Persistent extramural vascular invasion positivity on magnetic resonance imaging after neoadjuvant chemoradiotherapy predicts poor outcome in rectal cancer

被引:9
作者
Guner, Osman Serhat [1 ,3 ]
Tumay, Latif Volkan [2 ,3 ]
机构
[1] Acibadem Bodrum Hosp, Dept Surg, Bodrum, Mugla, Turkey
[2] Acibadem Bursa Hosp, Dept Surg, Bursa, Turkey
[3] Acibadem Univ, Vocat Sch Hlth Sci, Istanbul, Turkey
关键词
Extramural vascular invasion (EMVI); Magnetic resonance imaging (MRI); Neoadjuvant chemoradiotherapy; Outcome; Rectal cancer; Survival; CIRCUMFERENTIAL MARGIN INVOLVEMENT; VENOUS INVASION; PROGNOSTIC-SIGNIFICANCE; TUMOR RESPONSE; PREOPERATIVE CHEMORADIOTHERAPY; RESECTION MARGIN; LOCAL RECURRENCE; MRI; METASTASIS; SURVIVAL;
D O I
10.1016/j.asjsur.2021.01.011
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: In rectal cancer, extramural vascular invasion (EMVI) is the presence of tumour cells in blood vessels outside the muscular layer, which is associated with poor prognosis. Regression of EMVI on MRI following neoadjuvant chemoradiotherapy or its persistence may have prognostic implications. Methods: This retrospective study included 52 patients with rectal cancer who underwent total mesorectal excision following long-course neoadjuvant chemoradiotherapy (CRT). EMVI assessments were done on previous pelvic MRIs obtained before neoadjuvant CRT and eight weeks after the completion of neoadjuvant chemoradiotherapy in initially EMVI positive cases. Results: Persistently EMVI positive patients had worse overall survival and disease-free survival compared to initially EMVI negative patients and patients who returned to negative (p < 0.001 for both). Multivariate analysis identified persistent EMVI positivity after neoadjuvant treatment (HR, 102.9; p = 0.003) as significant independent predictor of worse overall survival; and persistent EMVI positivity (HR, 17.0; p = 0.002), mesorectal fascia involvement after neoadjuvant treatment (HR, 8.0; p = 0.017), and poor differentiation (HR, 10.3, p = 0.012) as significant independent predictors of worse disease-free survival. Conclusion: Persistent EMVI positivity after neoadjuvant therapy appears to be an independent factor for poor overall survival; and persistent EMVI positivity as well as mesorectal fascia involvement on post neoadjuvant therapy MRI and poor differentiation appears to be important predictors of poor disease free survival in rectal cancer patients. (c) 2021 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).
引用
收藏
页码:841 / 847
页数:7
相关论文
共 38 条
[1]   ROLE OF CIRCUMFERENTIAL MARGIN INVOLVEMENT IN THE LOCAL RECURRENCE OF RECTAL-CANCER [J].
ADAM, IJ ;
MOHAMDEE, MO ;
MARTIN, IG ;
SCOTT, N ;
FINAN, PJ ;
JOHNSTON, D ;
DIXON, MF ;
QUIRKE, P .
LANCET, 1994, 344 (8924) :707-711
[2]   Optimal Imaging Strategies for Rectal Cancer Staging and Ongoing Management [J].
Balyasnikova, Svetlana ;
Brown, Gina .
CURRENT TREATMENT OPTIONS IN ONCOLOGY, 2016, 17 (06)
[3]   Parameters for Predicting Tumour Response Following Neoadjuvant Chemoradiotherapy for Patients with Rectal Cancer [J].
Bengulescu, Iustinian ;
Radu, Petru ;
Iorga, Cristian ;
Bratucu, Mircea ;
Pasnicu, Costin ;
Garofil, Dragos ;
Popa, Florian ;
Strambu, Victor .
CHIRURGIA, 2020, 115 (03) :365-372
[4]   Rectal Cancer, Version 2.2018 Clinical Practice Guidelines in Oncology [J].
Benson, Al B., III ;
Venook, Alan P. ;
Al-Hawary, Mahmoud M. ;
Cederquist, Lynette ;
Chen, Yi-Jen ;
Ciombor, Kristen K. ;
Cohen, Stacey ;
Cooper, Harry S. ;
Deming, Dustin ;
Engstrom, Paul F. ;
Grem, Jean L. ;
Grothey, Axel ;
Hochster, Howard S. ;
Hoffe, Sarah ;
Hunt, Steven ;
Kamel, Ahmed ;
Kirilcuk, Natalie ;
Krishnamurthi, Smitha ;
Messersmith, Wells A. ;
Meyerhardt, Jeffrey ;
Mulcahy, Mary F. ;
Murphy, James D. ;
Nurkin, Steven ;
Saltz, Leonard ;
Sharma, Sunil ;
Shibata, David ;
Skibber, John M. ;
Sofocleous, Constantinos T. ;
Stoffel, Elena M. ;
Stotsky-Himelfarb, Eden ;
Willett, Christopher G. ;
Wuthrick, Evan ;
Gregory, Kristina M. ;
Gurski, Lisa ;
Freedman-Cass, Deborah A. .
JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK, 2018, 16 (07) :874-901
[5]   Intramural and extramural vascular invasion in colorectal cancer Prognostic Significance and Quality of Pathology Reporting [J].
Betge, Johannes ;
Pollheimer, Marion J. ;
Lindtner, Richard A. ;
Kornprat, Peter ;
Schlemmer, Andrea ;
Rehak, Peter ;
Vieth, Michael ;
Hoefler, Gerald ;
Langner, Cord .
CANCER, 2012, 118 (03) :628-638
[6]   Rectal adenocarcinoma: assessment of tumour involvement of the lateral resection margin by MRI of resected specimen [J].
Blomqvist, L ;
Rubio, C ;
Holm, T ;
Machado, M ;
Hindmarsh, T .
BRITISH JOURNAL OF RADIOLOGY, 1999, 72 (853) :18-23
[7]   Histological grading based on poorly differentiated clusters is predictive of tumour response and clinical outcome in rectal carcinoma treated with neoadjuvant chemoradiotherapy [J].
Bonetti, Luca Reggiani ;
Lionti, Simona ;
Domati, Federica ;
Pagliani, Giuliana ;
Mattioli, Elisabetta ;
Barresi, Valeria .
HISTOPATHOLOGY, 2017, 71 (03) :393-405
[8]   Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study [J].
Brown, G. ;
Daniels, I. R. ;
Heald, R. J. ;
Quirke, P. ;
Blomqvist, L. ;
Sebag-Montefiore, D. ;
Moran, B. J. ;
Holm, T. ;
Strassbourg, J. ;
Peppercorn, P. D. ;
Fisher, S. E. ;
Mason, B. .
BRITISH MEDICAL JOURNAL, 2006, 333 (7572) :779-782
[9]   Thin section MRI in multidisciplinary pre-operative decision making for patients with rectal cancer [J].
Brown, G .
BRITISH JOURNAL OF RADIOLOGY, 2005, 78 :S117-S127
[10]   Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging [J].
Brown, G ;
Radcliffe, AG ;
Newcombe, RG ;
Dallimore, NS ;
Bourne, MW ;
Williams, GT .
BRITISH JOURNAL OF SURGERY, 2003, 90 (03) :355-364