The prognostic value of extramural venous invasion in preoperative MRI of rectal cancer patients

Abstract

Aim This study aimed to examine the prognostic value of extramural venous invasion observed in preoperative MRI on survival and recurrences. Method In total, 778 rectal cancer patients were evaluated in multidisciplinary meetings in Helsinki University Hospital during the years 2016–2018. 635 patients met the inclusion criteria of stage I–III disease and were intended for curative treatment at the time of diagnosis. 128 had extramural venous invasion in preoperative MRI. Results The median follow‐up time was 2.5 years. In a univariate analysis extramural venous invasion was associated with poorer disease‐specific survival (hazard ratio [HR] 2.174, 95% CI 1.118–4.224, P = 0.022), whereas circumferential margin ≤1 mm, tumour stage ≥T3c or nodal positivity were not. Disease recurrence occurred in 17.3% of the patients: 13.4% had metastatic recurrence only, 1.7% mere local recurrence and 2.2% both metastatic and local recurrence. In multivariate analysis, extramural venous invasion (HR 1.734, 95% CI 1.127–2.667, P = 0.012) and nodal positivity (HR 1.627, 95% CI 1.071–2.472, P = 0.023) were risk factors for poorer disease‐free survival (DFS). Circumferential margin ≤1 mm was a risk factor for local recurrence in multivariate analysis (HR 5.675, 95% CI 1.274–25.286, P = 0.023). Conclusion In MRI, circumferential margin ≤1 mm is a risk factor for local recurrence, but the risk is quite well controlled with chemoradiotherapy and extended surgery. Extramural venous invasion instead is a significant risk factor for poorer DFS and new tools to reduce the systemic recurrence risk are needed.

Prognostic Analysis of Lymphovascular Invasion in Stages I–III Colorectal Cancer

“…28 For patients with rectal cancer, EMVI reported before magnetic resonance imaging also has predictive significance for tumor recurrence and metastasis. 30 However, the prognostic significance of intramural vascular invasion and lymphatic invasion is controversial. [31][32][33] In our study, 10 variables, including age, sex, CEA level, perineural invasion, tumor location, T stage, N stage, histologic grade, neoadjuvant chemoradiotherapy, and chemoradiation were initially included.…”

“…The survival analysis showed that EMVI decreased survival over time 28. For patients with rectal cancer, EMVI reported before magnetic resonance imaging also has predictive significance for tumor recurrence and metastasis 30. However, the prognostic significance of intramural vascular invasion and lymphatic invasion is controversial 31–33…”

Extramural vascular invasion nomogram before radical resection of rectal cancer based on magnetic resonance imaging

“…Many researchers have used this scoring system to preoperatively evaluate the EMVI status of rectal cancer alongside imaging features, serological tumor markers, pathological and genetic tests, and other features, but the results are inconsistent. Further, some of these methods are invasive, and we must consider the accuracy and sensitivity of diagnosis ( 10 , 11 ). Therefore, identifying, convenient, and accurate methods to predict EMVI in rectal cancer is worthwhile.…”

The ability of magnetic resonance imaging to predict lymph node metastases and the risk of recurrence in rectal cancer

“…1 The risk of rectal cancer recurrence (17.3%-39%), either metastatic or local, varies greatly depending on the stage and location of the tumour and the possible preoperative chemoradiotherapy. 2,3 Moreover, the local recurrence risk is smaller (7.1%-20%), yet still represents a rather significant cause of morbidity in patients. 4 Pretreatment magnetic resonance imaging (MRI) serves as an important tool for preoperative multidisciplinary team (MDT) meetings when weighing treatment options for a patient with nonmetastatic rectal cancer.…”

“…Rectal cancer impacts the lives of approximately 732 000 people in the world annually 1 . The risk of rectal cancer recurrence (17.3%–39%), either metastatic or local, varies greatly depending on the stage and location of the tumour and the possible preoperative chemoradiotherapy 2,3 . Moreover, the local recurrence risk is smaller (7.1%–20%), yet still represents a rather significant cause of morbidity in patients 4 …”