The prognostic importance of MRI detected extramural vascular invasion (mrEMVI) in locally advanced rectal cancer

Broek, J.J. van den; Wolf, Floor S. W. van der; Heijnen, Luc A.; Schreurs, W. H.

doi:10.1007/s00384-020-03632-9

Cited by 16 publications

(14 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Various studies demonstrate development of distant metastases in 6.7 to 23% mrEMVI negative cases compared with 24.5 to 55% in mrEMVI positive cases. 8 24 27 Our India-specific data shows a similar trend, with 26% mrEMVI negative and 41% mrEMVI positive developing distant metastases. The percentage of mrEMVI negative patients developing subsequent metastatic recurrence is slightly higher than other studies; the reasons for this could include the higher incidence of signet cell tumors in the Indian population and possible relatively advanced tumors at the time of presentation.…”

Section: Discussionsupporting

confidence: 67%

“…There is mixed data with regards to correlation of mrEMVI with OS, with some studies not finding statistically significant correlation. 28,29 While others demonstrating significantly worsened survival in mrEMVI positive patients, 24,27 our study findings showed a 3-year OS of 82% for mrEMVI positive cases, which was lesser than the OS of 87% for mrEMVI negative patients, but not statistically significant.…”

Section: Discussioncontrasting

confidence: 62%

See 1 more Smart Citation

Prognostic Significance of EMVI in Rectal Cancer in a Tertiary Cancer Hospital in India

Pangarkar

Baheti

Mistry

et al. 2021

Indian J Radiol Imaging

View full text Add to dashboard Cite

Background Presence of extramural venous invasion (EMVI) is a poor prognostic factor for rectal cancer as per literature. However, India-specific data are lacking. Aim The aim of the study is to determine the prognostic significance of EMVI in locally advanced rectal cancer on baseline MRI. Materials and Methods We retrospectively reviewed 117 MRIs of operable non-metastatic locally advanced rectal cancers in a tertiary cancer institute. Three dedicated oncoradiologists determined presence or absence of EMVI, and its length and thickness, in consensus. These patients were treated as per standard institutional protocols and followed up for a median period of 37 months (range: 2–71 months). Kaplan-Meier curves (95% CI) were used to determine disease-free survival (DFS), distant-metastases free survival (DMFS), and overall survival (OS). Univariate analysis was performed by comparing groups with log-rank test. Results EMVI positive cases were 34/114 (29%). More EMVI-positive cases developed distant metastasis compared with EMVI-negative cases (14/34–41% vs. 22/83–26%). The difference, however, was not statistically significant (p = 0.146). After excluding signet-ring cell cancers (n = 14), EMVI showed significant correlation with DMFS (p = 0.046), but not with DFS or OS. The median thickness and length of EMVI was 6 and 14 mm, respectively in patients who developed distant metastasis, as compared with 5 and 11 mm in those who did not, although this difference was not statistically significant. Conclusion EMVI is a predictor of distant metastasis in locally advanced non-metastatic, non-signet ring cell rectal cancers. EMVI can be considered another high-risk feature to predict distant metastasis.

show abstract

Section: Discussionsupporting

confidence: 67%

Section: Discussioncontrasting

confidence: 62%

Prognostic Significance of EMVI in Rectal Cancer in a Tertiary Cancer Hospital in India

Pangarkar

Baheti

Mistry

et al. 2021

Indian J Radiol Imaging

View full text Add to dashboard Cite

show abstract

“…In cases positive for MRI-EMVI, a short course of preoperative radiotherapy (SCPRT) or CRT is recommended, with the aim of reducing recurrence. Previous studies reveal correlations between MRI-EMVI and prognosis in terms of overall survival, RFS, and increased distant recurrence [ 7 , 9 , 12 , 34 , 35 ]. Smith et al [ 7 ] found significantly a worse 3-year RFS rate among patients positive for MRI-EMVI (35.0%) compared to patients negative for MRI-EMVI (74.1%).…”

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

View full text Add to dashboard Cite

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.

show abstract

“…None of the trials had been established to investigate the effect of mrEMVI on prognosis, but did report mrEMVI status as part of a multivariate analysis. After qualitative analysis, a consensus decision among authors (JT and RC) was made to exclude 13 articles owing to overlapping patient populations (n = 4), [23][24][25][26] high selection bias (n = 1), 27 high attrition bias (n = 3), [28][29][30] poor quality (n = 2), 31,32 no differentiation between baseline mrEMVI and post-treatment mrEMVI (n = 2), 14,15 and results not being comparable with other studies in the meta-analysis (n = 1). 33 Attrition bias was considered significant if median follow-up was short but 3-or 5-year survival outcomes were still reported.…”

Section: Qualitative Assessmentmentioning

confidence: 99%

Prognostic Importance of MRI-Detected Extramural Venous Invasion in Rectal Cancer: A Literature Review and Systematic Meta-Analysis

Tan

Carten

Babiker

et al. 2021

International Journal of Radiation Oncology*Biology*Physics

View full text Add to dashboard Cite

Purpose: Extramural venous invasion (EMVI) is recognized as a poor prognostic factor in rectal cancer. There are well-documented limitations associated with pathology detection of EMVI, including variable reporting and the inability to use it preoperatively to guide neoadjuvant treatment. Magnetic resonance imaging (MRI)-detected EMVI (mrEMVI) has been proposed as an imaging biomarker. This review assesses the prognostic significance of mrEMVI on survival outcomes and whether regression of mrEMVI after neoadjuvant therapy is associated with improvements in survival. Methods and Materials: An electronic search was carried out using MEDLINE and EMBASE databases using the search terms "rectum," "cancer,", "MRI," and "outcomes." A systematic review and meta-analysis were carried out in accordance with Preferred Reporting for Systematic Reviews and Meta-Analyses guidelines using Review Manager software. A qualitative review was performed. Results: A total of 7399 articles were identified, of which 33 were relevant to the review question. After a qualitative assessment, 20 articles were included in the meta-analysis. Baseline mrEMVI positivity is associated with significantly worsened overall survival (hazard ratio [HR] 1.84; 95% confidence interval [CI], 1.33-2.54; P = .0001) and significantly worsened disease-free survival (HR 2.41; 95% CI, 2.02-2.89; P < .00001). After neoadjuvant treatment, a positive mrEMVI status is associated with a significantly worsened overall and disease-free survival. Only 3 papers specifically looked at mrEMVI regression, but the results show that persistent mrEMVI-positive status after treatment is associated with significantly worsened disease-free survival compared with a change in mrEMVI from positive to negative (HR 1.93; 95% CI, 1.39-2.68; P < .0001). A subgroup analysis of MRI-detected lymph node metastases showed no significant association with survival, with a hazard ratio of 1.33 (95% CI, 0.98-1.80; P = .06). Conclusion: mrEMVI is significantly associated with worsened survival outcomes, both at baseline and after neoadjuvant treatment. Additionally, there is evidence that regression of mrEMVI after neoadjuvant treatment is associated with improved survival compared with mrEMVI persistence. The findings of this review emphasize the need for accurate and consistent reporting of mrEMVI status before and after neoadjuvant treatment and support the inclusion of mrEMVI into staging systems

show abstract

The prognostic importance of MRI detected extramural vascular invasion (mrEMVI) in locally advanced rectal cancer

Cited by 16 publications

References 14 publications

Prognostic Significance of EMVI in Rectal Cancer in a Tertiary Cancer Hospital in India

Prognostic Significance of EMVI in Rectal Cancer in a Tertiary Cancer Hospital in India

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

Prognostic Importance of MRI-Detected Extramural Venous Invasion in Rectal Cancer: A Literature Review and Systematic Meta-Analysis

Contact Info

Product

Resources

About