Survival In Rectal Cancer Research Articles

(OA10) Patterns of Care and Factors Predictive of Overall Survival In Metastatic Rectal Cancer

(OA10) Patterns of Care and Factors Predictive of Overall Survival In Metastatic Rectal Cancer

Prognostic markers of recurrence and survival in rectal cancer treated with neoadjuvant chemoradiotherapy and surgery

Aim: To identify markers of recurrence and survival in patients with locally advanced rectal cancer who received neoadjuvant chemoradiotherapy and surgery. Materials & methods: A total of 280 patients were identified in Manitoba between 2007 and 2012. Demographics and clinical data were collected. Cox regression models were used to identify outcome predictors. Results: A total of 53 patients achieved pathological complete response (pCR) and 160 patients received adjuvant chemotherapy (ACT). The median follow-up duration was 2.06 years. Recurrence and survival rates at 5 years were 33.2 and 77.0%, respectively. pCR and lymphovascular invasion predicted recurrence. pCR and ACT predicted better survival. Conclusion: pCR is a significant predictor of recurrence and survival and may be considered as an oncological end point. The patients who achieve pCR may not derive additional survival benefit from ACT.

Immunohistochemical Expression of Debiquitinating Enzyme OTUB1 in Colorectal Carcinoma

AbstractBackground and Objective: Colorectal Carcinoma (CRC) is the most common malignancy of the gastrointestinal tract. The overall five-year survival for colon cancer and rectal cancer are 65% and 68%, respectively with liver metastasis being the leading cause of death. Despite the use of active targeted drugs for treatment of metastatic CRC in the past decade, cure rates remain low. Therefore, research on novel markers for earlier diagnosis and target therapy of CRC is of a great concern. OTUB1 (OTU deubiquitinase, ubiquitin aldehyde binding 1) is a deubiquitinating enzyme (DUB) that belongs to the OTU (ovarian tumor) superfamily. The aim of this work is to study the immunohistochemical expression of OTUB1 in CRC and its correlation with the available clinico-pathological variables.Material and Methods: This retrospective study was conducted on a total number of 45 cases of CRC. All cases were retrieved from the archival files of the pathology labs of Ain Shams University Hospitals (from 2012-2016). Immu-nohistochemistry using rabbit polyclonal anti OTUB 1 antibody was performed.Results: OTUB 1 was overexpressed in CRC tissues, and the expression level of OTUB1 was correlated significantly with histologic grade (p<0.001), depth of invasion (pathological T) (p=0.03) and location of CRC (p=0.002). On the other hand, no significant correlation was found with age, gender, metastasis whether nodal or distant, TNM stage and size of tumor.Conclusion: OTUB1 may have a possible role in tumor differentiation as well as local tumor invasion, thus could be useful in identification of biologically aggressive tumors in colonoscopic biopsies in addition to providing a basis for targeted therapy which could play a major role in the treatment of CRC.

The prechemoradiotherapy/nadir ratio of white blood-cell count to predict tumor response and survival in locally advanced rectal cancer.

783 Background: Predicting treatment response of preoperative chemoradiotherapy (CRT) in patients with rectal cancer is important for physicians to guide a patient to the relevant treatment. We evaluate the change of white blood cell (WBC) count before and during CRT if it is associated with susceptibility to the CRT and affects tumor response. Methods: Medical records of 641 patients with rectal cancer who received preoperative CRT followed by curative surgery were retrospectively reviewed. Complete blood cell counts were measured weekly before and during the radiation therapy. We assessed the pre-CRT/nadir ratio of WBC count for the treatment response to CRT and recurrence-free survival. Results: The enrolled patients were divided into two groups of high WBC ratio (HWR) and low WBC ratio (LWR) with the cutoff value of 0.49, which was found by receiver operating characteristic curve (Sensitivity, 0.38 and 1-Specificity, 0.22; p=0.007). In 641 patients, 490 (76.4%) were HWR group and 151 (23.6%) were LWR group. Complete pathologic response rates were 12.2% in HWR group and 23.8% in LWR group, respectively (p=0.001). Downstaging rates of each group were 37.8% and 48.3%, respectively (p=0.02). In the logistic regression analysis, CEA level over 5ng/ml (Adjusted OR 0.566, 95% CI 0.351-0.912; p=0.019) and HWR (Adjusted OR 0.412, 95% CI 0.256-0.663; p=0.001) were significant adverse factors of the pathologic complete response. The 5-year recurrence-free survival rate was significantly higher in LWR group than in HWR group (67.6% and 83.3%; p=0.001). Conclusions: Low WBC ratio predicts a good tumor response to the preoperative CRT, and is significantly associated with an improved recurrence-free survival in rectal cancer.

Decrease of Sphincter Preserving Length Lowers the Postoperative Genital Function for Patients With Rectal Cancer.

With the increase in sphincter preserving rate of rectal cancer (RC) cancer, postoperative quality-of-life, such as genital dysfunction, has become a major issue in the patient management. In this study, we proposed a measurement, namely, the sphincter preserving length (SPL), and investigated the relationship between SPL and postoperative genital function and survival in RC patients. A total of 536 male patients who had a diagnosis of RC and underwent sphincter preserving rectal resection in the Sixth Affiliated Hospital of Sun Yat-sen University and the First Affiliated Hospital of Sun Yat-sen University between October 1997 and December 2013 were included in our study. SPL was defined as the distance between the lowest edge of the tumor to dentate line. Postoperative genital function was evaluated by erection function and ejaculation function. Five-year survival status was extracted from the hospital database. Larger SPL was significantly associated with poorer postoperative erection and ejaculation function. For a SPL of 7.25 cm, the sensitivity and specificity of the diagnosis of erection dysfunction was 68.6% and 68.8%, respectively. The corresponding sensitivity and specificity for the diagnosis of ejaculation dysfunction was 70.9% and 75.7%, respectively. SPL was also negatively associated with survival rate. Compared with lower anterior resection, patients with lower RC who underwent local resection or draw-out colon-anal anastomosis had better postoperative genital function. SPL might be a useful measurement to assess the risk of postoperative genital dysfunction and survival status and an indicator for initiation of early preventative treatment in patients with RC.

The influence of hospital and surgeon volume on survival and local control in rectal cancer: Long-term results of the CAO/ARO/AIO-94 trial.

738 Background: The association of hospital and surgeon volume with the outcome of rectal cancer patients is under debate. In this study the long-term influence of the hospital as well as the surgeon volume on overall survival and local recurrence were investigated. Methods: In a post-hoc analysis of the randomized phase III CAO/ARO/AIO-94 trial after a follow-up of more than 10 years, 799 patients with locally advanced rectal cancers were evaluated. Survival and local recurrence rates were stratified by the hospital recruitment volume (≤20 vs. 21-90 vs. &gt; 90 patients) and by the surgeon volume (≤10 vs. 11-50 vs. &gt; 50 procedures). Results: Patients treated in „high-volume“ hospitals had a longer overall survival than those treated in hospitals with medium or low treatment volume (p = 0.03). The surgeon volume was significantly associated with decreased local recurrences (p = 0.01) but had no influence on overall survival. The effect of neoadjuvant chemoradiation on local control was the strongest in patients being operated by medium-volume surgeons. Conclusions: Patients with locally advanced rectal cancers might benefit from treatment in in specialized high-volume hospitals. In particular, the surgeon volume had significant influence on local control.

Prognostic Value of Diffusion MR Imaging and Clinical-Pathologic Factors in Patients with Rectal Cancer

Background: Apparent diffusion coefficient (ADC) value measured from diffusion-weighted magnetic resonance (MR) images are highly correlated with pathological T or N stage, tumor differentiation grade, and extramural depth of tumor in patients with rectal cancer. Objectives: To assess the prognostic value of diffusion MR imaging and clinical-pathologic risk factors in patients with rectal cancer. Patients and Methods: This retrospective study was approved by our institutional review board and written informed consent was waived. Sixty-one consecutive patients with rectal cancer (41 men and 20 women; mean age, 64.5 ± 12.1 years; range, 32 - 86 years) underwent pelvic MR imaging. Tumor ADC value and clinical-pathologic risk factors were tested as possible risk factors for postoperative local recurrence or distant metastasis (LRDM) as well as disease-free survival outcome. Results: Of 62 tumors, 12 (19.4%) had postoperative LRDM (median follow-up 38.5 months). Plasmatic CA19-9 level (P = 0.0027), pathological N stage (P = 0.0018), lymphatic invasion (P < 0.0001), and tumor ADC value (P = 0.0076) were independently associated with postoperative LDRM. High plasmatic CA19-9 level (≥ 37 U/mL) (P = 0.010), ly2 (P = 0.020), ly3 (P < 0.0001), pathological N2 (P = 0.006), and low tumor ADC value (< 0.996 × 10-3 mm2/sec) (P = 0.0026) were associated with reduced disease-free survival. Conclusion: Preoperative tumor ADC and plasmatic CA19-9 were significantly associated with postoperative LRDM and disease-free survival in rectal cancer.

Overweight but not obesity is associated with decreased survival in rectal cancer.

Aim of the studyTo analyse the influence of overweight and obesity in disease-specific survival (DSS) in rectal cancers at stages I–III in a population with high prevalence of overweight/obesity.Material and methodsThe population (N = 304) consisted of Mexican patients with stage I–III rectal cancer during the period between 2009 and 2015. Patients were divided based on their body mass index (BMI) into normal weight 18–25 kg/m2, overweight 25–29 kg/m2, and obesity BMI > 30 kg/m2 groups. Comparison of clinicopathologic features and survival analysis were performed.ResultsThe median age was 58 years (interquartile range [IQR] 50–65) and the mean BMI was 26.03 ±4.06 kg/m2. Patients in the obesity and overweight groups received a lower proportion of preoperative treatment and had a higher proportion of patients in stage II. Overweight patients had a lower baseline neutrophil/lymphocyte ratio and lower survival rate than patients with normal weight and with obesity (mean survival of 69.5 months vs. 81.15 months and 86.4 months, respectively). The estimated five-year DSS was 51% for the overweight group, 81% for the normal group, and 82% for the obesity group (p = 0.026).ConclusionsPatients with stage I–III rectal cancer in the overweight group showed a lower DSS compared to groups with normal weight and with obesity, with the last two being similar.

直肠癌放射治疗研究进展

放射治疗作为局部晚期直肠癌综合治疗的一个重要组成部分，联合手术治疗可降低局部复发率，提高患者总生存率。近年来多项研究对如何进一步提高放疗疗效、放疗方式、T3N0M0患者是否都需要放疗及放疗与手术时间间隔等问题进行了探索，本篇综述除讨论放疗的基本作用，并对上述研究热点做出总结分析。 Radiotherapy (RT) is an important part of the comprehensive treatment of locally advanced rectal cancer, which reduces the local recurrence rate in combination with surgery and improves survival of rectal cancer. The timing of radiotherapy, the way of radiotherapy, the needs of radiotherapy for T3N0M0 rectal cancer, the timing of surgery are summarized as follows. This review will discuss not only the basic role of RT but also the associated with controversial issues in detail.

The Pivotal Role of Radiologists and Oncologists in Optimising Outcome and Survival in Non-metastatic Rectal Cancer

The Pivotal Role of Radiologists and Oncologists in Optimising Outcome and Survival in Non-metastatic Rectal Cancer

Rectal cancer survival in the United States by race and stage, 2001 to 2009: Findings from the CONCORD-2 study.

In the first CONCORD study, 5-year survival for patients with diagnosed with rectal cancer between 1990 and 1994 was <60%, with large racial disparities noted in the majority of participating states. We have updated these findings to 2009 by examining population-based survival by stage of disease at the time of diagnosis, race, and calendar period. Data from the CONCORD-2 study were used to compare survival among individuals aged 15 to 99 years who were diagnosed in 37 states encompassing up to 80% of the US population. We estimated net survival up to 5 years after diagnosis correcting for background mortality with state-specific and race-specific life table. Survival estimates were age-standardized with the International Cancer Survival Standard weights. We present survival estimates by race (all, black, and white) for 2001 through 2003 and 2004 through 2009 to account for changes in collecting the data for Surveillance, Epidemiology, and End Results Summary Stage 2000. There was a small increase in 1-year, 3-year, and 5-year net survival between 2001-2003 (84.6%, 70.7%, and 63.2%, respectively), and 2004-2009 (85.1%, 71.5%, and 64.1%, respectively). Black individuals were found to have lower 1-year, 3-year, and 5-year survival than white individuals in both periods; the absolute difference in survival between black and white individuals declined only for 5-year survival. Black patients had lower 5-year survival than whites at each stage at the time of diagnosis in both time periods. There was little improvement noted in net survival for patients with rectal cancer, with persistent disparities noted between black and white individuals. Additional investigation is needed to identify and implement effective interventions to ensure the consistent and equitable use of high-quality screening, diagnosis, and treatment to improve survival for patients with rectal cancer. Cancer 2017;123:5037-58. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Correlation of Cancer Stem-Cell Markers OCT4, SOX2, and NANOG with Clinicopathological Features and Prognosis in Operative Patients with Rectal Cancer.

PurposeTo investigate the association of cancer stem-cell markers [octamer-binding transcription factor 4 (OCT4), sex determining region Y-box 2 (SOX2), and Nanog homebox (NANOG)] expression with clinicopathological properties and overall survival (OS) in operative rectal cancer (RC) patients receiving adjuvant therapy.Materials and Methods153 patients with primary RC receiving surgery were enrolled. Tumor tissue and paired adjacent normal tissue sample were collected, and OCT4, SOX2, and NANOG expressions were assessed by immunofluorescent staining. The median follow-up duration was 5.2 years, and the last follow-up date was August 2016.ResultsTumor tissue OCT4 (p<0.001), SOX2 (p=0.003), and NANOG (p<0.001) expressions were higher than those in adjacent tissue. OCT4 expression was positively correlated with pathological grade (R=0.185, p=0.022), tumor size (R=0.224, p=0.005), and N stage (R=0.170, p=0.036). NANOG expression was positively associated with tumor size (R=0.169, p=0.036). Kaplan-Meier suggested that OCT4+ was associated with worse OS compared with OCT4− (p<0.001), while no association of SOX2 (p=0.121) and NANOG expressions (p=0.195) with OS was uncovered. Compared with one or no positive marker, at least two positive markers were associated with shorter OS (p<0.001), while all three positive markers were correlated with worse OS compared with two or less positive markers (p<0.001). Multivariate Cox's analysis revealed that OCT4+ (p<0.001) and N stage (p=0.046) were independent factors for shorter OS.ConclusionTumor tissue OCT4 expression was correlated with poor differentiation, tumor size, and N stage, and it can serve as an independent prognostic biomarker in operative patients with RC receiving adjuvant therapy.

Recurrence pattern of rectal cancer after surgical treatment. Analysis of 122 patients in a tertiary care center

Survival in rectal cancer has been related mainly to clinical and pathological staging. Recurrence is by far the most challenging issue when surgical treatment of rectal cancer is concerned. This study aims to establish a recurrence pattern for rectal adenocarcinoma submitted to surgical treatment between March 2003 and July 2016. After exclusion criteria were applied, one hundred twenty two patients were analyzed. Global recurrence was found in 22% of them, while 13.1% have had local recurrence. Disease-free survival was 23.9 months, in average, and medium follow-up was 34.13 months, varying from 6 to 115 months. Recurrence, in literature, is usually between 3 and 35% in 5 years, and shows a 5-years survival rate of only 5%. Around 50% of cases, recurrence is local, confined to pelvis. This data followed literature in most aspects evaluated, although finding a high rate of local recurrence remains a challenge in the seek for better surgical outcomes.

Elevated CEA is associated with worse survival in recurrent rectal cancer

This study investigated the prognostic impact of serum carcinoembryonic antigen (CEA) level in recurrent rectal cancer. We reviewed 745 patients who developed recurrence after curative treatment for rectal cancer between January 2000 and December 2012. Multivariate analyses for survival revealed that age > 60 years (p = 0.005), r-CEA ≥ 5 ng/ml (p < 0.001), disease free interval (DFI) < 12 months (p < 0.001), and palliative or conservative treatment (p < 0.001) were unfavorable factors.

Understanding and Resetting Radiation Sensitivity in Rectal Cancer.

The aim of the study was to explore specific microRNAs (miRs) in rectal cancer that would predict response to radiation and identify target pathways that may be exploited for neoadjuvant therapies. Chemoradiotherapy (CRT) response is a predictor of survival in rectal cancer. Studies have demonstrated changes in RNA expression correlate with chemoradiation sensitivity across cancers. Forty-five rectal cancer patients, partial responders (PR = 18), nonresponders (NR = 13), and complete responders (CR = 14) to CRT, as defined by a tumor regression score, were examined. miRs differentially expressed, using NanoString microArray profiling, were validated with qPCR. We quantified 1 miR and its downstream targets in patient samples. Chemosensitivity was measured in HCT-116, a human colorectal carcinoma cell line, using inhibitors of SHP2 and RAF. miR-451a, 502-5p, 223-3p, and 1246 were the most upregulated miRs (>1.5-fold change) in a NanoString profiling miR panel. qPCR revealed a decrease in expression of miR-451a in NRs. EMSY and CAB39, both downstream targets of miR-451a and involved in carcinogenesis (shown in TCGA) were increased in NRs (qPCR). Both targets are associated with worse survival in colorectal cancer. Inhibition of miR-451a in HCT-116 cells significantly decreased cell proliferation with treatment of SHP2 and RAF inhibitors. An integrated analysis of rectal cancer miRs may yield biomarkers of radioresistance and offer treatment targets for resensitization.

Identification of metastasis-associated microRNAs in serum from rectal cancer patients.

MicroRNAs (miRNAs) are promising prognostic and diagnostic biomarkers due to their high stability in blood. Here we investigate the expression of miRNAs and other noncoding (nc) RNAs in serum of rectal cancer patients. Serum from 96 rectal cancer patients was profiled using small RNA sequencing and expression of small RNAs was correlated with the clinicopathological characteristics of the patients. Multiple classes of RNAs were detected, including miRNAs and fragments of tRNAs, snoRNAs, long ncRNAs, and other classes of RNAs. Several miRNAs, miRNA variants (isomiRs) and other ncRNAs were differentially expressed between Stage IV and Stage I-III rectal cancer patients, including several members of the miR-320 family. Furthermore, we show that high expression of miR-320d as well as one tRNA fragment is associated with poor survival. We also show that several miRNAs and isomiRs are differentially expressed between patients receiving preoperative chemoradiotherapy and patients who did not receive any treatment before serum collection. In summary, our study shows that the expression of miRNAs and other small ncRNAs in serum may be used to predict distant metastasis and survival in rectal cancer.

Multiple Gene-Environment Interactions on the Angiogenesis Gene-Pathway Impact Rectal Cancer Risk and Survival.

Characterization of gene-environment interactions (GEIs) in cancer is limited. We aimed at identifying GEIs in rectal cancer focusing on a relevant biologic process involving the angiogenesis pathway and relevant environmental exposures: cigarette smoking, alcohol consumption, and animal protein intake. We analyzed data from 747 rectal cancer cases and 956 controls from the Diet, Activity and Lifestyle as a Risk Factor for Rectal Cancer study. We applied a 3-step analysis approach: first, we searched for interactions among single nucleotide polymorphisms on the pathway genes; second, we searched for interactions among the genes, both steps using Logic regression; third, we examined the GEIs significant at the 5% level using logistic regression for cancer risk and Cox proportional hazards models for survival. Permutation-based test was used for multiple testing adjustment. We identified 8 significant GEIs associated with risk among 6 genes adjusting for multiple testing: TNF (OR = 1.85, 95% CI: 1.10, 3.11), TLR4 (OR = 2.34, 95% CI: 1.38, 3.98), and EGR2 (OR = 2.23, 95% CI: 1.04, 4.78) with smoking; IGF1R (OR = 1.69, 95% CI: 1.04, 2.72), TLR4 (OR = 2.10, 95% CI: 1.22, 3.60) and EGR2 (OR = 2.12, 95% CI: 1.01, 4.46) with alcohol; and PDGFB (OR = 1.75, 95% CI: 1.04, 2.92) and MMP1 (OR = 2.44, 95% CI: 1.24, 4.81) with protein. Five GEIs were associated with survival at the 5% significance level but not after multiple testing adjustment: CXCR1 (HR = 2.06, 95% CI: 1.13, 3.75) with smoking; and KDR (HR = 4.36, 95% CI: 1.62, 11.73), TLR2 (HR = 9.06, 95% CI: 1.14, 72.11), EGR2 (HR = 2.45, 95% CI: 1.42, 4.22), and EGFR (HR = 6.33, 95% CI: 1.95, 20.54) with protein. GEIs between angiogenesis genes and smoking, alcohol, and animal protein impact rectal cancer risk. Our results support the importance of considering the biologic hypothesis to characterize GEIs associated with cancer outcomes.

Hospital safety-net burden does not predict differences in rectal cancer treatment and outcomes

BackgroundSafety-net hospitals have been shown to have inferior short-term surgical outcomes. The aim of this study was to compare rectal cancer management and survival across hospitals stratified by payer mix. Materials and methodsRectal cancer patients (n = 296,068) were identified using the 1998-2010 National Cancer Data Base. Hospitals were grouped into safety-net burden categories, according to the proportion of patients with Medicaid or no health insurance, as follows: low-, medium-, and high-burden hospitals (HBHs). Patient and tumor characteristics, processes of care, and outcomes were evaluated, and regression analysis was used to investigate correlations between hospital safety-net burden on patient survival. ResultsHBH encountered patients with more advanced disease (P < 0.001). Despite this, stage I-III patients at HBH had equal likelihood of receiving surgery and guideline-appropriate radiation and chemotherapy (all P > 0.05). The 30-day readmissions and mortality were also similar across safety-net groups (all P > 0.05). Multivariate analysis showed no difference in survival between HBH and low-burden hospital (P = 0.164). ConclusionsHospital payer mix may not adversely influence management of rectal cancer. This study highlights potential areas to improve cancer care for vulnerable patient populations.

Impact of Duration of Neoadjuvant Radiation on Rectal Cancer Survival: A Real World Multi-center Retrospective Cohort Study

BackgroundThe utility of neoadjuvant radiotherapy (nRT) for the treatment of stage II and III rectal cancer is well-established. However, the optimal duration of nRT in this setting remains controversial. Using a population-based cohort of patients with stage II and III rectal cancer (RC) treated with curative intent, our aims were to (1) examine the patterns of nRT use and (2) explore the relationship between different nRT schedules and survival in the real-world setting. MethodsThis is a multi-center retrospective cohort study based on population-based data from 5 regional comprehensive cancer centers in British Columbia, Canada. We analyzed patients diagnosed with clinical stage II or III RC from 2006 to 2010 and treated with either short-course (SC) or long-course (LC) nRT prior to curative intent surgery. Logistic regression models were constructed to determine the factors associated with the course of nRT delivered to patients. Kaplan-Meier methods and Cox regression that accounted for known prognostic factors were used to evaluate the relationship between nRT schedule and overall (OS), disease-free (DFS), local recurrence-free (LRFS), and distant recurrence-free survival (DRFS). ResultsWe identified 427 patients: the median age was 65 years (range, 31 to 94 years), 67% were men, 87% had T3 or T4 tumors, and 74% had N1 or N2 disease. Among them, 241 (56%) received SC and 186 (44%) received LC. Adjusting for confounders, patients with N1 or N2 disease were more likely to undergo LC (odds ratio [OR], 5.08; 95% confidence interval [CI], 2.51-11.22; P < .0001 and OR, 8.35; 95% CI, 3.35-22.39; P < .0001, respectively), whereas older age patients were less likely to receive LC (OR, 0.95; 95% CI, 0.94-0.98; P < .0001). In Kaplan-Meier analysis, there were no significant differences observed in OS, DFS, LRFS, and DRFS between SC and LC. Likewise, multivariate analyses demonstrated that OS (hazard ratio [HR], 0.91; 95% CI, 0.61-1.37; P = .66), DFS (HR, 1.06; 95% CI, 0.68-1.64; P = .80), LRFS (HR, 0.79; 95% CI, 0.39-1.57; P = .50) and DRFS (HR, 0.99; 95% CI, 0.60-1.61; P = .95) were similar regardless of nRT schedules. Additional baseline clinical and tumor characteristics did not influence outcomes (all P > .05). ConclusionAppropriate preoperative selection of SC versus LC nRT for locally advanced RC based on patient and tumor characteristics was not associated with differences in survival outcomes in the real-world setting.

Extramural venous invasion on pretreatment MRI and surgical pathology: Is there a role in predicting prognosis in rectal cancer?

e15165 Background: Extramural venous invasion (EMVI) describes tumor cells invading the veins beyond the muscularis propria and has been previously recognized as a predictor for survival and disease recurrence in rectal cancer. EMVI is generally diagnosed on pathology after surgical resection. Pretreatment MRI has been proposed as a surrogate imaging biomarker for recognition of EMVI. Our objective is to study the prognostic significance of EMVI in rectal cancers based on pretreatment MRI imaging to determine its correlation with overall survival (OS), local recurrence (LR), and distant metastases (DM). We also compare MRI-detected EMVI to EMVI detected on pathology to evaluate correlation. Methods: In this ongoing study, records of rectal cancer patients with a pretreatment staging MRI diagnosed between 2004-2015 were retrospectively reviewed (n = 180). Pretreatment rectal MRIs were evaluated for different imaging characteristics, including EMVI. The endpoint of OS was calculated using the Kaplan-Meier method and compared with a log-rank test. A p&lt; 0.05 was considered significant. Cox proportional hazard ratios for LR and DM were generated using clinical, imaging, and pathologic characteristics. Results: Most patients were male (63%) with a median age at diagnosis of 63 years (28.5-95.2). Eighty percent of patients received neoadjuvant chemoradiation (nCRT) followed by surgery and adjuvant chemotherapy (AC); 20% received nCRT followed by surgery. A pathologic complete response was achieved in 17% of patients. Median survival was 48.5 months (2.6-145.2); five-year OS was 85%. The receipt of AC improved OS (HR 0.40, CI 0.2-0.9). Of 70 patients with EMVI noted on the pretreatment MRI, 22 (31%) had EMVI on pathology (p = 0.05). EMVI on MR was not found to be prognostically significant for OS, LR, or DM. EMVI on pathology was found to be significant for DM (HR 3.74, CI 1.8-8.0). Conclusions: Preliminary results show that pretreatment MR-detected EMVI was not found to be predictive for OS, LR, or DM, but pathologically-detected EMVI was found to be a predictor for DM. Further analysis of the relationship between this surrogate imaging biomarker on post-CRT MRI and outcomes is ongoing.