ISSN: 1859 - 2872
The correlation between mrTRG and pathological response in stage II-III rectal cancer patients treated with total neoadjuvant therapy
Main Article Content
Keywords
Rectal cancer, MRI, mrTRG, pCR, Total neoadjuvant therapy.
Abstract
Objective: To evaluate the correlation between MRI response (mrTRG) and pathological response (pCR) in stage II-III rectal cancer patients who underwent total neoadjuvant therapy (TNT). Subject and method: A retrospective, combined with prospective descriptive study on 125 patients with stage II-III rectal cancer treated with TNT and total mesorectal excision (TME) at 108 Military Central Hospital and Nghe An Oncology Hospital from 3/2022 to 1/2025. Result: The good response rate in MRI (mrTRG1-2) was 40%, while the pCR rate was 32.8%. There was moderate agreement between mrTRG 1-2 and pCR (Kappa = 0.502). mrTRG 1-2 predicted pCR with 75.6% sensitivity; 77.4% specificity; 62% positive predictive value; 86.7% negative predictive value; 76.8% accuracy and odd ratio of 10.6 (p<0.0001). Conclusion: Post-TNT MRI with mrTRG categorisation has a moderate correlation and is a good tool for predicting pathological response and guiding personalised treatment strategies.
Article Details
References
1. Cancer today. , accessed: 20/04/2026.
2. Hofheinz RD et al (2005) Localised rectal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 36(9): 1007-1024.
3. Sauer R, Becker H, Hohenberger W et al Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351: 1731-1740.
4. Gambacorta MA et al (2021) Timing to achieve the highest rate of pCR after preoperative radiochemotherapy in rectal cancer: A pooled analysis of 3085 patients from 7 randomized trials. Radiother Oncol 154: 154-160.
5. Conroy T et al (2021) Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol 22(5): 702-715.
6. Bahadoer RR et al (2021) Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): A randomised, open-label, phase 3 trial. Lancet Oncol 22(1): 29-42.
7. Lauwereins L et al (2025) A 2-year prospective study on the evolution of Low Anterior Resection Syndrome (LARS) following rectal cancer surgery. Int J Colorectal Dis 40(1): 220.
8. Floris S Verheij et al (2024) Long-Term Results of Organ Preservation in Patients With Rectal Adenocarcinoma Treated With Total Neoadjuvant Therapy: The Randomized Phase II OPRA Trial. J Clin Oncol. 42: 500-506.
9. van der Valk MJM et al (2018) Long-term outcomes of clinical complete responders in the International Watch & Wait Database. The Lancet 391: 2537-2545.
10. Niu S et al (2023) The role of MRI after neochemoradiotherapy in predicting pathological tumor regression grade. Front Oncol 13: 1118518.
11. Al-Sukhni E et al (2012) Diagnostic accuracy of MRI for assessment of T category, lymph node metastases, and circumferential resection margin involvement in patients with rectal cancer: A systematic review and meta-analysis. Ann Surg Oncol 19(7): 2212-23.
12. Phạm Công Khánh et al (2020) Vai trò của cộng hưởng từ trong đánh giá giai đoạn ung thư trực tràng đoạn giữa và dưới được phẫu thuật triệt để. Tạp chí Y dược học Cần Thơ 30: 79-88.
13. Trần Thị Mai et al (2026) Vai trò của cộng hưởng từ trong chẩn đoán giai đoạn ung thư trực tràng thấp sau hóa xạ trị tiền phẫu tại Bệnh viện Đại học Y Hà Nội. Tạp chí Y học Việt Nam 558(1): 234-238.
14. Hav M et al (2015) Pathologic Assessment of Rectal Carcinoma after Neoadjuvant Radio(chemo)therapy: Prognostic Implications. Biomed Res Int 2015: 574540.
15. Emmanouil Fokas ASL et al (2022) Chemoradiotherapy Plus Induction or Consolidation Chemotherapy as Total Neoadjuvant Therapy for Patients With Locally Advanced Rectal Cancer: Long-term Results of the CAO/ARO/AIO-12 Randomized Clinical Trial. JAMA Oncol 8(1).
16. Jin J TY et al (2022) Multicenter, Randomized, Phase III Trial of Short-Term Radiotherapy Plus Chemotherapy Versus Long-Term Chemoradiotherapy in Locally Advanced Rectal Cancer (STELLAR). J Clin Oncol 40(15): 1681-1692.
17. Francesco Sclafani et al (2017) Comparison between MRI and pathology in the assessment of tumour regression grade. Br J Cancer 117: 1478–1485.
18. Hall WA et al (2023) Prospective Correlation of Magnetic Resonance Tumor Regression Grade With Pathologic Outcomes in Total Neoadjuvant Therapy for Rectal Adenocarcinoma. J Clin Oncol 41(29): 4643-4651.
19. ESGAR Rectal Imaging Guideline Group. MRI to guide clinical management of rectal cancer: updated consensus recommendations from the European Society of Gastrointestinal and Abdominal Radiology (ESGAR): PART II—Restaging and response evaluation. Eur Radiol (2026). https://doi.org/10.1007/s00330-025-12275-9.
20. Smith JJ et al (2018) Assessment of a watch-and-wait strategy for rectal cancer. JAMA Oncology 4(7): 180039.
2. Hofheinz RD et al (2005) Localised rectal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 36(9): 1007-1024.
3. Sauer R, Becker H, Hohenberger W et al Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351: 1731-1740.
4. Gambacorta MA et al (2021) Timing to achieve the highest rate of pCR after preoperative radiochemotherapy in rectal cancer: A pooled analysis of 3085 patients from 7 randomized trials. Radiother Oncol 154: 154-160.
5. Conroy T et al (2021) Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol 22(5): 702-715.
6. Bahadoer RR et al (2021) Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): A randomised, open-label, phase 3 trial. Lancet Oncol 22(1): 29-42.
7. Lauwereins L et al (2025) A 2-year prospective study on the evolution of Low Anterior Resection Syndrome (LARS) following rectal cancer surgery. Int J Colorectal Dis 40(1): 220.
8. Floris S Verheij et al (2024) Long-Term Results of Organ Preservation in Patients With Rectal Adenocarcinoma Treated With Total Neoadjuvant Therapy: The Randomized Phase II OPRA Trial. J Clin Oncol. 42: 500-506.
9. van der Valk MJM et al (2018) Long-term outcomes of clinical complete responders in the International Watch & Wait Database. The Lancet 391: 2537-2545.
10. Niu S et al (2023) The role of MRI after neochemoradiotherapy in predicting pathological tumor regression grade. Front Oncol 13: 1118518.
11. Al-Sukhni E et al (2012) Diagnostic accuracy of MRI for assessment of T category, lymph node metastases, and circumferential resection margin involvement in patients with rectal cancer: A systematic review and meta-analysis. Ann Surg Oncol 19(7): 2212-23.
12. Phạm Công Khánh et al (2020) Vai trò của cộng hưởng từ trong đánh giá giai đoạn ung thư trực tràng đoạn giữa và dưới được phẫu thuật triệt để. Tạp chí Y dược học Cần Thơ 30: 79-88.
13. Trần Thị Mai et al (2026) Vai trò của cộng hưởng từ trong chẩn đoán giai đoạn ung thư trực tràng thấp sau hóa xạ trị tiền phẫu tại Bệnh viện Đại học Y Hà Nội. Tạp chí Y học Việt Nam 558(1): 234-238.
14. Hav M et al (2015) Pathologic Assessment of Rectal Carcinoma after Neoadjuvant Radio(chemo)therapy: Prognostic Implications. Biomed Res Int 2015: 574540.
15. Emmanouil Fokas ASL et al (2022) Chemoradiotherapy Plus Induction or Consolidation Chemotherapy as Total Neoadjuvant Therapy for Patients With Locally Advanced Rectal Cancer: Long-term Results of the CAO/ARO/AIO-12 Randomized Clinical Trial. JAMA Oncol 8(1).
16. Jin J TY et al (2022) Multicenter, Randomized, Phase III Trial of Short-Term Radiotherapy Plus Chemotherapy Versus Long-Term Chemoradiotherapy in Locally Advanced Rectal Cancer (STELLAR). J Clin Oncol 40(15): 1681-1692.
17. Francesco Sclafani et al (2017) Comparison between MRI and pathology in the assessment of tumour regression grade. Br J Cancer 117: 1478–1485.
18. Hall WA et al (2023) Prospective Correlation of Magnetic Resonance Tumor Regression Grade With Pathologic Outcomes in Total Neoadjuvant Therapy for Rectal Adenocarcinoma. J Clin Oncol 41(29): 4643-4651.
19. ESGAR Rectal Imaging Guideline Group. MRI to guide clinical management of rectal cancer: updated consensus recommendations from the European Society of Gastrointestinal and Abdominal Radiology (ESGAR): PART II—Restaging and response evaluation. Eur Radiol (2026). https://doi.org/10.1007/s00330-025-12275-9.
20. Smith JJ et al (2018) Assessment of a watch-and-wait strategy for rectal cancer. JAMA Oncology 4(7): 180039.
Article Sidebar
Published
Aug 15, 2026
Issue
Section
Articles
How to Cite
HoàngN. H., HàN. T., ChâuN. Đình, ĐứcN. T., XuânL. T. T., AnH. H., & BiểuB. Q. (2026). The correlation between mrTRG and pathological response in stage II-III rectal cancer patients treated with total neoadjuvant therapy. Tạp Chí Y Dược lâm sàng 108, 21(7). https://doi.org/10.52389/ydls.v21i7.3133