Prognostic significance of MR identified EMVI, tumour deposits, mesorectal nodes and pelvic side wall disease in locally advanced rectal cancer.

Autor: Chandramohan A; Department of Radiology, Christian Medical College, Vellore, India., Mittal R; Department of Colorectal Surgery, Christian Medical College, Vellore, India., Dsouza R; Department of Radiology, Christian Medical College, Vellore, India., Yezzaji H; Department of Colorectal Surgery, Christian Medical College, Vellore, India., Eapen A; Department of Radiology, Christian Medical College, Vellore, India., Simon B; Department of Radiology, Christian Medical College, Vellore, India., John R; Department of Radiology, Christian Medical College, Vellore, India., Singh A; Department of Medical Oncology, Christian Medical College, Vellore, India., Ram TS; Department of Radiation Oncology, Christian Medical College, Vellore, India., Jesudason MR; Department of Colorectal Surgery, Christian Medical College, Vellore, India., Masih D; Department of Pathology, Christian Medical College, Vellore, India., Karuppusami R; Department of Biostatistics, Christian Medical College, Vellore, India.
Jazyk: angličtina
Zdroj: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland [Colorectal Dis] 2022 Apr; Vol. 24 (4), pp. 428-438. Date of Electronic Publication: 2022 Jan 07.
DOI: 10.1111/codi.16032
Abstrakt: Aim: To study the prognostic significance of MRI identified tumour deposits (TD), extramural vascular invasion (EMVI), lymph node metastases (LNM) and pelvic sidewall (PSW) disease in rectal cancer.
Methods: This IRB approved study was conducted on patients with stage IIA-IIIC rectal adenocarcinoma treated with neoadjuvant long course chemoradiotherapy (LCCRT) and total mesorectal excision (TME) type of surgery between 2012-2018. A radiologist blinded to outcome reviewed staging and restaging magnetic resonance imaging (MRI) for TD, EMVI, LNM and PSW. The agreement between four radiologists was studied and we obtained outcome data from a prospectively maintained database. The prognostic significance of imaging findings was assessed.
Results: A total of 297 (186 males) patients with a mean age of 47.3 (SD14.4) years were included in the study. The majority had T3 (n = 206) or T4 (n = 59) stage disease. The mean duration of follow-up was 49.3 ± 25 months (6.6-101 months). 5-year overall (OS) and disease-free survival (DFS) was 84% and 74%, respectively. Staging and restaging MRI had EMVI in 49.5% and 31.3%; TD in 47.5% and 31.6%; LNM in 61.1% and 38.1% and PSW in 11.4% and 6.1%. OS was adversely affected by EMVI, TD and PSW with the adjusted HR (aHR) of 3.32, 3.31, 3.27 for staging MRI and 2.99, 3.1, 2.81 for restaging MRI, respectively, p < 0.05. DFS was affected by EMVI (aHR = 1.85, 2.33) and TD (aHR = 1.83, 2.19), p < 0.05. Persistence of these findings after LCCRT led to worst outcome. Intra- and interobserver agreement for EMVI, TD and LN was 0.789, 0.734, 0.406 and 0.449, 0.354, 0.376, respectively, p < 0.001.
Conclusions: MRI identified that TD, EMVI and PSW disease are independent poor prognostic indicators in rectal cancer patients. Interobserver agreement for these findings was moderate to fair.
(© 2021 The Association of Coloproctology of Great Britain and Ireland.)
Databáze: MEDLINE
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