ArticleJournal of gastrointestinal oncology2026
Overstaging of the mesorectal fascia following neoadjuvant therapy and its impact on therapeutic management: a single-center retrospective cohort study of 506 mesorectal fascia positive patients.
Article in Journal of gastrointestinal oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Integrating clinical and genomic features to predict response to neoadjuvant therapy in microsatellite-stable rectal cancer.Therapeutic advances in medical oncology · 2026Article
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7 authors.
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Abstract
Background: Accurate assessment of mesorectal fascia (MRF) involvement status after neoadjuvant therapy (NAT) is critical for guiding post-NAT treatment. However, the discordance between magnetic resonance imaging (MRI)-based evaluations and histopathological results may drive overtreatment and complicate organ-preservation strategies. This study aimed to evaluate the association between post-NAT MRF involvement and pathological circumferential resection margin (CRM) positivity. Methods: This retrospective cohort study included treatment-naïve rectal cancer patients with MRI-confirmed MRF involvement between January 2014 and January 2024. All patients underwent MRI restaging after the NAT. The diagnostic performance, including sensitivity and specificity, of MRI-assessed MRF status was assessed to determine its efficacy in predicting pathological CRM positivity. Logistic regression and mixed-effects models were used to quantify the association between MRF status and CRM positivity. Cox regression analysis was used to assess the effect of MRF positivity on survival outcomes. Results: Among 506 enrolled patients, restaging MRI showed persistent MRF involvement in 50.2% (254/506). The CRM-positive rate was 10.2% in the MRF-positive group, compared to 1.6% in the MRF-negative group. Concordance between MRI and pathological assessment was poor (sensitivity: 0.867, specificity: 0.521, Kappa: 0.086). Nevertheless, MRF positivity independently predicted CRM positivity [odds ratio (OR): 6.228, 95% confidence interval (CI): 2.349-21.507, P<0.001]. In non-metastatic (M0) patients, MRF positivity correlated with worse overall survival [hazard ratio (HR): 2.300, 95% CI: 1.067-4.957, P=0.03]. However, no significant association was observed in metastatic (M1) patients (HR: 1.614, 95% CI: 0.859-3.031, P=0.14). For patients with post-NAT MRF-positive, integrating RAS status improved postoperative survival prediction accuracy [area under the curve (AUC): 1-year: 0.74 Conclusions: MRI assessment of MRF involvement showed limited concordance with pathological CRM status after NAT. Integration of MRF status and RAS status refines prognostic stratification in non-metastatic MRF-positive rectal cancer, guiding subsequent treatment decisions.
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