Mural and Extramural Venous Invasion and Prognosis in Colorectal Cancer

Gibson, Katherine M; Chan, Charles; Chapuis, Pierre; Dent, Owen F.; Bokey, Les

doi:10.1097/dcr.0000000000000162

Cited by 40 publications

(67 citation statements)

References 17 publications

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“…The meta-analysis has also shown that MRI-detected prevalence of EMVI in rectal cancer is 34.6% (CI: 23.7–47.4%) and thus amounts to over a third of all rectal cancers. Although the link between pathological EMVI and liver metastases is well-established (Talbot et al , 1980), its reporting by individual pathologists is highly variable with documented pathological underreporting of pEMVI resulting in rates of only 9–21% in published audits (Stewart et al , 2007; Courtney et al , 2009; Messenger et al , 2011, 2012; Betge et al , 2012; Bhangu et al , 2013; Kirsch et al , 2013; Gibson et al , 2014). Furthermore pathological EMVI status is only available after surgery, thus limiting the ability to tailor preoperative therapy.…”

Section: Discussionmentioning

confidence: 99%

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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

et al. 2017

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Background:Pathological extramural vascular invasion (EMVI) is an independent prognostic factor in rectal cancer, but can also be identified on MRI-detected extramural vascular invasion (mrEMVI). We perform a meta-analysis to determine the risk of metastatic disease at presentation and after surgery in mrEMVI-positive patients compared with negative tumours.Methods:Electronic databases were searched from January 1980 to March 2016. Conventional meta-analytical techniques were used to provide a summative outcome. Quality assessment of the studies was performed.Results:Six articles reported on mrEMVI in 1262 patients. There were 403 patients in the mrEMVI-positive group and 859 patients in the mrEMVI-negative group. The combined prevalence of mrEMVI-positive tumours was 0.346(range=0.198–0.574). Patients with mrEMVI-positive tumours presented more frequently with metastases compared to mrEMVI-negative tumours (fixed effects model: odds ratio (OR)=5.68, 95% confidence interval (CI) (3.75, 8.61), z=8.21, df=2, P<0.001). Patients who were mrEMVI-positive developed metastases more frequently during follow-up (random effects model: OR=3.91, 95% CI (2.61, 5.86), z=6.63, df=5, P<0.001).Conclusions:MRI-detected extramural vascular invasion is prevalent in one-third of patients with rectal cancer. MRI-detected extramural vascular invasion is a poor prognostic factor as evidenced by the five-fold increased rate of synchronous metastases, and almost four-fold ongoing risk of developing metastases in follow-up after surgery.

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Section: Discussionmentioning

confidence: 99%

“…The link between histopathological extramural vascular invasion (EMVI) in specimens and metastatic disease was first reported in by Brown and Warren (1938) (Gibson et al , 2014). Talbot et al (1980, 1981) subsequently showed that tumour spread into ‘thick-walled vessels’ was evident in almost 52% of 703 rectal cancer specimens.…”

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confidence: 95%

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

et al. 2017

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“…Manual cross‐referencing resulted in two additional papers. The remaining 20 papers, comprising 8078 patients, were included in the meta‐analysis …”

Section: Resultsmentioning

confidence: 99%

“…There is a wide variation in reported frequencies of IMVI in CRC, ranging from 8% to 39% . Analogous to EMVI, this variation might be explained by differences in pathological assessment .…”

Section: Introductionmentioning

confidence: 99%

The value of intramural vascular invasion in colorectal cancer – a systematic review and meta‐analysis

et al. 2017

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Extramural venous invasion (EMVI) is a well-known prognostic factor in colorectal cancer (CRC). Vascular invasion within the bowel wall, intramural vascular invasion (IMVI), has received less attention and its incidence and prognostic importance in CRC is not completely known. A systematic literature search was performed focusing on the impact of IMVI in CRC. Data were analysed using Review Manager version 5.3 on incidence and clinical endpoints local recurrence, 5-year cancer-specific survival (CSS) and 5-year overall survival (OS). Meta-analysis was performed in terms of risk ratios (RR) and hazard ratios (HR) with 95% confidence interval (95% CI). Of the initial 1199 papers identified by our search strategy, 20 were included in this meta-analysis. Of the 8078 included patients, 1008 patients had IMVI (12.5%). Studies that re-examined histological slides showed a higher incidence of IMVI compared to studies extracting IMVI from pathology reports (17.6 versus 7.7%, P < 0.001). Detection of IMVI increased significantly with the use of additional staining (22.9 versus 12.3%, P < 0.001). IMVI was associated with a decreased CSS HR: 1.6, 95% CI 1.2-2.2 in multivariate analysis). A borderline significant effect was observed for IMVI on local recurrence (RR: 1.5, 95% CI: 0.98-2.3) and OS (RR: 1.2, 95% CI: 1.0-1.4). In conclusion, despite the limited number of studies, there is a clear association with outcome in the presence of IMVI. This warrants more attention to this under-reported prognostic factor.

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“…It is well known the importance of histological tumor grade/differentiation, of invasion depth, and of the tumor distance from the radial margin in the rectum. Less appreciated, but equally important events are tumor budding (18), extramural venous invasion (38), and perineural invasion (39). These changes occur at the tumor invasive front.…”

Section: The Problemmentioning

confidence: 99%

Detection of Intratumor Heterogeneity in Modern Pathology: A Multisite Tumor Sampling Perspective

2017

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Current sampling protocols of neoplasms along the digestive tract and in the urinary bladder have to be updated, as they do not respond to the necessities of modern personalized medicine. We show here that an adapted version of multisite tumor sampling (MSTS) is a sustainable model to overcome current deficiencies in digestive and bladder tumors when they are large enough so as to make unaffordable a total sampling. The new method is based on the divide-and-conquer algorithm and includes a slight modification of the MSTS, which proved to be useful very recently in clear cell renal cell carcinoma. This in silico analysis confirms the usefulness of MSTS for detecting intratumor heterogeneity (ITH) in tumors arising in hollow viscera. However, MSTS does not seem to improve routine traditional sampling in detecting tumor budding, extramural venous invasion, and perineural invasion. We conclude that (1) MSTS is the best method for tumor sampling to detect ITH balancing high performance and sustainable cost, (2) MSTS must be adapted to tumor shape and tumor location for an optimal performance.

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Mural and Extramural Venous Invasion and Prognosis in Colorectal Cancer

Cited by 40 publications

References 17 publications

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

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

The value of intramural vascular invasion in colorectal cancer – a systematic review and meta‐analysis

Detection of Intratumor Heterogeneity in Modern Pathology: A Multisite Tumor Sampling Perspective

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