A meta-analysis comparing the risk of metastases in patients with rectal cancer and MRI-detected extramural vascular invasion (mrEMVI) vs mrEMVI-negative cases

Siddiqui, Muhammed R; Simillis, Constantinos; Hunter, Chris; Chand, Manish; Bhoday, Jemma; Garant, Aurélie; Vuong, T.; Artho, Giovanni; Rasheed, Shahnawaz; Tekkis, Paris; Abulafi, A. M.; Brown, Gina

doi:10.1038/bjc.2017.99

Cited by 114 publications

(92 citation statements)

References 43 publications

(95 reference statements)

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“…This is concordant with previous studies that found mrEMVI to be associated with poor prognosis. In a large meta‐analysis including 1262 patients, those with mrEMVI developed metastases more frequently than those with mrEMVI‐negative tumours (odds ratio 5·68; P < 0·001). These findings highlight the critical role of mrEMVI evaluation in patient stratification.…”

Section: Discussionsupporting

confidence: 90%

Early MRI predictors of disease-free survival in locally advanced rectal cancer from the GRECCAR 4 trial

Nougaret

Castan

Forges

et al. 2019

British Journal of Surgery

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Background: Tailored neoadjuvant treatment of locally advanced rectal cancer (LARC) may improve outcomes. The aim of this study was to determine early MRI prognostic parameters with which to stratify neoadjuvant treatment in patients with LARC.Methods: All patients from a prospective, phase II, multicentre randomized study (GRECCAR4; NCT01333709) were included, and underwent rectal MRI before treatment, 4 weeks after induction chemotherapy and after completion of chemoradiotherapy (CRT). Tumour volumetry, MRI tumour regression grade (mrTRG), T and N categories, circumferential resection margin (CRM) status and extramural vascular invasion identified by MRI (mrEMVI) were evaluated.Results: A total of 133 randomized patients were analysed. Median follow-up was 41⋅4 (95 per cent c.i. 36⋅6 to 45⋅2) months. Thirty-one patients (23⋅3 per cent) developed tumour recurrence. In univariable analysis, mrEMVI at baseline was the only prognostic factor associated with poorer outcome (P = 0⋅015). After induction chemotherapy, a larger tumour volume on MRI (P = 0⋅019), tumour volume regression of 60 per cent or less (P = 0⋅002), involvement of the CRM (P = 0⋅037), mrEMVI (P = 0⋅026) and a poor mrTRG (P = 0⋅023) were associated with poor outcome. After completion of CRT, the absence of complete response on MRI (P = 0⋅004), mrEMVI (P = 0⋅038) and a poor mrTRG (P = 0⋅005) were associated with shorter disease-free survival. A final multivariable model including all significant variables (baseline, after induction, after CRT) revealed that Eastern Cooperative Oncology Group performance status (P = 0⋅011), sphincter involvement (P = 0⋅009), mrEMVI at baseline (P = 0⋅002) and early tumour volume regression of 60 per cent or less after induction (P = 0⋅007) were associated with relapse.Conclusion: Baseline and early post-treatment MRI parameters are associated with prognosis in LARC. Future preoperative treatment should stratify treatment according to baseline mrEMVI status and early tumour volume regression.

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Section: Discussionsupporting

confidence: 90%

Early MRI predictors of disease-free survival in locally advanced rectal cancer from the GRECCAR 4 trial

Nougaret

Castan

Forges

et al. 2019

British Journal of Surgery

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“…52 EMVI status may also be a poor prognostic factor for metastases, as a recent meta-analysis reported mrEMVI positive patients presented five times more frequently with synchronous metastases and developed metastases four times more often after curative resection than mrEMVI negative tumors. 53 The combination of MRI assessment of EMVI, a 1-mm or less distance from the tumor to the surgical resection plane, and the mrTRG in patients after nCRT may be more powerful prognostic predictors than T and N stages. 31 With these signs, MRI provides invaluable prognostic information, and is an essential part of the staging for the MDT to make appropriate treatment decisions.…”

Section: Using High-resolution Mri To Determine Prognosis and Predictmentioning

confidence: 98%

Staging of Locally Advanced Rectal Cancer Beyond TME

Keller

2020

Clin Colon Rectal Surg

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The management of rectal cancer is complex and continually evolving. With advancements in technology and the use of multidisciplinary teams to guide the treatment decision making, staging, oncologic, and functional outcomes are improving, and the management is moving toward personalized treatment strategies to optimize each individual patient's outcomes. Key in this evolution is imaging. Magnetic resonance imaging (MRI) has emerged as the dominant method of pelvic imaging in rectal cancer, and use of MRI for staging is best practice in multiple international guidelines. MRI allows a noninvasive assessment of the tumor site, relationship to surrounding structures, and provides highly accurate rectal cancer staging, which is necessary for determining the appropriate treatment strategy. However, the applications of MRI extend far beyond pretreatment staging. MRI can be used to predict outcomes in locally advanced rectal cancer and guide the surgical or nonsurgical plan, serving as a predictive and prognostic biomarker. With continued MRI hardware improvement and new sequence development, MRI may offer new perspectives in the assessment of treatment response and new innovations that could provide better insight into the staging, restaging, and outcomes with rectal cancer.

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“…These deposits are strong adverse prognostic determinants, and there is a relation between extramural extranodal tumor deposits and extramural venous invasion [89,90]. Lymphovascular involvement which is tumor invasion into veins, especially extramural veins, or lymphatics is thought to be an adverse prognostic factor [91][92][93]. Perineural invasion is also associated with an elevated risk of recurrence and poor prognosis [94,95].…”

Section: Prognosismentioning

confidence: 99%

Colon Cancer

Koç¹,

Çelik²,

Akyol³

2019

Current Trends in Cancer Management

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Colorectal cancers (CRCs) are commonly diagnosed malignancy in both men and women. Although it is a common disease, mortality rates decrease with widespread use of screening methods and novel developments in surgery. Physical examination, abdomen and pelvic computerized tomography, and chest imaging are necessary for preoperative staging and surgical planning of a newly diagnosed colon cancer. CRCs usually develop from adenomatous polyps. Although curative treatment of localized colon cancer is surgery, endoscopic polypectomy is sufficient when severe dysplasia or carcinoma in situ is detected on a polyp surface. Total mesorectal excision and neoadjuvant chemoradiotherapy in rectum cancers resulted in significant reductions in morbidity, mortality, and recurrence rates. Recently, complete mesocolic excision and central vascular ligation method has been described in the surgical treatment of colon cancer to achieve similar results. Unfortunately, metastatic colon cancer rate at presentation is approximately 20%. Surgery is a potentially curative option in selected patients with liver and lung metastasis. Pathologic stage of the tumor at presentation is the most important prognostic factor after resection. Therefore, early diagnosis of colon cancer by screening methods and new surgical techniques will lead to better results in survival rates.

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A meta-analysis comparing the risk of metastases in patients with rectal cancer and MRI-detected extramural vascular invasion (mrEMVI) vs mrEMVI-negative cases

Cited by 114 publications

References 43 publications

Early MRI predictors of disease-free survival in locally advanced rectal cancer from the GRECCAR 4 trial

Early MRI predictors of disease-free survival in locally advanced rectal cancer from the GRECCAR 4 trial

Staging of Locally Advanced Rectal Cancer Beyond TME

Colon Cancer

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