title: 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.
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.
  
  
  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.
authors.affiliation: Mayday University Hospital, Croydon, Surrey, UK.
authors.forename: Fiona G M
authors.initials: FG
authors.lastname: Taylor
authors.forename: Philip
authors.initials: P
authors.lastname: Quirke
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Heald
authors.forename: Brendan
authors.initials: B
authors.lastname: Moran
authors.forename: Lennart
authors.initials: L
authors.lastname: Blomqvist
authors.forename: Ian
authors.initials: I
authors.lastname: Swift
authors.forename: David J
authors.initials: DJ
authors.lastname: Sebag-Montefiore
authors.forename: Paris
authors.initials: P
authors.lastname: Tekkis
authors.forename: Gina
authors.initials: G
authors.lastname: Brown
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001707:Biopsy, Needle; D003082:Colectomy / Q000379:methods; D016001:Confidence Intervals; D018572:Disease-Free Survival; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000401:mortality; D009367:Neoplasm Staging; D015588:Observer Variation; D011300:Preoperative Care / Q000379:methods; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D012007:Rectum / Q000473:pathology*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome