1. 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.
- Author
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Geffen EGMV, Nederend J, Sluckin TC, Hazen SJA, Horsthuis K, Beets-Tan RGH, Marijnen CAM, Tanis PJ, and Kusters M
- Subjects
- Humans, Male, Female, Middle Aged, Retrospective Studies, Aged, Prognosis, Cross-Sectional Studies, Neoplasm Grading, Netherlands, Neoplasm Recurrence, Local diagnostic imaging, Neoplasm Recurrence, Local pathology, Neoplasm Staging, Survival Rate, Disease-Free Survival, Rectal Neoplasms pathology, Rectal Neoplasms therapy, Rectal Neoplasms diagnostic imaging, Magnetic Resonance Imaging, Neoadjuvant Therapy, Neoplasm Invasiveness
- 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., Competing Interests: Declaration of competing interest The authors have declared no conflicts of interests., (© 2024 Published by Elsevier Ltd.)
- Published
- 2024
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