The prognostic importance of MRI detected extramural vascular invasion (mrEMVI) in locally advanced rectal cancer
| Autor: | Luc A. Heijnen, Wilhelmina H. Schreurs, J J van den Broek, F S W van der Wolf |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Colorectal cancer Locally advanced Logistic regression 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Neoplasm Invasiveness Risk factor Neoplasm Staging Proportional Hazards Models Extramural business.industry Rectal Neoplasms Hazard ratio Gastroenterology Rectum Hepatology medicine.disease Prognosis Magnetic Resonance Imaging 030220 oncology & carcinogenesis Cohort 030211 gastroenterology & hepatology Radiology business |
| Zdroj: | International journal of colorectal disease. 35(10) |
| ISSN: | 1432-1262 |
| Popis: | MRI detected extramural vascular invasion (mrEMVI) is a poor prognostic factor in rectal cancer patients. The objectives of this study were to assess survival outcomes in patients with and without mrEMVI and to compare the prognostic value of mrEMVI with other rectal cancer features. In a Dutch high volume rectal cancer center cohort of sixty-seven locally advanced rectal cancer patients, an independent radiologist reviewed all primary staging MRI scans. The presence of mrEMVI was correlated to tumor specific and survival outcomes. 20/67 patients had mrEMVI positive rectal cancer. 55% (11/20) developed metachronous metastases, compared with 23% (11/47) in the mrEMVI negative group (OR 4.0, p = 0.01). Overall survival was also decreased with a Hazard ratio of 3.3 (p = 0.01). A multivariable logistic regression with a backward selection procedure was conducted including cT-stage, c-N-stage, extramural tumor invasion depth, mesorectal fascia involvement, distance to anorectal junction, tumor length, mrEMVI, CEA level, and synchronous metastases. After stepwise removal based on p value, only positive mrEMVI remained as a single significant predictor for metachronous metastases (OR: 4.16 , p < 0.05). Positive mrEMVI is a poor prognostic factor in locally advanced rectal cancer with a 4-fold increased risk of developing metachronous metastases after surgery and a worsened overall survival. mrEMVI also appeared an independent risk factor, with a stronger prediction for metachronous metastases than other MRI-detectable tumor characteristics. mrEMVI should be incorporated in all risk stratification guidelines for rectal cancer. |
| Databáze: | OpenAIRE |
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