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Preoperative High-resolution Magnetic Resonance Imaging Can Identify Good Prognosis Stage I, II, and III Rectal Cancer Best Managed by Surgery Alone: A Prospective, Multicenter, European Study

Taylor, Fiona G.M MBBS, FMRCS*; Quirke, Philip PhD, BM, FRCPath; Heald, Richard J MB, Bch, FRCS; Moran, Brendan MB, Bchir, FRCSI; Blomqvist, Lennart MD, PhD§; Swift, Ian MS, FRCS, FICS*; Sebag-Montefiore, David J FRCP, FRCR; Tekkis, Paris BMBS, MD, FRCS**; Brown, Gina MBBS, MD, FRCR for the MERCURY study group††

Annals of Surgery:
doi: 10.1097/SLA.0b013e31820b8d52
Original Articles
Abstract

Objective: To assess local recurrence, disease-free survival, and overall survival in magnetic resonance imaging (MRI)–predicted good prognosis tumors treated by surgery alone.

Background: The MERCURY study reported that high-resolution MRI can accurately stage rectal cancer. The routine policy in most centers involved in the MERCURY study was primary surgery alone in MRI-predicted stage II or less and in MRI “good prognosis” stage III with selective avoidance of neoadjuvant therapy.

Patients and Methods: Data were collected prospectively on all patients included in the MERCURY study who were staged as MRI-defined “good” prognosis tumors. “Good” prognosis included MRI-predicted safe circumferential resection margins, with MRI-predicted T2/T3a/T3b (less than 5 mm spread from muscularis propria), regardless of MRI N stage. None received preoperative or postoperative radiotherapy. Overall survival, disease-free survival, and local recurrence were calculated.

Results: Of 374 patients followed up in the MERCURY study, 122 (33%) were defined as “good prognosis” stage III or less on MRI. Overall and disease-free survival for all patients with MRI “good prognosis” stage I, II and III disease at 5 years was 68% and 85%, respectively. The local recurrence rate for this series of patients predicted to have a good prognosis tumor on MRI was 3%.

Conclusions: The preoperative identification of good prognosis tumors using MRI will allow stratification of patients and better targeting of preoperative therapy. This study confirms the ability of MRI to select patients who are likely to have a good outcome with primary surgery alone.

In Brief

This study was a prospective, multi-centre, European study that recruited consecutive patients with rectal cancer. All patients underwent detailed preoperative assessment with high resolution MRI and have now been followed up for 5 years. Data is presented for patients identified to have good prognostic features on MRI.

Author Information

*Mayday University Hospital, 530 London Road, Croydon, Surrey, UK.

Pathology & Tumor Biology, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK.

Pelican Cancer Foundation, North Hampshire Hospital, Basingstoke, Hampshire, UK.

§Karolinska University Hospital, Stockholm, Sweden.

St James's Institute of Oncology, Saint James University Hospital, Leeds, UK.

**The Royal Marsden NHS Foundation Trust, London, UK.

††The Royal Marsden Hospital, Downs Road, Sutton, UK.

Reprints: Gina Brown, MBBS, MD, FRCR, Department of Radiology, The Royal Marsden Hospital NHS Trust, Downs Rd, Sutton SM2 5PT, UK. E-mail: Gina.Brown@rmh.nhs.uk.

The sponsors of the study had no role in the design and conduct of the study, data collection, management, analysis, and interpretation of the data, preparation, review, or approval of the manuscript or the decision to submit the article for publication. G.B. had full access to all data in the study, and had responsibility for the decision to submit for publication.

Funding: Siemens Medical, UK; Pelican Cancer Foundation and the Croydon Colorectal Cancer Charity, Yorkshire Cancer Research; NIHR Biomedical Research Centre.

Role of the funding source: The funding of the original MERCURY study was provided by educational grants from Siemens Medical UK and the Pelican Cancer Foundation.

The Follow-up study has been supported by the Croydon Colorectal Cancer Charity.

F.T. is funded by the Croydon Colorectal Cancer Charity and the Pelican Cancer Foundation.

P.Q. is funded by a program grant from Yorkshire Cancer Research.

G.B. is supported by the NIHR Biomedical Research Centre.

© 2011 Lippincott Williams & Wilkins, Inc.