Feasibility of mesorectal vascular invasion in predicting early distant metastasis in patients with stage T3 rectal cancer based on rectal MRI

Kim, Young Chul; Kim, Jai Keun; Kim, Do Young; Lee, Jei Hee; Shin, Sung Jae

doi:10.1007/s00330-015-3837-6

Cited by 23 publications

(13 citation statements)

References 37 publications

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“…In the present study, mrEMVI at baseline was a strong predictor of DFS. 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).…”

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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“…Newly formed capillaries are characterized by tortuous architecture and increased permeability compared with mature vessels; thus, they can be easily penetrated by tumour cells [16, 17]. mrEMVI, which is associated with a worse outcome, is an imaging indicator of tumour progression [10, 22]. In terms of biological explanations, we propose that tumour cells within intratumoural vessels, with further development, may extend into vessels outside the rectal wall to form EMVI [10, 23].…”

Section: Discussionmentioning

confidence: 99%

“…This method has shown accuracy in identifying EMVI, especially in vessels greater than 3 mm in diameter [3, 7, 8]. In addition, several studies have suggested that MRI-detected EMVI (mrEMVI) is a strongly predictive of poor prognosis [9, 10]. Therefore, the identification of EMVI based on high-resolution MRI can be regarded as more clinically relevant than histological identification.…”

Section: Introductionmentioning

confidence: 99%

Association between high-resolution MRI-detected extramural vascular invasion and tumour microcirculation estimated by dynamic contrast-enhanced MRI in rectal cancer: preliminary results

et al. 2019

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Background To determine whether magnetic resonance imaging (MRI)-detected extramural vascular invasion (mrEMVI) status is associated with quantitative perfusion parameters derived from dynamic contrast-enhanced MRI (DCE-MRI) in rectal cancer. Methods Seventy-two patients with rectal adenocarcinoma who underwent curative surgery alone within 2 weeks following rectal MRI were enrolled in this retrospective study. mrEMVI status was determined based on high-resolution MRI. The quantitative perfusion parameters ( K trans , k ep and v e ) derived from DCE-MRI were calculated from all sections containing tumours. DCE-MRI parameters and clinicopathological variables in patients with different mrEMVI statuses were compared. Results For patients who were mrEMVI positive, the tumours demonstrated significantly lower k ep values ( P = 0.012) and higher v e values ( P = 0.021) than tumours of patients who were mrEMVI negative, while the K trans value displayed no significant difference ( P = 0.390). The patients who were mrEMVI positive had larger tumour size, higher pathological tumour stage and increased regional nodal metastases compared to those who were mrEMVI negative (2.9 cm vs. 3.5 cm, P = 0.011; 63.8% vs. 92.0%, P = 0.010; 36.2% vs. 76.0%, P = 0.001; respectively). Conclusions This study demonstrated for the first time that tumour microcirculation is altered in mrEMVI-positive patients with rectal adenocarcinoma, as evidenced by significantly lower k ep and higher v e values. In addition, these patients were more likely to have a larger tumour size, a higher pathological tumour stage and regional nodal metastases than mrEMVI-negative patients.

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“…A prospective, large population-based study showed that lymph node metastasis was an independent risk factor of synchronous liver metastases in CRC (33). However, recent studies have shown that radiologic lymph node metastases from rectal MRI did not significantly predict liver metastases (16,34). Further studies are evidently needed for assessing radiologic lymph node metastases in CRC.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have reported that mesorectal vascular and fascia invasion by rectal magnetic resonance imaging (MRI) in rectal cancer patients independently predict early metastases (15,16), and thus, it was suggested that liver MRI should be performed at diagnosis in high risk patients. Recently, a clinical trial (SERENADE) was initiated to determine the usefulness of DW-MRI for screening synchronous liver metastases in high risk primary CRC patients (17).…”

Section: Index Termsmentioning

confidence: 99%

Identifying CT-Based Risk Factors Associated with Synchronous Liver Metastases in Colorectal Cancer

Seo

Choi

Kim

2017

J Korean Soc Radiol

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Feasibility of mesorectal vascular invasion in predicting early distant metastasis in patients with stage T3 rectal cancer based on rectal MRI

Abstract: • Mesorectal vascular invasion (MVI) may be a radiologic prognostic factor for rectal cancer. • Specificity of MVI was higher than lymphovascular invasion in predicting early metastasis. • Mesorectal vascular invasion may be a better predictor for early distant metastasis.

Cited by 23 publications

References 37 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

Association between high-resolution MRI-detected extramural vascular invasion and tumour microcirculation estimated by dynamic contrast-enhanced MRI in rectal cancer: preliminary results

Identifying CT-Based Risk Factors Associated with Synchronous Liver Metastases in Colorectal Cancer

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