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For medical professionals only to read and refer
to see what Professor Gu Jin's team at Peking University Shougang Hospital said that
the screening of patients for preoperative treatment of rectal cancer has always been controversial
。 The Lancet Oncology published a retrospective study comparing survival data from high-risk rectal cancer patients defined by the National Institute for Health and Care Excellence (NICE) guidelines with high-risk rectal cancer detected by MRI, and concluded that MRI evaluation would better screen people
who would benefit from preoperative radiotherapy.
Regarding the inclusion of the study population, evaluation methods and other issues, doctors such as Gao Qingkun of Professor Gu Jin's team at Peking University Shougang Hospital expressed their views and published them in The Lancet Oncology
.
Professor Gu Jin was invited by the "medical community" to share this "Sino-foreign Summit Academic Dialogue" and express his academic views
.
It has been demonstrated that MRI is more accurate in evaluating preoperative treatment of rectal cancer
At present, NICE guidelines (2020 edition) and National Comprehensive Cancer Network (NCCN) guidelines recommend that all rectal cancer patients except T1-T2 and N0 rectal cancer patients receive preoperative radiotherapy
.
MRI evaluation includes patients with rectal cancer extramural vein invasion, tumor deposition (TDs), and positive surgical margins into the high-risk group
.
The original retrospective study concluded that guideline recommendations would lead to more patients receiving preoperative radiotherapy, and that prognostic factors assessed by MRI would better identify populations
requiring preoperative radiotherapy.
Professor Gu Jin's team had an academic discussion with the other team: Professor Gu Jin's team:
First, this retrospective study included a total of 378 patients, of which 130 patients with stage T1 rectal cancer underwent radical surgery
.
NCCN and European Society of Medical Oncology (ESMO) guidelines recommend local resection surgery
for patients with stage T1 rectal cancer.
▎ Author's reply:
We did not trace the reason for radical resection in patients with stage T1N0 rectal cancer, because this is beyond the scope
of our study.
However, the rate of local resection in patients with stage T1 rectal cancer is relatively low, and we believe that future MRI will be able to assist in screening this subset of patients
who can undergo local resection.
The objective of MRI evaluation is to select patients
who are able to benefit from de-escalation without compromising safety (i.
e.
, without risk factors).
MRI risk assessment can reduce the probability of preoperative radiotherapy in non-high-risk patients, and can also reduce the probability
of radical resection in patients with stage T1 non-high-risk rectal cancer.
Professor Gu Jin's team: In this study, only 8.
7% of
patients with high-risk stage T1-2N0 rectal cancer evaluated by MRI were evaluated.
And the entire study contains about 1/3 of the cases unrelated to MRI to determine high-risk factors, will it affect the accuracy of prognosis based on MRI to a certain extent? In addition, there was a great divergence
between the diagnosis of MRI and pathology in the study about tumor deposition (TDs).
TDs often indicate lymph node metastases
in this patient.
In MRI evaluation, 78 patients developed TDs; Only 14 patients with pathological diagnosis developed TDs
.
Does this mean that the accuracy of MRI in assessing lymph node metastases is still debatable?
▎ The author replied:
We believe that the accuracy of imaging evaluation does not lie in its consistency with pathological diagnosis, but more importantly, MRI as a preoperative evaluation method for the formulation of rectal cancer treatment plan
.
In the study, pathological diagnosis was staged using the fifth edition of TNM
.
In this version, it is believed that tumor nodules need to be larger than 3 mm to be called lymph nodes, regardless of their histological appearance
.
Therefore, many of the lymph nodes that are incorporated may be TDs
.
This may make a difference between the use of MRI to evaluate and the pathological diagnosis, but it cannot be considered a "miscalculation"
.
The gastrointestinal MDT team of Peking University Shougang Hospital introduced
this group of young doctors from gastrointestinal surgery, medical oncology, hepatobiliary and pancreatic surgery, medical imaging and pathology, and has experienced fruitful results
since its establishment in 2019.
The gastrointestinal MDT team organizes the study of top publications every week, and the department heads, experts and business backbones take turns to teach to share clinical research experience, learn and exchange the latest diagnosis and treatment and research progress at home and abroad, analyze the research ideas of the article, and improve the scientific research awareness
of young doctors.
This article is precisely under the leadership of Dean Gu Jin, after many in-depth analysis and discussion by the MDT team, the contention
for the work of peers is reached.
Expert ProfileProfessor
Gu Jin is currently the chief physician, professor and doctoral supervisor of Peking University Cancer Hospital President of Peking University Shougang Hospital, member of the Standing Committee of the Central Committee of the Chinese Peasants' and Workers' Democratic Party, deputy to the National People's Congress, special supervisor of the National Supervision Commission; Former Chairman of Colorectal Cancer Professional Committee of Chinese Anti-Cancer Association, Vice Chairman of Oncology Society of Chinese Medical Association, Vice Chairman of Oncology Professional Committee of Beijing Medical Association, Vice President of Beijing Medical Association, Vice President of Beijing Medical Association, Chairman of Oncology Professional Committee of Beijing Medical Doctor Association; He is a member of the American College of Surgeons (FACS), a foreign member of the French National Academy of Surgeons, a member of the American Academy of Colorectal Surgeons (ASCRS), a member of the Asian Surgical Association, and a member of the International Association of
University Colorectal Surgeons (ISUCRS).
。 He also serves as the editor-in-chief of the World Journal of Gastrointestinal Surgery, the associate editor of the Chinese Journal of Gastrointestinal Surgery, the associate editor of the Chinese Journal of Surgery, and the editorial board members of the Chinese Journal of General Surgery, the Chinese Journal of Surgery, the Chinese Journal of Practical Surgery, and the Chinese Journal of Digestive Surgery.
Editorial Board Member of British Medical Journal Chinese Edition, Editorial Board Member of Lancet Chinese Edition, and Editorial Board Member
of North American Journal of Surgery China Edition.
He is a member of the expert group of the Chinese version of the NCCN guidelines for colorectal cancer, the leader of the expert group of the National Health and Family Planning Commission "Chinese Colorectal Cancer Diagnosis and Treatment Standards 2013-2015 Edition", and the leader of the expert group of the "Guidelines for the
Clinical Application of Antitumor Drugs" of the National Health Commission.
to see what Professor Gu Jin's team at Peking University Shougang Hospital said that
the screening of patients for preoperative treatment of rectal cancer has always been controversial
。 The Lancet Oncology published a retrospective study comparing survival data from high-risk rectal cancer patients defined by the National Institute for Health and Care Excellence (NICE) guidelines with high-risk rectal cancer detected by MRI, and concluded that MRI evaluation would better screen people
who would benefit from preoperative radiotherapy.
Regarding the inclusion of the study population, evaluation methods and other issues, doctors such as Gao Qingkun of Professor Gu Jin's team at Peking University Shougang Hospital expressed their views and published them in The Lancet Oncology
.
Professor Gu Jin was invited by the "medical community" to share this "Sino-foreign Summit Academic Dialogue" and express his academic views
.
It has been demonstrated that MRI is more accurate in evaluating preoperative treatment of rectal cancer
At present, NICE guidelines (2020 edition) and National Comprehensive Cancer Network (NCCN) guidelines recommend that all rectal cancer patients except T1-T2 and N0 rectal cancer patients receive preoperative radiotherapy
.
MRI evaluation includes patients with rectal cancer extramural vein invasion, tumor deposition (TDs), and positive surgical margins into the high-risk group
.
The original retrospective study concluded that guideline recommendations would lead to more patients receiving preoperative radiotherapy, and that prognostic factors assessed by MRI would better identify populations
requiring preoperative radiotherapy.
Professor Gu Jin's team had an academic discussion with the other team: Professor Gu Jin's team:
First, this retrospective study included a total of 378 patients, of which 130 patients with stage T1 rectal cancer underwent radical surgery
.
NCCN and European Society of Medical Oncology (ESMO) guidelines recommend local resection surgery
for patients with stage T1 rectal cancer.
▎ Author's reply:
We did not trace the reason for radical resection in patients with stage T1N0 rectal cancer, because this is beyond the scope
of our study.
However, the rate of local resection in patients with stage T1 rectal cancer is relatively low, and we believe that future MRI will be able to assist in screening this subset of patients
who can undergo local resection.
The objective of MRI evaluation is to select patients
who are able to benefit from de-escalation without compromising safety (i.
e.
, without risk factors).
MRI risk assessment can reduce the probability of preoperative radiotherapy in non-high-risk patients, and can also reduce the probability
of radical resection in patients with stage T1 non-high-risk rectal cancer.
Professor Gu Jin's team: In this study, only 8.
7% of
patients with high-risk stage T1-2N0 rectal cancer evaluated by MRI were evaluated.
And the entire study contains about 1/3 of the cases unrelated to MRI to determine high-risk factors, will it affect the accuracy of prognosis based on MRI to a certain extent? In addition, there was a great divergence
between the diagnosis of MRI and pathology in the study about tumor deposition (TDs).
TDs often indicate lymph node metastases
in this patient.
In MRI evaluation, 78 patients developed TDs; Only 14 patients with pathological diagnosis developed TDs
.
Does this mean that the accuracy of MRI in assessing lymph node metastases is still debatable?
▎ The author replied:
We believe that the accuracy of imaging evaluation does not lie in its consistency with pathological diagnosis, but more importantly, MRI as a preoperative evaluation method for the formulation of rectal cancer treatment plan
.
In the study, pathological diagnosis was staged using the fifth edition of TNM
.
In this version, it is believed that tumor nodules need to be larger than 3 mm to be called lymph nodes, regardless of their histological appearance
.
Therefore, many of the lymph nodes that are incorporated may be TDs
.
This may make a difference between the use of MRI to evaluate and the pathological diagnosis, but it cannot be considered a "miscalculation"
.
Professor Gu Jin's comments
The review article was written by the Multidisciplinary Collaboration (MDT) team at Peking University Shougang Hospital and published in The Lancet Oncology
.
The MDT team of gastrointestinal tumors found problems in the literature study organized regularly and conducted in-depth exploration, and after 7-8 discussion meetings, the manuscript was completed and accepted
by the editorial department.
This is also another honor
achieved by the gastrointestinal MDT team since 2020 after winning the national championship of the national CSCO sailing away digestive tumor MDT competition.
Although the gastrointestinal MDT team of Peking University Shougang Hospital is very young, it is very hardworking
.
We regularly hold closed training on standardized diagnosis and treatment, centralized examinations and certificates, a strong learning atmosphere, and dare to give opinions
on high-level magazines.
The gastrointestinal MDT team of Peking University Shougang Hospital introduced
this group of young doctors from gastrointestinal surgery, medical oncology, hepatobiliary and pancreatic surgery, medical imaging and pathology, and has experienced fruitful results
since its establishment in 2019.
The gastrointestinal MDT team organizes the study of top publications every week, and the department heads, experts and business backbones take turns to teach to share clinical research experience, learn and exchange the latest diagnosis and treatment and research progress at home and abroad, analyze the research ideas of the article, and improve the scientific research awareness
of young doctors.
This article is precisely under the leadership of Dean Gu Jin, after many in-depth analysis and discussion by the MDT team, the contention
for the work of peers is reached.
Expert ProfileProfessor
Gu Jin is currently the chief physician, professor and doctoral supervisor of Peking University Cancer Hospital President of Peking University Shougang Hospital, member of the Standing Committee of the Central Committee of the Chinese Peasants' and Workers' Democratic Party, deputy to the National People's Congress, special supervisor of the National Supervision Commission; Former Chairman of Colorectal Cancer Professional Committee of Chinese Anti-Cancer Association, Vice Chairman of Oncology Society of Chinese Medical Association, Vice Chairman of Oncology Professional Committee of Beijing Medical Association, Vice President of Beijing Medical Association, Vice President of Beijing Medical Association, Chairman of Oncology Professional Committee of Beijing Medical Doctor Association; He is a member of the American College of Surgeons (FACS), a foreign member of the French National Academy of Surgeons, a member of the American Academy of Colorectal Surgeons (ASCRS), a member of the Asian Surgical Association, and a member of the International Association of
University Colorectal Surgeons (ISUCRS).
。 He also serves as the editor-in-chief of the World Journal of Gastrointestinal Surgery, the associate editor of the Chinese Journal of Gastrointestinal Surgery, the associate editor of the Chinese Journal of Surgery, and the editorial board members of the Chinese Journal of General Surgery, the Chinese Journal of Surgery, the Chinese Journal of Practical Surgery, and the Chinese Journal of Digestive Surgery.
Editorial Board Member of British Medical Journal Chinese Edition, Editorial Board Member of Lancet Chinese Edition, and Editorial Board Member
of North American Journal of Surgery China Edition.
He is a member of the expert group of the Chinese version of the NCCN guidelines for colorectal cancer, the leader of the expert group of the National Health and Family Planning Commission "Chinese Colorectal Cancer Diagnosis and Treatment Standards 2013-2015 Edition", and the leader of the expert group of the "Guidelines for the
Clinical Application of Antitumor Drugs" of the National Health Commission.
