Oncologic Outcomes Associated With MRI-detected Extramural Venous Invasion (mrEMVI) in Rectal Cancer

Fournier, F; Motamedi, Mohammad Ali Kalantar; Brown, Carl J; Phang, Terry; Raval, Manoj J.; Hague, Cameron; Karimuddin, Ahmer

doi:10.1097/sla.0000000000004636

Cited by 16 publications

(16 citation statements)

References 44 publications

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“…Even if several studies suggest this conclusion, 15–17 EMVI is still not really considered in the decision‐making during MDT meetings 30 . Many potentially already metastatic patients are treated focusing only on the primary rectal tumor (CRT plus TME).…”

Section: Discussionmentioning

confidence: 99%

“…The transition of chemotherapy into the preoperative phase requires robust predictive factors to guide patient selection. Among the predictors of distant recurrence, extramural vascular invasion (EMVI) detected by preoperative MRI is emerging as one of the most accurate 14–17 . This study analyzed the relationship between MRI‐detected EMVI (mrEMVI), its pathological counterpart (pEMVI), and the development of distant metastases in a single‐center series of resected rectal cancers.…”

Section: Introductionmentioning

confidence: 99%

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MRI‐detected extramural vascular invasion (mrEMVI) as the best predictive factor to identify candidates to total neoadjuvant therapy in locally advanced rectal cancer

Massucco

Fontana

Mussetto

et al. 2022

Journal of Surgical Oncology

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Background and Objectives Chemotherapy in locally advanced rectal cancer (LARC) is shifting from an adjuvant setting to a total neoadjuvant therapy (TNT) strategy, that relies on distant metastases (DM) risk prediction. This study aims to assess the accuracy of magnetic resonance imaging‐detected extramural vascular invasion (mrEMVI) as predictive factor for DM in LARC, compared with other MRI‐detected and pathologic factors. Methods This retrospective single‐center study analyzed data extracted from a series of consecutive patients curatively resected for rectal cancer at Mauriziano Hospital in Turin (Italy) from January 2013 to December 2018. Results Data from 69 patients were analyzed. MrEMVI was detected in 31 (44.9%) cases. Median follow‐up was 39.9 months. DM and local recurrence occurred in 19 (27.5%) and 4 (5.8%) patients. One‐ and 3‐year cumulative incidence of DM were 32.3% (95% confidence interval [CI]: 0.17–0.49) and 56.8% (95% CI: 0.35–0.74) in the mrEMVI‐positive group and 5.4% (95% CI: 0.01–0.16) and 14.0% (95% CI: 0.05–0.27) in the mrEMVI‐negative group (log‐rank test, p < 0.001). In the multivariate analysis of MRI factors, mrEMVI was the only independent predictor of DM (HR: 3.59, CI: 1.21–10.69, p = 0.02). Conclusions This study confirmed that mrEMVI is a powerful predictor of DM in LARC. It should be routinely reported and considered during multidisciplinary care strategy planning.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

MRI‐detected extramural vascular invasion (mrEMVI) as the best predictive factor to identify candidates to total neoadjuvant therapy in locally advanced rectal cancer

Massucco

Fontana

Mussetto

et al. 2022

Journal of Surgical Oncology

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“…This feature is a stronger predictor of distant metastasis than other morphologic features of the tumor observed by MRI. Preoperative EMVI positivity in localized advanced rectal cancer also significantly increases the risk of recurrence and metastasis after radical surgery ( 3 , 4 ). The National Comprehensive Cancer Network (NCCN) and the European Society of Medical Oncology (ESMO) include baseline EMVI status as a risk stratification factor in patients with rectal cancer ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

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

Tian

Li²,

Xie³

et al. 2023

Front. Oncol.

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PurposeThis study verified the value of magnetic resonance imaging (MRI) to construct a nomogram to preoperatively predict extramural vascular invasion (EMVI) in rectal cancer using MRI characteristics.Materials and methodsThere were 55 rectal cancer patients with EMVI and 49 without EMVI in the internal training group. The external validation group consisted of 54 rectal cancer patients with EMVI and 55 without EMVI. High-resolution rectal T2WI, pelvic diffusion-weighted imaging (DWI) sequences, and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) were used. We collected the following data: distance between the lower tumor margin and the anal margin, distance between the lower tumor margin and the anorectal ring, tumor proportion of intestinal wall, mrT stage, maximum tumor diameter, circumferential resection margin, superior rectal vein width, apparent diffusion coefficient (ADC), T2WI EMVI score, DWI and DCE-MRI EMVI scores, demographic information, and preoperative serum tumor marker data. Logistic regression analyses were used to identify independent risk factors of EMVI. A nomogram prediction model was constructed. Receiver operating characteristic curve analysis verified the predictive ability of the nomogram. P < 0.05 was considered significant.ResultTumor proportion of intestinal wall, superior rectal vein width, T2WI EMVI score, and carbohydrate antigen 19-9 were significant independent predictors of EMVI in rectal cancer and were used to create the model. The areas under the receiver operating characteristic curve, sensitivities, and specificities of the nomogram were 0.746, 65.45%, and 83.67% for the internal training group, respectively, and 0.780, 77.1%, and 71.3% for the external validation group, respectively.Data conclusionA nomogram including MRI characteristics can predict EMVI in rectal cancer preoperatively and provides a valuable reference to formulate individualized treatment plans and predict prognosis.

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“…For patients with rectal cancer, extramural venous invasion (EMVI) is associated with high rates of distant metastasis and low rates of overall survival (OS) 1,2 . Traditionally, EMVI has been diagnosed by the pathological analysis of surgical tumor specimens.…”

Section: Introductionmentioning

confidence: 99%

Survival outcomes of different neoadjuvant treatment regimens in patients with locally advanced rectal cancer and MRI‐detected extramural venous invasion

Chen,

Ma,

Song

et al. 2023

Cancer Medicine

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PurposeMRI‐detected extramural venous invasion (mrEMVI) is associated with poor survival outcomes in patients with locally advanced rectal cancer (LARC). An mrEMVI‐positive status is considered a strong indication for neoadjuvant treatment, but the optimal regimen is unknown.Patients and MethodsWe retrospectively compared pathological and survival outcomes of 584 patients diagnosed with mrEMVI‐positive rectal cancer between January 2013 and October 2021, and receiving either neoadjuvant chemotherapy (NCT) alone, neoadjuvant chemoradiotherapy (nCRT) alone, or nCRT plus NCT, prior to total mesorectal excision. Propensity score matching (PSM) was used to balance clinical bias between groups, which were compared using chi‐square testing and Kaplan–Meier curves.ResultsMedian follow‐up was 33.9 (range, 10.2–100.4) months. The 3‐year overall survival (OS), disease‐free survival (DFS), distant metastasis‐free survival (DMFS), and locoregional relapse‐free survival (LRFS) rates for all patients were 90.4%, 57.5%, 61.1%, and 85.7%, respectively. Of 584 mrEMVI‐positive patients at the time of diagnosis, 457 (78.3%) were EMVI‐negative on surgical pathology, and they had significantly better 3‐year OS, DMFS, DFS, and LRFS rates (all p < 0.001) than patients who remained EMVI‐positive. After PSM was applied, patients receiving nCRT alone had significantly better 3‐year OS (96.8% vs. 86.5%, p = 0.005) and DMFS (67.1% vs. 53.5%, p = 0.03) rates than those receiving NCT alone. Patients receiving NCT plus nCRT had higher pathological complete response (PCR) (10.8% vs. 2.7%, p = 0.04) and downstaging (33.8% vs. 5.3%, p < 0.001) rates than those receiving nCRT alone, but survival rates did not differ (all p > 0.05).ConclusionMost EMVI‐positive patients with LARC converted to EMVI‐negative after neoadjuvant treatment, resulting in improved OS and DFS. Patients receiving nCRT had more favorable survival outcomes than those receiving NCT, suggesting the importance of including neoadjuvant radiotherapy. Patients receiving NCT in addition to nCRT had higher rates of PCR and downstaging, but their survival rates were not better.

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Oncologic Outcomes Associated With MRI-detected Extramural Venous Invasion (mrEMVI) in Rectal Cancer

Cited by 16 publications

References 44 publications

MRI‐detected extramural vascular invasion (mrEMVI) as the best predictive factor to identify candidates to total neoadjuvant therapy in locally advanced rectal cancer

MRI‐detected extramural vascular invasion (mrEMVI) as the best predictive factor to identify candidates to total neoadjuvant therapy in locally advanced rectal cancer

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

Survival outcomes of different neoadjuvant treatment regimens in patients with locally advanced rectal cancer and MRI‐detected extramural venous invasion

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