MRI-detected extramural vascular invasion potentiates the risk for pathological metastasis to the lateral lymph nodes in rectal cancer

Hamabe, Atsushi; Imamura, Masayuki; Onodera, Koichi; Okita, Kenji; Nishidate, Toshihiko; Okuya, Koichi; Akizuki, Emi; Miura, Ryo; Korai, Takahiro; Hatakenaka, Masamitsu; Takemasa, Ichiro

doi:10.1007/s00595-021-02250-4

Cited by 13 publications

(17 citation statements)

References 45 publications

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“…In patients with strongly suspected LLN metastasis, multidisciplinary therapeutic interventions (e.g., preoperative therapy followed by ME and LLN dissection) might suppress LLN recurrence. Hamabe et al [ 40 ] reported that stratification based on MRI-EMVI and LLN size could be used to assess individual risk of LLN metastasis. In our present study, pretreatment MRI-EMVI and LLN size were associated with LLN metastasis.…”

Section: Discussionmentioning

confidence: 99%

Combination of extramural venous invasion and lateral lymph node size detected with magnetic resonance imaging is a reliable biomarker for lateral lymph node metastasis in patients with rectal cancer

et al. 2022

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Purpose Pathological extramural venous invasion (EMVI) is defined as the active invasion of malignant cells into veins beyond the muscularis propria in colorectal cancer. It is associated with poor prognosis and increases the risk of disease recurrence. Specific findings on MRI (termed MRI-EMVI) are reportedly associated with pathological EMVI. In this study, we aimed to identify risk factors for lateral lymph node (LLN) metastasis related to rectal cancer and to evaluate whether MRI-EMVI could be a new and useful imaging biomarker to help LLN metastasis diagnosis besides LLN size. Methods We investigated 67 patients who underwent rectal resection and LLN dissection for rectal cancer. We evaluated MRI-EMVI grading score and examined the relationship between MRI-EMVI and LLN metastasis. Results Pathological LLN metastasis was detected in 18 cases (26.9%), and MRI-EMVI was observed in 32 cases (47.8%). Patients were divided into two cohorts, according to LLN metastasis. Multivariate analyses demonstrated that higher risk of LLN metastasis was significantly associated with MRI-EMVI (P = 0.0112) and a short lateral lymph node axis (≥ 5 mm) (P = 0.0002). The positive likelihood ratios of MRI-EMVI alone, LLN size alone, and the combination of both factors were 2.12, 4.84, and 16.33, respectively. Patients negative for both showed better 2-year relapse-free survival compared to other patients (84.4% vs. 62.1%, P = 0.0374). Conclusions MRI-EMVI was a useful imaging biomarker for identifying LLN metastasis in patients with rectal cancer. The combination of MRI-EMVI and LLN size can improve diagnostic accuracy.

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Section: Discussionmentioning

confidence: 99%

Combination of extramural venous invasion and lateral lymph node size detected with magnetic resonance imaging is a reliable biomarker for lateral lymph node metastasis in patients with rectal cancer

et al. 2022

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“…Moreover, a recent study by Hamabe et al. ( 25 ) reported that MRI-based EMVI positivity in rectal cancer patients was significantly associated with pathological LPLN metastasis (OR and 95% CI, 6.53 and 1.26–33.8). In addition to all the above imaging features, a number of previous studies have also found some clinicopathological characteristics significantly associated with pathological LPLN metastasis ( 26 – 28 ).…”

Section: Discussionmentioning

confidence: 97%

“…Based on this, Hiyoshi et al reported that clinical mesorectal node positivity (cN+) based on MRI could also be a predictive factor to evaluate LPLN status preoperatively (24). Moreover, a recent study by Hamabe et al (25) reported that MRIbased EMVI positivity in rectal cancer patients was significantly associated with pathological LPLN metastasis (OR and 95% CI, 6.53 and 1. 26-33.8).…”

Section: Discussionmentioning

confidence: 98%

Development and External Validation of a Preoperative Nomogram for Predicting Lateral Pelvic Lymph Node Metastasis in Patients With Advanced Lower Rectal Cancer

Zhang

Shi

et al. 2022

Front. Oncol.

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BackgroundThe preoperative prediction of lateral pelvic lymph node (LPLN) metastasis is crucial in determining further treatment strategies for advanced lower rectal cancer patients. In this study, we established a nomogram model to preoperatively predict LPLN metastasis and then externally validated the accuracy of this model.MethodsA total of 287 rectal cancer patients who underwent LPLN dissection were included in this study. Among them, 200 patients from the Peking University First Hospital were included in the development set, and 87 patients from the First Affiliated Hospital of Xi’an Jiaotong University were included in the independent external validation set. Multivariate logistic regression analysis was used to develop the nomogram. The performance of the nomogram was assessed based on its calibration, discrimination, and clinical utility.ResultsFive factors (differentiation grade, extramural vascular invasion, distance of the tumor from the anal verge, perirectal lymph node status, and largest short-axis diameter of LPLN) were identified and included in the nomogram. The nomogram developed based on the analysis showed robust discrimination with an area under the receiver operating characteristic curve (AUC) of 0.878 (95% CI, 0.824–0.932). The validation set showed good discrimination with an AUC of 0.863 (95% CI, 0.779–0.948). Decision curve analysis showed that the nomogram was clinically useful.ConclusionsThe present study proposed a clinical-imaging nomogram with a combination of clinicopathological risk factors and imaging features. After external verification, the predictive power of the nomogram model was satisfactory, and it is expected to be a convenient, visual, and personalized clinical tool for assessing the risk of LPLN metastasis in advanced lower rectal cancer patients.

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“…Perineural growth and lympho-vascular invasion are known risk factors for recurrence in rectal cancer and are found in approximately one in every four to five patients with rectal cancer during histopathological examination [ 16 , 17 ]. The significance of extramural vascular invasion as a risk factor of LLNM has recently been recognised and requires further studies [ 18 ]. The specific prognostic value of these risk factors varies however with other tumour characteristics, especially in high-risk tumours [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Management, treatment and prognostic significance of lateral lymph node metastases in rectal cancer—a regional cohort study

Agger

Åkerlund

Ekberg

et al. 2021

Int J Colorectal Dis

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Purpose Lateral lymph node metastases in rectal cancer remain a clinical challenge. Different treatment regimens have been suggested. This retrospective regional cohort study examines outcome after combined oncological and surgical treatment of MRI-positive lateral lymph nodes (LLN). Methods Data from the Swedish Colorectal Cancer Registry (SCRCR) and patient records were used for retrospective analysis of resected high-risk rectal cancers between 2009 and 2014. The aim was to compare tumour characteristics, neoadjuvant therapy, recurrence and outcome after lateral lymph node dissection. Results One thousand and one hundred nineteen cases were identified and after exclusion 344 patients with cT3–T4 ≤ 10 cm from the anal verge were analysed. Thirty (8.7%) patients with MRI-positive LLN were identified. Synchronous distant metastases were associated with MRI-positive LLN (p-value 0.019). Long-course chemoradiotherapy was clinical practice in cases of MRI-positive LLN. No differences in local (p-value 0.154) or distant (p-value 0.343) recurrence rates between MRI-positive LLN patients and MRI-negative patients were detected. Only four patients underwent lateral lymph node dissection (LLND). There was no significant difference in overall survival during follow-up between the MRI-negative (CI at 95%; 99–109 months) and MRI-positive group (CI at 95%; 69–108 months; p-value 0.14). Conclusion Lateral lymph node metastases present a challenging clinical situation. The present study shows that combination of neoadjuvant therapy and selective LLND is an applicable strategy in cases of MRI-positive LLN.

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MRI-detected extramural vascular invasion potentiates the risk for pathological metastasis to the lateral lymph nodes in rectal cancer

Cited by 13 publications

References 45 publications

Combination of extramural venous invasion and lateral lymph node size detected with magnetic resonance imaging is a reliable biomarker for lateral lymph node metastasis in patients with rectal cancer

Combination of extramural venous invasion and lateral lymph node size detected with magnetic resonance imaging is a reliable biomarker for lateral lymph node metastasis in patients with rectal cancer

Development and External Validation of a Preoperative Nomogram for Predicting Lateral Pelvic Lymph Node Metastasis in Patients With Advanced Lower Rectal Cancer

Management, treatment and prognostic significance of lateral lymph node metastases in rectal cancer—a regional cohort study

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