Prediction of Distant Metastasis Risk After Radical Surgery for Mid-Low Rectal Cancer Using A Nomogram Constructed by High-Resolution MRI
10.3969/j.issn.1005-5185.2025.10.016
- VernacularTitle:基于高分辨MRI构建的列线图预测中低位直肠癌根治术后远处转移风险
- Author:
Jiaming QIN
1
;
Tianqi LIU
;
Mengxin CHEN
;
Xingyi LIU
;
Wenjin DONG
;
Wenhong WANG
Author Information
1. 南开大学医学院,天津 300071
- Publication Type:Journal Article
- Keywords:
Rectal neoplasms;
Magnetic resonance imaging;
Metastasis;
Surgical procedures,operative;
Nomograms;
Risk;
Forecasting
- From:
Chinese Journal of Medical Imaging
2025;33(10):1120-1126
- CountryChina
- Language:Chinese
-
Abstract:
Purpose To develop and validate a nomogram incorporating high-resolution MRI and clinicopathological indicators for predicting distant metastasis after curative resection of mid-low rectal cancer.Materials and Methods This retrospective study analyzed 219 patients with pathologically confirmed mid-low rectal cancer from Tianjin Union Medical Center(December 2016 to December 2021).Patients were categorized into metastasis(n=46)and non-metastasis(n=173)groups based on postoperative distant metastasis occurrence.All patients underwent preoperative pelvic MRI with measurement of posterior mesangial thickness(PMT),mesentery fat area(MFA)and mesenteric fascia envelopment volume(MFEV)on high-resolution T2WI.Clinicopathological and imaging data were collected.Cox proportional hazards model identified predictive factors for distant metastasis,and a risk probability nomogram was constructed.Predictive performance,goodness-of-fit and clinical applicability were evaluated.Results Kaplan-Meier analysis demonstrated significantly higher distant metastasis risk in patients with PMT≤1.43 cm,MFA≤19.31 cm2 and MFEV≤137.46 cm3 compared to those with higher values(χ2=29.07,8.71,19.05;all P<0.05).Cox regression identified tumor differentiation(HR=0.536,95％CI 0.290-0.990),pathological N stage(HR=0.397,95％CI 0.210-0.747),perirectal structure invasion(HR=0.242,95％CI 0.068-0.865)and PMT(HR=0.334,95％CI 0.168-0.664)as independent predictors.The nomogram achieved a concordance index of 0.775 with good calibration.Decision curve analysis demonstrated substantial net benefit across wide probability thresholds,indicating excellent clinical applicability.Conclusion Patients with PMT≤1.43 cm,MFA≤19.31 cm2 and MFEV≤137.46 cm3 exhibit elevated distant metastasis risk.The nomogram incorporating tumor differentiation,pathological N stage,perirectal structure invasion and PMT effectively predicts distant metastasis after curative resection of mid-low rectal cancer.
