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综述｜｜Reviews 磁共振成像 2024年7月第15卷第7期 Chin J Magn Reson Imaging, Jul, 2024, Vol. 15, No. 7

基于磁共振的局部进展期直肠癌新辅助治疗后

肿瘤退缩分级评分方法应用现状

何宏，陈思宇，胡富碧 *

作者单位成都医学院第一附属医院放射科，成都 610000
* 通信作者胡富碧，E-mail: yingxianghu_cmc @163.com
中图分类号 R445.2；R735.37 文献标识码 A DOI 10.12015/issn.1674-8034.2024.07.034
本文引用格式何宏, 陈思宇, 胡富碧 . 基于磁共振的局部进展期直肠癌新辅助治疗后肿瘤退缩分级评分方法应用现状[J]. 磁共振
成像, 2024, 15(7): 204-209.
[摘要] 随着结直肠癌的发病率和死亡率在全球范围内显著上升，局部进展期直肠癌（locally advanced rectal cancer, LARC）的
治疗策略引起了广泛关注。目前，新辅助治疗（neoadjuvant chemoradiotherapy, NCRT）后行全直肠系膜切除术（total
mesorectal excision, TME）被推荐为 LARC的标准治疗方案。尽管 NCRT能显著改善预后，但 LARC患者对此治疗响应存在显著
差异。因此，准确评估 NCRT 的疗效对于临床决策和个体化医疗具有重要意义。当前的疗效评估方法包括血清肿瘤标记物、内
镜、直肠腔内超声、CT/MRI 等，但各有局限。近年来，磁共振肿瘤退缩分级（magnetic resonance tumor regression grade,
mrTRG）系统因其无辐射、多方位成像、软组织分辨率高和动态连续观察的优点而受到关注和推荐，因此，本文旨在通过分析
最新的国内外研究文献，着重探讨LARC患者NCRT后mrTRG的应用价值及其现状。
[关键词] 局部进展期直肠癌；新辅助治疗；磁共振成像；肿瘤退缩分级
Application status of tumor regression grading method after neoadjuvant chemoradiotherapy
based on magnetic resonance imaging for locally advanced rectal cancer

HE Hong, CHEN Siyu, HU Fubi *
Department of Radiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610000, China
* Correspondence to HU F B, E-mail: yingxianghu_cmc@163.com
Received 20 Mar 2024, Accepted 9 Jul 2024; DOI 10.12015/issn.1674-8034.2024.07.034
Cite this article as HE H, CHEN S Y, HU F B. Application status of tumor regression grading method after neoadjuvant chemoradiotherapy
based on magnetic resonance imaging for locally advanced rectal cancer[J]. Chin J Magn Reson Imaging, 2024, 15(7): 204-209.
Abstract As the incidence and mortality rates of colorectal cancer continue to rise globally, the treatment strategies for locally
advanced rectal cancer (LARC) have garnered widespread attention. Currently, total mesorectal excision (TME) following neoadjuvant
chemoradiotherapy (NCRT) is recommended as the standard treatment protocol for LARC. Although NCRT can significantly improve
outcomes, there is notable variability in LARC patient responses to this treatment. Therefore, accurately assessing the efficacy of NCRT
is crucial for clinical decision-making and personalized medicine. Current methods for assessing treatment efficacy include serum tumor
markers, endoscopy, endorectal ultrasound, and CT/MRI, each with its limitations. In recent years, the magnetic resonance tumor
regression grade (mrTRG) has gained attention and recommendation for its advantages of radiation-free, multi-directional imaging, high
soft tissue resolution and dynamic continuous observation. Hence, this article aims to analyze the latest domestic and foreign research
literature, and focus on the research value and current status of mrTRG after NCRT in LARC patients.
Key words locally advanced rectal cancer; neoadjuvant chemoradiotherapy; magnetic resonance imaging; tumor regression grading

0 引言难度、提高 R0 切除率，并可选用不同的手术方式以
近年来，全球和中国的结直肠癌发病率和死亡率提高保肛率 [9-11] 。因此，准确评估 LARC 患者 NCRT
显著上升 [1-2] ，其中大多数患者初次诊断即为局部进展的疗效对于临床决策和个体化医疗具有重要意义。
[3]
期直肠癌（locally advanced rectal cancer, LARC）。目术后病理学检查是 NCRT评价的金标准，其中肿
前，国内外各大权威指南推荐在新辅助治疗瘤退缩分级（tumor regression grade, TRG）是其主要
（neoadjuvant chemoradiotherapy, NCRT）后行全直肠内容之一。TRG 的历史始于 20 世纪 90 年代，最初的
[12]
系膜切除术（total mesorectal excision, TME），作为 TRG 系统由 MANDARD 等于 1994 年提出并应用
LARC 的标准治疗方案 [4-5] 。但由于肿瘤异质性以及于食管癌患者，用于评估术前放化疗的效果。随后，
[13]
个体差异等因素，约 15%~27% 的患者能实现病理完这一方法被 DWORAK 等应用于直肠癌的疗效评
全缓解（pathological complete response, PCR）。对估。目前 TRG 已被包括国家综合癌症网络（National
[6]
于完全缓解的患者，推荐等待观察策略，效果及结局 Comprehensive Cancer Network, NCCN）和美国癌症
接近传统手术，同时可避免手术带来的并发症 [7-8] 。联合委员会（American Joint Committee on Cancer,
对于未完全缓解但有肿瘤退缩的患者，可降低手术 AJCC）在内的多个临床实践指南作为评价指标。其

收稿日期 2024-03-20 接受日期 2024-07-09

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