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, 1532-2157, Volume 50, 6, Page 108307, 10.1016/j.ejso.2024.108307

Contributors

Van Geffen, Eline G M [1] [2] Nederend, Joost 0000-0002-9905-5866 [3] Sluckin, Tania C 0000-0002-5913-2644 [1] [2] Hazen, Sanne-Marije J A 0000-0001-8372-1986 [1] [2] Horsthuis, Karin 0000-0001-9699-4561 [1] [2] Beets-Tan, Regina Gien Hoa [4] [5] [6] [7] Marijnen, Corrie A M 0000-0003-0189-5953 [7] [8] Tanis, Pieter Job 0000-0002-3146-3310 [1] [2] [9] Kusters, Miranda 0000-0002-2468-9186 (Corresponding author) [1] [2] Group, the Dutch Snapshot Research [1] [2] [3] [4] [5] [6] [7] [8] [9] Aalbers, Arend G.J. Van Aalten, Susanna Maria Amelung, Femke Julie Ankersmit, Marjolein Antonisse, Imogeen E Ashruf, Jesse F Aukema, Tjeerd S Avenarius, Henk Bahadoer, Renu R 0000-0002-6321-6453 Bakers, Frans C H 0000-0002-2327-4712 Bakker, Ilsalien S. Bangert, Fleur Barendse, Renée M. Beekhuis, Heleen M D Beets, Geerard L O 0000-0002-1671-9912 Bemelman, Willem Adrianus Berbée, Maaike De Bie, Shira H Bisschops, Robert H C Blok, Robin D. Van Bockel, Liselotte W Boer, Anniek H Boer, Frank C Den 0000-0003-3754-1137 Boerma, Evert-Jan Gijsbert 0000-0001-6782-5670 Boogerd, Leonora S F Borstlap, Jaap Borstlap, Wernard Aat Antoine Bouwman, Johanna E. Braak, Sicco J Braat, Manon N G J A 0000-0001-6580-4331 Bradshaw, Jennifer Brandsma, Amarins T A Van Breest Smallenburg, Vivian Van Den Broek, Wim T Van Der Burg, Sjirk W Burger, Jacobus W.A. Burghgraef, Thijs Adriaan 0000-0001-8781-9630 Cate, David W G Ten 0009-0003-3152-0797 Ceha, Heleen M Cnossen, Jeltsje S Van Den Braak, Robert R J Coebergh 0000-0001-9310-6629 Consten, Esther C J Corver, Maaike Crolla, Rogier M P H 0000-0003-2617-1791 Curutchet, Sam Daniels-Gooszen, Alette W Davids, Paul H P Dekker, Emmelie N Dekker, Jan Willem Teunis 0000-0003-2027-0027 Demirkiran, Ahmet Derksen, Tyche Diederik, Arjen L Dinaux, Anne M Dogan, Kemal van Dop, Ilse M. Greve, Kitty E Droogh-De Duijsens, Hanneke M H Dunker, Michalda S Duyck, Johan Van Duyn, Eino B Van Egdom, Laurentine S E 0000-0003-2640-1948 Eijlers, Bram El-Massoudi, Youssef van Elderen, Saskia Emmen, Anouk M L H Engelbrecht, Marc van Erp, Anne C. Van Essen, Jeroen A Fabry, Hans F J Fassaert, Thomas Feitsma, Eline A 0000-0001-8626-0863 Feshtali, Shirin Shahbazi Frietman, Bas 0000-0002-3298-9330 Furnée, Edgar J B van Geel, Anne M. Geijsen, Elisabeth D Van Geloven, Anna A W Gerhards, Michael F. Gielkens, Hugo Van Gils, Renza A H Goense, Lucas Govaert, Marc J P M Van Grevenstein, Wilhelmina M U De Groof, Elisabeth J de Groot, Irene de Haas, Robbert J. Hakkenbrak, Nadia A G Hartogh, Mariska D Den Heesink, Vera Heikens, Joost T 0000-0002-0063-1705 Hendriksen, Ellen M. Van Den Hoek, Sjoerd Van Der Hoeven, Erik J R J Hoff, Christiaan Hogewoning, Anna Hogewoning, Cornelis R C 0000-0003-4683-8741 Hoogendoorn, Stefan van Hoorn, Francois Van Der Hul, René L Van Hulst, Rieke Imani, Farshad Inberg, Bas Intven, Martijn P W 0000-0002-5068-5517 Janssen, Pedro De Jong, Chris E J Jonkers, Jacoline Jou-Valencia, Daniela Keizers, Bas Ketelaers, Stijn H J 0000-0002-0756-5894 Knöps, Eva Van Koeverden, Sebastiaan W Kok, Sylvia Kolderman, Stephanie E M De Korte, Fleur I Kortekaas, Robert Th J Korving, Julie C. Koster, Ingrid M. Krdzalic, Jasenko Krielen, Pepijn 0000-0002-1294-7053 Kroese, Leonard Frederik 0000-0002-4702-5227 Krul, Eveline J T Lahuis, Derk H H Lamme, Bas Van Landeghem, An A G Leijtens, Jeroen W A 0000-0002-0807-0471 Leseman-Hoogenboom, Mathilde M De Lijster, Manou S Marsman, Martijn S Martens, MilouH. Masselink, Ilse van der Meij, Wout Meijnen, Philip Melenhorst, Jarno De Mey, Dietrich J L Moelker-Galuzina, Julia Morsink, Linda Mulder, Erik J. Muller, Karin Musters, Gijsbert Daniel Neijenhuis, Peter A. De Nes, Lindsey C F 0000-0001-7923-6312 Nielen, M. van den Nieuwboer, Jan B.J. Nieuwenhuis, Jonanne F Nonner, Joost Noordman, Bo Jan Nordkamp, Stefi 0000-0002-9738-8691 Olthof, Pim B 0000-0002-1691-1808 Oosterling, Steven J. Ootes, Daan Oppedijk, Vera Ott, Pieter Paulusma, Ida Peeters, Koen C M J 0000-0002-9332-1334 Pereboom, Ilona T A Peringa, Jan Pironet, Zoë Plate, Joost D J Polat, Fatih Poodt, Ingrid G M 0000-0001-9137-7599 Posma, Lisanne A E Prette, Jeroen F Pultrum, Bareld B Qaderi, Seyed M van Rees, Jan M. Renger, Rutger-Jan Rombouts, Anouk J M 0000-0002-7272-3051 Roosen, Lodewijk J Brinke, Ellen A Roskott-Ten Rothbarth, Joost Rouw, Dennis B Rozema, Tom Rütten, Heidi Rutten, Harm J T Van Der Sande, Marit E Schaafsma, Boudewijn E Schasfoort, Renske A Scheurkogel, Merel M Van Der Velden, Arjan P Schouten Schreurs, Wilhelmina H. Schuivens, Puck M.E. Sietses, Colin Simons, Petra C G Slob, Marjan J Slooter, Gerrit Dirk Van Der Sluis, Martsje Smalbroek, Bo P 0000-0002-8502-4890 Smits, Anke B Spillenaar Bilgen, Ernst Jan 0000-0002-4125-9268 Spruit, Patty H Stam, Tanja C Stoker, Jaap 0000-0002-9822-3784 Talsma, Aaldert K Temmink, Sofieke J D Mireille The, G.Y. Tielbeek, Jeroen A W Van Tilborg, Aukje A J M Van Tilborg, Fiek A J B Van Trier, Dorothée Tuynman, Jurriaan Benjamin 0000-0001-5952-8000 Van Der Valk, Maxime J M Vanhooymissen, Inge J S M L Vasbinder, G Boudewijn C Veeken, Cornelis J Velema, Laura A Van De Ven, Anthony Willem Hendrik Verdaasdonk, Emiel G G 0000-0002-2168-294X Verduin, Wouter M 0000-0002-1039-2277 Verhagen, Tim Verheijen, Paul M. Vermaas, Maarten Verrijssen, An-Sofie E 0000-0002-5193-2831 Verschuur, Anna Vera D 0000-0001-8085-1355 Schaik, Harmke Verwoerd-van Vliegen, Roy F A Voets, Sophie Vogelaar, F Jeroen Vogelij, Clementine L.A. Vos-Westerman, Johanna de Vries, Marianne Vroemen, Joy C Van Vugt, Bas S T Wegdam, Johannes A 0000-0002-3287-0233 Van Wely, Bob J Westerterp, Marinke Van Westerveld, Paul P Van Westreenen, Henderik Leendert 0000-0002-1910-2723 Wijma, Allard G 0000-0003-4227-4715 de Wilt, Johannes H.W. De Wit, Bart Willem Karel Wit, Fennie Woensdregt, Karlijn van Woerden, Victor Van Der Wolf, Floor S W van der Wolk, Sander Wybenga, Johannes M Van Der Zaag, Edwin S Zamaray, Bobby 0000-0002-2361-7578 Zandvoort, Herman J A van der Zee, Dennis Zeilstra, Annette P Zheng, Kang J. Zimmerman, David D.E. Zorgdrager, Marcel

Affiliations

  1. [1] Amsterdam UMC Location VUmc
  2. [NORA names: Netherlands; Europe, EU; OECD];
  3. [2] Amsterdam University Medical Centers
  4. [NORA names: Netherlands; Europe, EU; OECD];
  5. [3] Catharina Ziekenhuis
  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.

Keywords

DM, DM rates, DM risk, LR rate, LR risk, MRI scans, MRI-detected extramural venous invasion, abdominal radiologists, absence, advanced rectal cancer, analysis, anorectal junction, associated in multivariate analysis, cT3, cancer, cohort study, cross-sectional study, decreased DFS, detection, disappearance, disease-free survival, extramural venous invasion, follow-up, grade, grade 3, hospital, images, impact, increased LR risk, invasion, junction, local recurrence, localization, locally advanced rectal cancer, magnetic resonance imaging, median follow-up, months, mrEMVI, multivariate analysis, national cohort study, negative oncological impact, neo-adjuvant treatment, neoadjuvant therapy, overall survival, patients, prognostic significance, radiologists, radiology training, rate, reassessment, rectal cancer, rectal surgery, recurrence, resection, resonance imaging, response, response to neo-adjuvant treatment, restaging, restaging magnetic resonance imaging, retrospective cross-sectional study, risk, risk of DM, stage, study, surgery, survival, survival rate, therapy, training, treatment, venous invasion

Funders

  • Dutch Cancer Society

Data Provider: Digital Science