Article,
Prognostic significance of MRI-detected extramural venous invasion according to grade and response to neo-adjuvant treatment in locally advanced rectal cancer A national cohort study after radiologic training and reassessment
Affiliations
- [1] Canc Ctr Amsterdam, Treatment & Qual Life & Imaging & Biomarkers, Amsterdam, Netherlands [NORA names: Netherlands; Europe, EU; OECD];
- [2] Canc Ctr Amsterdam, Treatment & Qual Life & Imaging & Biomarkers, Amsterdam, Netherlands [NORA names: Netherlands; Europe, EU; OECD];
- [3] Catharina Hosp, Dept Radiol, Michelangelolaan 2, Eindhoven, Netherlands [NORA names: Netherlands; Europe, EU; OECD];
- [4] Univ Maastricht, GROW Sch Oncol & Dev Biol, Dept Pathol, Univ singel 40, Maastricht, Netherlands [NORA names: Netherlands; Europe, EU; OECD];
- [5] Univ Southern Denmark, Odense Univ Hosp, Dept Radiol, Dept Clin Res, Campusvej 55, DK-5230 Odense, Denmark [NORA names: Region of Southern Denmark; Hospital; Denmark; Europe, EU; Nordic; OECD];
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Abstract
Background: Detection of grade 3 -4 extra mural venous invasion (mrEMVI) on magnetic resonance imaging (MRI) is associated with an increased distant metastases (DM) -rate. This study aimed to determine the impact of different grades of mrEMVI and their disappearance after neoadjuvant therapy. Methods: A Dutch national retrospective cross-sectional study was conducted, including patients who underwent resection for rectal cancer in 2016 from 60/69 hospitals performing rectal surgery. Patients with a cT3-4 tumour <= 8 cm from the anorectal junction were selected and their MRI-scans were reassessed by trained abdominal radiologists. Positive mrEMVI grades (3 and 4) were analyzed in regard to 4-year local recurrence (LR), DM, disease-free survival (DFS) and overall survival (OS). Results: The 1213 included patients had a median follow-up of 48 months (IQR 30 -54). Positive mrEMVI was present in 324 patients (27%); 161 had grade 3 and 163 had grade 4. A higher mrEMVI stage (grade 4 vs grade 3 vs no mrEMVI) increased LR-risk (21% vs 18% vs 7%, <0.001) and DM-risk (49% vs 30% vs 21%, p < 0.001) and decreased DFS (42% vs 55% vs 69%, p < 0.001) and OS (62% vs 76% vs 81%, p < 0.001), which remained independently associated in multivariable analysis. When mrEMVI had disappeared on restaging MRI, DM -rate was comparable to initial absence of mrEMVI (both 26%), whereas LR -rate remained high (22% vs 9%, p = 0.006). Conclusion: The negative oncological impact of mrEMVI on recurrence and survival rates was dependent on grading. Disappearance of mrEMVI on restaging MRI decreased the risk of DM, but not of LR.