Magnetic Resonance Imaging-Detected Extramural Venous Invasion in Rectal Cancer before and after Preoperative Chemoradiotherapy: Diagnostic Performance and Prognostic Significance

Lee, Eun Sun; Kim, Min Ju; Park, Sung Chan; Hur, Bo Yun; Hyun, Jong Hee; Chang, Hee Jin; Baek, Ji Yeon; Kim, Sun Young; Kim, Dae Yong; Oh, Jae Hwan

doi:10.1007/s00330-017-4978-6

Cited by 61 publications

(49 citation statements)

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“…Based on multivariate analysis, only post-CRT MRI features such as EMVI post (HR, 2.259; p = 0.048) for OS and extramesorectal LN (HR, 2.610; p = 0.008) and EMVI post (HR, 5.011; p < 0.001) for DFS were the significant MR parameters in predicting patients' prognosis. These observations were well in line with those of the previous studies ( 30 ) and our common belief. This is likely because treatment response to CRT may vary among patients, and it is generally difficult to predict the responsiveness before treatment.…”

Section: Discussionsupporting

confidence: 94%

Prognostic Value of Tumor Regression Grade on MR in Rectal Cancer: A Large-Scale, Single-Center Experience

et al. 2020

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Objective To determine the prognostic value of MRI-based tumor regression grading (mrTRG) in rectal cancer compared with pathological tumor regression grading (pTRG), and to assess the effect of diffusion-weighted imaging (DWI) on interobserver agreement for evaluating mrTRG. Materials and Methods Between 2007 and 2016, we retrospectively enrolled 321 patients (male:female = 208:113; mean age, 60.2 years) with rectal cancer who underwent both pre-chemoradiotherapy (CRT) and post-CRT MRI. Two radiologists independently determined mrTRG using a 5-point grading system with and without DWI in a one-month interval. Two pathologists graded pTRG using a 5-point grading system in consensus. Kaplan-Meier estimation and Cox-proportional hazard models were used for survival analysis. Cohen's kappa analysis was used to determine interobserver agreement. Results According to mrTRG on MRI with DWI, there were 6 mrTRG 1, 48 mrTRG 2, 109 mrTRG 3, 152 mrTRG 4, and 6 mrTRG 5. By pTRG, there were 7 pTRG 1, 59 pTRG 2, 180 pTRG 3, 73 pTRG 4, and 2 pTRG 5. A 5-year overall survival (OS) was significantly different according to the 5-point grading mrTRG ( p = 0.024) and pTRG ( p = 0.038). The 5-year disease-free survival (DFS) was significantly different among the five mrTRG groups ( p = 0.039), but not among the five pTRG groups ( p = 0.072). OS and DFS were significantly different according to post-CRT MR variables: extramural venous invasion after CRT (hazard ratio = 2.259 for OS, hazard ratio = 5.011 for DFS) and extramesorectal lymph node (hazard ratio = 2.610 for DFS). For mrTRG, k value between the two radiologists was 0.309 (fair agreement) without DWI and slightly improved to 0.376 with DWI. Conclusion mrTRG may predict OS and DFS comparably or even better compared to pTRG. The addition of DWI on T2-weighted MRI may improve interobserver agreement on mrTRG.

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Section: Discussionsupporting

confidence: 94%

Prognostic Value of Tumor Regression Grade on MR in Rectal Cancer: A Large-Scale, Single-Center Experience

et al. 2020

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“…5 Various studies have shown a wide range of MRI sensitivity (28-90%) and specificity (41-94%) for detection of EMVI. 2,3,6,7 Since the time of EMVI's introduction for rectal cancer with MRI, the accuracy of pre-operative assessment has been known to be approximately 70-80% at best. 2,3,7,8 Lim et al reported diagnostic-predictive values of MRI in identifying EMVI in primary rectal cancer; specifically, the sensitivity, specificity and accuracy were 28, 94, and 80%, respectively.…”

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confidence: 99%

Added value of diffusion-weighted imaging for evaluation of extramural venous invasion in patients with primary rectal cancer

Ahn

Kim

Son

et al. 2019

The British Journal of Radiology

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Extramural venous invasion (EMVI) refers to the presence of cancer cells/tissue within the veins beyond the muscularis propria of the rectal wall. EMVI is regarded as a bad prognostic indicator in terms of local recurrence, distant metastasis, as well as overall patient survival. 1 In patients with rectal cancer, EMVI can provide a pathway for hematogenous dissemination of tumor cells, and is an independent risk factor for synchronous metastasis. 1,2 Moreover, EMVI, which is detected on MRI, is assumed to be helpful in predicting disease relapse. 2-4

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“…Therefore, the European Society for Medical Oncology guidelines suggest that mrEMVI indicates high risk; CRT followed by TME is recommended in such cases [24]. Moreover, several studies have shown that the presence of ymrEMVI, which was evaluated after the neoadjuvant treatment, and not only mrEMVI, had prognostic impact [23,[25][26][27]. Our study revealed that mrEMVI remained after NAC except for 2 patients.…”

Section: Discussionmentioning

confidence: 59%

Predicting prognosis according to preoperative chemotherapy response in patients with locally advanced lower rectal cancer

Shiraishi

Sasaki²,

Ikeda

et al. 2019

Preprint

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Background: Neoadjuvant chemoradiotherapy is regarded as the standard of treatment for locally advanced lower rectal cancer, although some of these cases are systemic, and distant control may be inadequate. Neoadjuvant chemotherapy could compensate for such shortcomings, potentially yielding better survival outcomes. We aimed to stratify patients into prognostic groups on the basis of preoperative factors, including response to neoadjuvant chemotherapy. Methods: We retrospectively analyzed patients with locally advanced lower rectal adenocarcinoma (clinical stage II/III with high-risk features of distant metastasis) who were treated with neoadjuvant chemotherapy (without radiotherapy) followed by curative resection between 2010 and 2017. Reduction in tumor volume (before vs. after neoadjuvant chemotherapy) was measured using magnetic resonance imaging, and a reduction above 60% was defined as a good response. Recurrence and overall survival were evaluated. Results: The cohort comprised 102 patients. Good response to neoadjuvant chemotherapy was associated with better 5-year recurrence-free survival (good responders: 81.1%, poor responders: 49.0%; p =0.001) and 5-year overall survival (good responders: 94.9%, poor responders: 80.6%; p =0.06). In a multivariate analysis, extramural venous invasion on magnetic resonance imaging after neoadjuvant chemotherapy and a tumor volume reduction rate <60 were found to be significantly and independently associated with worse recurrence-free survival (hazard ratio: 2.74, 95% confidence interval: 1.36–5.50, p =0.005 and hazard ratio: 3.48, 95% confidence interval: 1.57–7.72, p =0.002, respectively). Good responders without extramural venous invasion had the best 5-year recurrence-free and overall survival (89.0% and 93.8%, respectively). Poor responders with extramural venous invasion had the worst 5-year recurrence-free and overall survival (21.4% and 50.0%, respectively). Conclusions: Reductions in tumor volume after neoadjuvant chemotherapy were associated with a better prognosis in patients with locally advanced lower rectal cancer. Extramural venous invasion was a preoperative prognostic factor.

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Magnetic Resonance Imaging-Detected Extramural Venous Invasion in Rectal Cancer before and after Preoperative Chemoradiotherapy: Diagnostic Performance and Prognostic Significance

Abstract: • Diagnostic performance of MRI for EMVI after preoperative chemoradiotherapy is good. • The mean DFS was lower in yMR-EMVI-positive than yMR-EMVI-negative patients. • MRI can facilitate prognosis prediction of rectal cancer patients with preoperative chemoradiotherapy.

Cited by 61 publications

References 23 publications

Prognostic Value of Tumor Regression Grade on MR in Rectal Cancer: A Large-Scale, Single-Center Experience

Prognostic Value of Tumor Regression Grade on MR in Rectal Cancer: A Large-Scale, Single-Center Experience

Added value of diffusion-weighted imaging for evaluation of extramural venous invasion in patients with primary rectal cancer

Predicting prognosis according to preoperative chemotherapy response in patients with locally advanced lower rectal cancer

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