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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2021; 31(03): 560-565
DOI: 10.1055/s-0041-1736404
Original Article

Prognostic Significance of EMVI in Rectal Cancer in a Tertiary Cancer Hospital in India

Sayali Y. Pangarkar
1   Department of Radio-diagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India
2   Homi Bhabha National Institute, Mumbai, Maharashtra, India
,
Akshay D. Baheti
1   Department of Radio-diagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India
,
Kunal A. Mistry
1   Department of Radio-diagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India
2   Homi Bhabha National Institute, Mumbai, Maharashtra, India
,
Amit J. Choudhari
1   Department of Radio-diagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India
2   Homi Bhabha National Institute, Mumbai, Maharashtra, India
,
Vasundhara R. Patil
1   Department of Radio-diagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India
2   Homi Bhabha National Institute, Mumbai, Maharashtra, India
,
Ankita Ahuja
1   Department of Radio-diagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India
2   Homi Bhabha National Institute, Mumbai, Maharashtra, India
,
Aparna N. Katdare
1   Department of Radio-diagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India
2   Homi Bhabha National Institute, Mumbai, Maharashtra, India
,
Akshay B. Patil
3   Division of Clinical Research and Statistics, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Vikas S. Ostwal
2   Homi Bhabha National Institute, Mumbai, Maharashtra, India
4   Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
,
Mukta R. Ramadwar
2   Homi Bhabha National Institute, Mumbai, Maharashtra, India
5   Department of Pathology Tata Memorial Centre, Mumbai, Maharashtra, India
,
Reena Z. Engineer
2   Homi Bhabha National Institute, Mumbai, Maharashtra, India
6   Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
,
Avanish P. Saklani
2   Homi Bhabha National Institute, Mumbai, Maharashtra, India
7   Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
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Abstract

Background Presence of extramural venous invasion (EMVI) is a poor prognostic factor for rectal cancer as per literature. However, India-specific data are lacking.

Aim The aim of the study is to determine the prognostic significance of EMVI in locally advanced rectal cancer on baseline MRI.

Materials and Methods We retrospectively reviewed 117 MRIs of operable non-metastatic locally advanced rectal cancers in a tertiary cancer institute. Three dedicated oncoradiologists determined presence or absence of EMVI, and its length and thickness, in consensus. These patients were treated as per standard institutional protocols and followed up for a median period of 37 months (range: 2–71 months). Kaplan-Meier curves (95% CI) were used to determine disease-free survival (DFS), distant-metastases free survival (DMFS), and overall survival (OS). Univariate analysis was performed by comparing groups with log-rank test.

Results EMVI positive cases were 34/114 (29%). More EMVI-positive cases developed distant metastasis compared with EMVI-negative cases (14/34–41% vs. 22/83–26%). The difference, however, was not statistically significant (p = 0.146). After excluding signet-ring cell cancers (n = 14), EMVI showed significant correlation with DMFS (p = 0.046), but not with DFS or OS. The median thickness and length of EMVI was 6 and 14 mm, respectively in patients who developed distant metastasis, as compared with 5 and 11 mm in those who did not, although this difference was not statistically significant.

Conclusion EMVI is a predictor of distant metastasis in locally advanced non-metastatic, non-signet ring cell rectal cancers. EMVI can be considered another high-risk feature to predict distant metastasis.

Keywords

extramural venous invasion - MRI - rectal cancer

Financial Support and Sponsorship

None.




Publication History

Article published online:
26 October 2021

© 2021. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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