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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.




Publikationsverlauf

Artikel online veröffentlicht:
26. Oktober 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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  • References

  • 1 Consensus Document for Management of Colorectal Cancer. ICMR, New Delhi; 2014: 11-13
  • 2 Patil PS, Saklani A, Gambhire P. et al. Colorectal cancer in India: an audit from a tertiary center in a low prevalence area. Indian J Surg Oncol 2017; 8 (04) 484-490
    CrossrefPubMedGoogle Scholar
  • 3 Nitsche U, Zimmermann A, Späth C. et al. Mucinous and signet-ring cell colorectal cancers differ from classical adenocarcinomas in tumor biology and prognosis. Ann Surg 2013; 258 (05) 775-782 , discussion 782–783
    CrossrefPubMedGoogle Scholar
  • 4 Chew MH, Yeo SA, Ng ZP. et al. Critical analysis of mucin and signet ring cell as prognostic factors in an Asian population of 2,764 sporadic colorectal cancers. Int J Colorectal Dis 2010; 25 (10) 1221-1229
    CrossrefPubMedGoogle Scholar
  • 5 Tamhankar AS, Ingle P, Engineer R, Bal M, Ostwal V, Saklani A. Signet ring colorectal carcinoma: do we need to improve the treatment algorithm?. World J Gastrointest Oncol 2016; 8 (12) 819-825
    CrossrefPubMedGoogle Scholar
  • 6 Siddiqui MRS, Simillis C, Hunter C. et al. A meta-analysis comparing the risk of metastases in patients with rectal cancer and MRI-detected extramural vascular invasion (mrEMVI) vs mrEMVI-negative cases. Br J Cancer 2017; 116 (12) 1513-1519
    CrossrefPubMedGoogle Scholar
  • 7 Bhangu A, Fitzgerald JE, Slesser A, Northover JM, Faiz O, Tekkis P. Prognostic significance of extramural vascular invasion in T4 rectal cancer. Colorectal Dis 2013; 15 (11) e665-e671
    CrossrefPubMedGoogle Scholar
  • 8 Bugg WG, Andreou AK, Biswas D, Toms AP, Williams SM. The prognostic significance of MRI-detected extramural venous invasion in rectal carcinoma. Clin Radiol 2014; 69 (06) 619-623
    CrossrefPubMedGoogle Scholar
  • 9 Sohn B, Lim JS, Kim H. et al. MRI-detected extramural vascular invasion is an independent prognostic factor for synchronous metastasis in patients with rectal cancer. Eur Radiol 2015; 25 (05) 1347-1355
    CrossrefPubMedGoogle Scholar
  • 10 Smith NJ, Shihab O, Arnaout A, Swift RI, Brown G. MRI for detection of extramural vascular invasion in rectal cancer. AJR Am J Roentgenol 2008; 191 (05) 1517-1522
    CrossrefPubMedGoogle Scholar
  • 11 Jhaveri KS, Hosseini-Nik H, Thipphavong S. et al. MRI detection of extramural venous invasion in rectal cancer: correlation with histopathology using elastin stain. AJR Am J Roentgenol 2016; 206 (04) 747-755
    CrossrefPubMedGoogle Scholar
  • 12 Griffin MR, Bergstralh EJ, Coffey RJ, Beart Jr RW, Melton III LJ. Predictors of survival after curative resection of carcinoma of the colon and rectum. Cancer 1987; 60 (09) 2318-2324
    CrossrefPubMedGoogle Scholar
  • 13 Compton CC, Greene FL. The staging of colorectal cancer: 2004 and beyond. CA Cancer J Clin 2004; 54 (06) 295-308
    CrossrefPubMedGoogle Scholar
  • 14 Balch GC, De Meo A, Guillem JG. Modern management of rectal cancer: a 2006 update. World J Gastroenterol 2006; 12 (20) 3186-3195
    CrossrefPubMedGoogle Scholar
  • 15 Taylor FG, Swift RI, Blomqvist L, Brown G. A systematic approach to the interpretation of preoperative staging MRI for rectal cancer. AJR Am J Roentgenol 2008; 191 (06) 1827-1835
    CrossrefPubMedGoogle Scholar
  • 16 Talbot IC, Ritchie S, Leighton MH, Hughes AO, Bussey HJ, Morson BC. The clinical significance of invasion of veins by rectal cancer. Br J Surg 1980; 67 (06) 439-442
    CrossrefPubMedGoogle Scholar
  • 17 Shirouzu K, Isomoto H, Kakegawa T, Morimatsu M. A prospective clinicopathologic study of venous invasion in colorectal cancer. Am J Surg 1991; 162 (03) 216-222
    CrossrefPubMedGoogle Scholar
  • 18 Horn A, Dahl O, Morild I. Venous and neural invasion as predictors of recurrence in rectal adenocarcinoma. Dis Colon Rectum 1991; 34 (09) 798-804
    CrossrefPubMedGoogle Scholar
  • 19 Chand M, Siddiqui MR, Swift I, Brown G. Systematic review of prognostic importance of extramural venous invasion in rectal cancer. World J Gastroenterol 2016; 22 (04) 1721-1726
    CrossrefPubMedGoogle Scholar
  • 20 Bokey EL, Chapuis PH, Dent OF. et al. Factors affecting survival after excision of the rectum for cancer: a multivariate analysis. Dis Colon Rectum 1997; 40 (01) 3-10
    CrossrefPubMedGoogle Scholar
  • 21 Harrison JC, Dean PJ, el-Zeky F, Vander Zwaag R. From Dukes through Jass: pathological prognostic indicators in rectal cancer. Hum Pathol 1994; 25 (05) 498-505
    CrossrefPubMedGoogle Scholar
  • 22 Kim TH, Woo S, Han S, Suh CH, Vargas HA. The diagnostic performance of MRI for detection of extramural venous invasion in colorectal cancer: a systematic review and meta-analysis of the literature. AJR Am J Roentgenol 2019; 213 (03) 575-585
    CrossrefPubMedGoogle Scholar
  • 23 Hunter CJ, Garant A, Vuong T. et al. Adverse features on rectal MRI identify a high-risk group that may benefit from more intensive preoperative staging and treatment. Ann Surg Oncol 2012; 19 (04) 1199-1205
    CrossrefPubMedGoogle Scholar
  • 24 Zhang XY, Wang S, Li XT. et al. MRI of extramural venous invasion in locally advanced rectal cancer: relationship to tumor recurrence and overall survival. Radiology 2018; 289 (03) 677-685
    CrossrefPubMedGoogle Scholar
  • 25 Smith NJ, Barbachano Y, Norman AR, Swift RI, Abulafi AM, Brown G. Prognostic significance of magnetic resonance imaging-detected extramural vascular invasion in rectal cancer. Br J Surg 2008; 95 (02) 229-236
    CrossrefPubMedGoogle Scholar
  • 26 Seehaus A, Vaccaro C, Quadrelli M. et al. Magnetic resonance and extramural vascular invasion in patients with rectal cancer and liver metastases. Acta Gastroenterol Latinoam 2015; 45 (01) 31-36
    PubMedGoogle Scholar
  • 27 van den Broek JJ, van der Wolf FSW, Heijnen LA, Schreurs WH. The prognostic importance of MRI detected extramural vascular invasion (mrEMVI) in locally advanced rectal cancer. Int J Colorectal Dis 2020; 35 (10) 1849-1854
    CrossrefPubMedGoogle Scholar
  • 28 Gu C, Yang X, Zhang X. et al. The prognostic significance of MRI-detected extramural venous invasion, mesorectal extension, and lymph node status in clinical T3 mid-low rectal cancer. Sci Rep 2019; 9 (01) 12523
    CrossrefPubMedGoogle Scholar
  • 29 Sun Y, Li J, Shen L, Wang X, Tong T, Gu Y. Predictive value of MRI-detected extramural vascular invasion in stage T3 rectal cancer patients before neoadjuvant chemoradiation. Diagn Interv Radiol 2018; 24 (03) 128-134
    CrossrefPubMedGoogle Scholar
  • 30 Intven M, Reerink O, Philippens ME. Dynamic contrast enhanced MR imaging for rectal cancer response assessment after neo-adjuvant chemoradiation. J Magn Reson Imaging 2015; 41 (06) 1646-1653
    CrossrefPubMedGoogle Scholar
  • 31 Kim SH, Lee JM, Gupta SN, Han JK, Choi BI. Dynamic contrast-enhanced MRI to evaluate the therapeutic response to neoadjuvant chemoradiation therapy in locally advanced rectal cancer. J Magn Reson Imaging 2014; 40 (03) 730-737
    CrossrefPubMedGoogle Scholar
  • 32 Alberda WJ, Dassen HP, Dwarkasing RS. et al. Prediction of tumor stage and lymph node involvement with dynamic contrast-enhanced MRI after chemoradiotherapy for locally advanced rectal cancer. Int J Colorectal Dis 2013; 28 (04) 573-580
    CrossrefPubMedGoogle Scholar
  • 33 Jhaveri KS, Hosseini-Nik H. MRI of rectal cancer: an overview and update on recent advances. AJR Am J Roentgenol 2015; 205 (01) W42-55
    CrossrefPubMedGoogle Scholar
  • 34 Ale Ali H, Kirsch R, Razaz S. et al. Extramural venous invasion in rectal cancer: overview of imaging, histopathology, and clinical implications. Abdom Radiol (NY) 2019; 44 (01) 1-10
    CrossrefPubMedGoogle Scholar
  • 35 Beets-Tan RGH, Lambregts DMJ, Maas M. et al. Magnetic resonance imaging for clinical management of rectal cancer: Updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol 2018; 28 (04) 1465-1475
    CrossrefPubMedGoogle Scholar