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

Eline G.M Van Geffen,Aukje A.J.M Van Tilborg,Johanna E Bouwman,Laura A Velema,Johan Duyck,Stephanie E.M Kolderman,Jurriaan B Tuynman,Edgar J.B Furnée,Philip Meijnen,Renu R Bahadoer,Wernard A.A Borstlap,Vivian Van Breest Smallenburg,Bo P Smalbroek,Anne M Dinaux,Anne C Van Erp,Jeroen W.A Leijtens,Cornelis R.C Hogewoning,Koen C.M.J Peeters,Sophie Voets,Laurentine S.E Van Egdom,Wouter M Verduin,Victor Van Woerden,Harmke Verwoerd-Van Schaik,Milouh Martens,Jonanne F Nieuwenhuis,Fleur Bangert,Tom Rozema,Paul M Verheijen,Sjoerd Van Den Hoek,Jeltsje S Cnossen,Femke J Amelung,Seyed M Qaderi,Elisabeth D Geijsen,Jaap Stoker,Sofieke J.D Temmink,Bas S.T Van Vugt,Rutger-Jan Renger,Shira H De Bie,Regina G.H Beets-Tan,Linda Morsink,Wilhelmina H Schreurs,Johanna Vos-Westerman,F Jeroen Vogelaar,Gijsbert D Musters,Anna V.D Verschuur,Roy F.A Vliegen,An A.G Van Landeghem,Clementine L.A Vogelij,Eveline J.T Krul,Youssef El-Massoudi,Pieter J Tanis,Karin Horsthuis,Jaap Borstlap,Hugo Gielkens,Anna Hogewoning,Cornelis J Veeken,Fennie Wit,Ernst J Spillenaar-Bilgen,Jarno Melenhorst,Martijn P.W Intven,Zoë Pironet,Arjan P Schouten Van Der Velden,Henderik L Van Westreenen,Tyche Derksen,Hanneke M.H Duijsens,Susanna M Van Aalten,Hans F.J Fabry,Chris E.J De Jong,Ilsalien S Bakker,Herman J.A Zandvoort,Joost Nonner,Robert R.J Coebergh Van Den Braak,Heleen M Ceha,Johannes A Wegdam,Dennis B Rouw,Vera Oppedijk,Heleen M.D Beekhuis,Erik J Mulder,Eline A Feitsma,Jeroen F Prette,Sicco J Braak,Willem A Bemelman,David W.G Ten Cate,Thomas Fassaert,Michalda S Dunker,Sebastiaan Van Koeverden,Farshad Imani,Geerard L Beets,Petra C.G Simons,Floor S.W Van Der Wolf,Emmelie N Dekker,Anke B Smits,Ingrid M Koster,Dorothée Van Trier,Evert-Jan G Boerma,Saskia Van Elderen,Nadia A.G Hakkenbrak,Peter A Neijenhuis,Liselotte W Van Bockel,Lodewijk J Roosen,Martijn S Marsman,Pedro Janssen,Jeroen A.W Tielbeek,Frans C.H Bakers,Julia Moelker-Galuzina,Arjen L Diederik,G Boudewijn C Vasbinder,Annette P Zeilstra,Wilhelmina M.U Van Grevenstein,Jan M Van Rees,G.Y Mireille The,Joost T Heikens,Julie C Korving,Rieke Van Hulst,Bareld B Pultrum,Jennifer Bradshaw,Amarins T.A Brandsma,Thijs A Burghgraef,Ellen A Roskott-Ten Brinke,Ahmet Demirkiran,Renza A.H Van Gils,Daniela Jou-Valencia,Lindsey C.F De Nes,René L Van Der Hul,Renée M Barendse,Anouk M.L.H Emmen,Marc Engelbrecht,Karin Muller,Anouk J.M Rombouts,Stefan Hoogendoorn,David D.E Zimmerman,Eino B Van Duyn,Robin D Blok,Aaldert K Talsma,Paul P Van Westerveld,Bo J Noordman,Boudewijn E Schaafsma,Paul H.P Davids,Kang J Zheng,Vera Heesink,Fatih Polat,An-Sofie E Verrijssen,Gerrit D Slooter,Inge J.S Vanhooymissen,Maxime J.M Van Der Valk,Marc J.P.M Govaert,Martsje Van Der Sluis,Ilse Masselink,Maarten Vermaas,Lisanne A.E Posma,Marjan J Slob,Leonora S.F Boogerd,Daan Ootes,Jacoline Jonkers,Lucas Goense,Mariska D Den Hartogh,Anniek H Boer,Johannes H.W De Wilt,Michael F Gerhards,Corrie A.M Marijnen,Bas Lamme,Jasenko Krdzalic,Robert H.C Bisschops,Henk Avenarius,Francois Van Hoorn,Anna A.W Van Geloven,Tania C Sluckin,Anne M Van Geel,Pepijn Krielen,Miranda Kusters,Ellen M Hendriksen,Esther C.J Consten,Emiel G.G Verdaasdonk,Ilona T.A Pereboom,Alette W Daniëls-Gooszen,Steven J Oosterling,Maaike Corver,Marit E Van Der Sande,Tjeerd S Aukema,Heidi Rütten,Mathilde M Leseman-Hoogenboom,Sylvia Kok,Ingrid G.M Poodt,Sjirk W Van Der Burg,Fiek Van Tilborg,Arend G.J Aalbers,Joy C Vroemen,Tanja C Stam,M Nielen,Renske A Schasfoort,Bas Inberg,Wout Van Der Meij,Stijn H.J Ketelaers,Puck M.E Schuivens,Wim T Van Den Broek,Marcel Zorgdrager,Shirin S Feshtali,Manon N.G.J.A Braat,Pieter Ott,Marinke Westerterp,Jan Peringa,Kitty E Droogh-De Greve,Tim Verhagen,Marianne De Vries,Eva Knöps,Kemal Dogan,Colin Sietses,Derk H.H Lahuis,Bas Keizers,Pim B Olthof,Johannes M Wybenga,Karlijn Woensdregt,Bram Eijlers,Ilse M Van Dop,E Joline De Groof,Jan B.J Van Den Nieuwboer,Anthony W.H Van De Ven,Fleur I De Korte,Sander Van Der Wolk,Bobby Zamaray,Dennis Van Der Zee,Dietrich J.L De Mey,Irene De Groot,Bart W.K De Wit,Robert T.J Kortekaas,Robbert J De Haas,Bas Frietman,Jan Willem T Dekker,Edwin S Van Der Zaag,Harm J.T Rutten,Patty H Spruit,Jeroen A Van Essen,Joost Rothbarth,Jacobus W.A Burger,Rogier M.P.H Crolla,Sanne-Marije J.A Hazen,Frank C Den Boer,Allard G Wijma,Joost D.J Plate,Maaike Berbée,Ida Paulusma,Manou S De Lijster,Stefi Nordkamp,Jesse F Ashruf,Merel M Scheurkogel,Bob J Van Wely,Marjolein Ankersmit,Sam Curutchet,Joost Nederend,Leonard F Kroese,Imogeen E Antonisse,Erik J.R.J Van Der Hoeven,Christiaan Hoff

doi:10.1016/j.ejso.2024.108307

Abstract

BackgroundDetection 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. MethodsA 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). ResultsThe 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). ConclusionThe 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.

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