open access publication

Article, 2024

Prognostic significance of MRI-detected extramural venous invasion according to grade and response to neo-adjuvant treatment in locally advanced rectal cancer A national cohort study after radiologic training and reassessment

European Journal of Surgical Oncology, ISSN 0748-7983, Volume 50, 6, 10.1016/j.ejso.2024.108307

Contributors

Geffen E.G.M.V. 0000-0003-4700-0633 [1] [2] Nederend J. 0000-0002-9905-5866 [3] Sluckin T.C. [1] [2] Hazen S.-M.J.A. 0000-0001-8372-1986 [1] [2] Horsthuis K. 0000-0001-9699-4561 [1] [2] Beets-Tan R.G.H. 0000-0002-8533-5090 [4] [5] [6] Marijnen C.A.M. 0000-0003-0189-5953 [6] [7] Tanis P.J. 0000-0002-3146-3310 [1] [8] [9] Kusters M. 0000-0002-2468-9186 (Corresponding author) [1] [2] Aalbers A.G.J. van Aalten S.M. Amelung F.J. Ankersmit M. Antonisse I.E. Ashruf J.F. Aukema T.S. Avenarius H. Bahadoer R.R. Bakers F.C.H. Bakker I.S. Bangert F. Barendse R.M. Beekhuis H.M.D. Beets G.L. 0000-0002-1671-9912 Bemelman W.A. Berbee M. de Bie S.H. Bisschops R.H.C. Blok R.D. van Bockel L.W. Boer A.H. Den Boer F.C. Boerma E.-J.G. Boogerd L.S.F. Borstlap J. Borstlap W.A.A. Bouwman J.E. Braak S.J. Braat M.N.G.J.A. Bradshaw J. Brandsma A.T.A. van Breest Smallenburg V. van den Broek W.T. van der Burg S.W. Burger J.W.A. Burghgraef T.A. Ten Cate D.W.G. 0009-0003-3152-0797 Ceha H.M. Cnossen J.S. Coebergh Van Den Braak R.R.J. Consten E.C.J. Corver M. Crolla R.M.P.H. Curutchet S. Daniels-Gooszen A.W. Davids P.H.P. Dekker E.N. Dekker J.W.T. 0000-0002-3429-468X Demirkiran A. 0000-0001-8104-3296 Derksen T. Diederik A.L. Dinaux A.M. Dogan K. van Dop I.M. Droogh-De Greve K.E. Duijsens H.M.H. Dunker M.S. Duyck J. van Duyn E.B. van Egdom L.S.E. Eijlers B. El-Massoudi Y. van Elderen S. Emmen A.M.L.H. Engelbrecht M. van Erp A.C. 0000-0001-7336-6319 van Essen J.A. Fabry H.F.J. Fassaert T. Feitsma E.A. Feshtali S.S. Frietman B. Furnee E.J.B. 0000-0002-3712-3798 van Geel A.M. Geijsen E.D. Van Geloven A.A.W. Gerhards M.F. Gielkens H. van Gils R.A.H. Goense L. Govaert M.J.P.M. van Grevenstein W.M.U. Joline De Groof E. de Groot I. de Haas R.J. 0000-0002-4915-6781 Hakkenbrak N.A.G. Hartogh M.D. Heesink V. Heikens J.T. Hendriksen E.M. van den Hoek S. van der Hoeven E.J.R.J. Hoff C. Hogewoning A. Hogewoning C.R.C. Hoogendoorn S. van Hoorn F. van der Hul R.L. van Hulst R. Imani F. 0000-0001-6641-9945 Inberg B. Intven M.P.W. 0000-0002-5068-5517 Janssen P. de Jong C.E.J. Jonkers J. Jou-Valencia D. Keizers B. Ketelaers S.H.J. Knops E. van Koeverden S. Kok S. Kolderman S.E.M. de Korte F.I. Kortekaas R.T.J. Korving J.C. Koster I.M. Krdzalic J. Krielen P. 0000-0002-1294-7053 Kroese L.F. Krul E.J.T. Lahuis D.H.H. Lamme B. van Landeghem A.A.G. Leijtens J.W.A. Leseman-Hoogenboom M.M. de Lijster M.S. Marsman M.S. Martens M.H. Masselink I. van der Meij W. Meijnen P. Melenhorst J. de Mey D.J.L. Moelker-Galuzina J. Morsink L. Mulder E.J. Muller K. Musters G.D. Neijenhuis P.A. de Nes L.C.F. Nielen M. van den Nieuwboer J.B.J. Nieuwenhuis J.F. Nonner J. Noordman B.J. Nordkamp S. Olthof P.B. Oosterling S.J. Ootes D. Oppedijk V. Ott P. Paulusma I. Peeters K.C.M.J. Pereboom I.T.A. Peringa J. Pironet Z. Plate J.D.J. Polat F. Poodt I.G.M. Posma L.A.E. Prette J.F. Pultrum B.B. Qaderi S.M. van Rees J.M. Renger R.-J. Rombouts A.J.M. Roosen L.J. Roskott-Ten Brinke E.A. Rothbarth J. Rouw D.B. Rozema T. Rutten H. Rutten H.J.T. 0000-0003-2532-950X van der Sande M.E. Schaafsma B.E. Schasfoort R.A. Scheurkogel M.M. Schouten Van Der Velden A.P. Schreurs W.H. Schuivens P.M.E. Sietses C. Simons P.C.G. Slob M.J. Slooter G.D. van der Sluis M. Smalbroek B.P. Smits A.B. Spillenaar-Bilgen E.J. Spruit P.H. Stam T.C. Stoker J. Talsma A.K. Temmink S.J.D. The G.Y.M. Tielbeek J.A.W. van Tilborg A.A.J.M. van Tilborg F. van Trier D. Tuynman J.B. 0000-0001-5952-8000 van der Valk M.J.M. Vanhooymissen I.J.S. Vasbinder G.B.C. Veeken C.J. Velema L.A. van de Ven A.W.H. Verdaasdonk E.G.G. Verduin W.M. Verhagen T. Verheijen P.M. Vermaas M. Verrijssen A.-S.E. Verschuur A.V.D. Schaik H.V.-V. Vliegen R.F.A. Voets S. Vogelaar F.J. Vogelij C.L.A. Vos-Westerman J. de Vries M. Vroemen J.C. van Vugt B.S.T. Wegdam J.A. van Wely B.J. Westerterp M. van Westerveld P.P. van Westreenen H.L. Wijma A.G. de Wilt J.H.W. de Wit B.W.K. Wit F. Woensdregt K. van Woerden V. van der Wolf F.S.W. van der Wolk S. Wybenga J.M. van der Zaag E.S. Zamaray B. Zandvoort H.J.A. van der Zee D. Zeilstra A. Zheng K.J. Zimmerman D.D.E. Zorgdrager M.

Affiliations

  1. [1] Cancer Center Amsterdam
  2. [NORA names: Netherlands; Europe, EU; OECD];
  3. [2] Vrije Universiteit Amsterdam
  4. [NORA names: Netherlands; Europe, EU; OECD];
  5. [3] Catharina Hospital
  6. [NORA names: Netherlands; Europe, EU; OECD];
  7. [4] Maastricht University
  8. [NORA names: Netherlands; Europe, EU; OECD];
  9. [5] Odense University Hospital
  10. [NORA names: Region of Southern Denmark; Hospital; Denmark; Europe, EU; Nordic; OECD];

Abstract

Background: Detection of grade 3–4 extra mural venous invasion (mrEMVI) on magnetic resonance imaging (MRI) is associated with an increased distant metastases (DM)-rate. This study aimed to determine the impact of different grades of mrEMVI and their disappearance after neoadjuvant therapy. Methods: A Dutch national retrospective cross-sectional study was conducted, including patients who underwent resection for rectal cancer in 2016 from 60/69 hospitals performing rectal surgery. Patients with a cT3-4 tumour ≤8 cm from the anorectal junction were selected and their MRI-scans were reassessed by trained abdominal radiologists. Positive mrEMVI grades (3 and 4) were analyzed in regard to 4-year local recurrence (LR), DM, disease-free survival (DFS) and overall survival (OS). Results: The 1213 included patients had a median follow-up of 48 months (IQR 30–54). Positive mrEMVI was present in 324 patients (27%); 161 had grade 3 and 163 had grade 4. A higher mrEMVI stage (grade 4 vs grade 3 vs no mrEMVI) increased LR-risk (21% vs 18% vs 7%, <0.001) and DM-risk (49% vs 30% vs 21%, p < 0.001) and decreased DFS (42% vs 55% vs 69%, p < 0.001) and OS (62% vs 76% vs 81%, p < 0.001), which remained independently associated in multivariable analysis. When mrEMVI had disappeared on restaging MRI, DM-rate was comparable to initial absence of mrEMVI (both 26%), whereas LR-rate remained high (22% vs 9%, p = 0.006). Conclusion: The negative oncological impact of mrEMVI on recurrence and survival rates was dependent on grading. Disappearance of mrEMVI on restaging MRI decreased the risk of DM, but not of LR.

Funders

  • KWF Kankerbestrijding

Data Provider: Elsevier