CI: 1.88-7.41]). 3-year LRF rate was 16.5%. Increased LRF was associated with increasing mrT (HR: 1.43 per cm [95% CI: 1.26-1.63]), nodal positivity (HR 2.70 [95% CI 1.39-5.24]) and mrTSH (HR 2.66 [95% CI 1.29-5.48]).CONCLUSIONS: In SCCA, the study demonstrates that mrT and mrN stages are prognostic, while mrEMVI and mrTSH may be novel prognostic factors.

AB - BACKGROUND: In patients with squamous cell carcinoma of the anus (SCCA), magnetic resonance (MR) imaging is recommended for pre-treatment staging prior to chemo-radiotherapy (CRT), but large-scale evaluation of its staging performance is lacking.METHODS: We re-characterised pre-treatment MRs from 228 patients with non-metastatic SCCA treated consecutively by CRT (2006-2015) at one UK cancer centre. We derived TN staging from tumour size (mrTr) and nodal involvement (mrN), and additionally characterised novel beyond TN features such as extramural vascular invasion (mrEMVI) and tumour signal heterogeneity (mrTSH). Primary outcomes were 5-year overall survival (OS) and 3-year loco-regional failure (LRF). Time-to-event analyses used Kaplan-Meier estimates; Hazard Ratios (HRs) with confidence intervals (CIs) were derived from Cox models.RESULTS: With a median follow up of 60.9 months, 5-year OS was 74%. Poor OS was associated with increasing mrT (HR: 1.12 per cm [95% CI: 1.07-1.33]), nodal positivity (HR 2.08 [95% CI 1.23-3.52]) and mrEMVI (HR 3.66 [95% CI: 1.88-7.41]). 3-year LRF rate was 16.5%. Increased LRF was associated with increasing mrT (HR: 1.43 per cm [95% CI: 1.26-1.63]), nodal positivity (HR 2.70 [95% CI 1.39-5.24]) and mrTSH (HR 2.66 [95% CI 1.29-5.48]).CONCLUSIONS: In SCCA, the study demonstrates that mrT and mrN stages are prognostic, while mrEMVI and mrTSH may be novel prognostic factors.

KW - Humans

KW - Anus Neoplasms/therapy

KW - Male

KW - Magnetic Resonance Imaging/methods

KW - Female

KW - Middle Aged

KW - Aged

KW - Neoplasm Staging

KW - Carcinoma, Squamous Cell/diagnostic imaging

KW - Chemoradiotherapy

KW - Adult

KW - Aged, 80 and over

KW - Prognosis

U2 - 10.1038/s41416-024-02759-8

DO - 10.1038/s41416-024-02759-8

M3 - Article

C2 - 39169173

SN - 0007-0920

VL - 131

SP - 1137

EP - 1146

JO - British Journal of Cancer

JF - British Journal of Cancer

IS - 7

ER -

Pre-treatment magnetic resonance imaging in anal cancer: large-scale evaluation of mrT, mrN and novel staging parameters

Abstract

Keywords

UN SDGs

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