Significance Of Extramural Venous Invasion Research Articles

The prognostic significance of extramural venous invasion detected via contrast-enhanced computed tomography colonography in colon cancer.

167 Background: The precise effects of extramural venous invasion (EMVI) and Spiculation on colon cancer recurrence remain poorly understood. This study investigated the clinical significance of ctEMVI and ctSpiculation as diagnosed via preoperative contrast-enhanced CT colonography (CTC) using three-dimensional multiplanar reconstruction (3D MPR) images. Methods: Patients with stage I–Ⅲ colon cancer (T2 or deeper) diagnosed via CTC at the National Cancer Center Hospital in Japan between 2013 and 2018 were retrospectively evaluated for ctEMVI and ctSpiculation, diagnosed by two observers using 3D MPR images of slices 0.5 mm thick. The interobserver reliability was assessed with Cohen’s kappa statistic, and recurrence-free survival (RFS) was analyzed using Kaplan–Meier curves. Preoperative clinical factors were subjected to Cox regression analysis in relation to RFS. Results: Of 922 patients, 544 eligible cases were analyzed. There were 50 (9.2%) ctEMVI-positive cases and 494 (90.8%) ctEMVI-negative cases, along with 186 (34.2%) ctSpiculation-positive cases and 358 (65.8%) with negative findings. Kappa coefficients for ctEMVI and ctSpiculation were 0.830 and 0.718, respectively. Kaplan–Meier analysis and log-rank tests demonstrated lower RFS in ctEMVI- and ctSpiculation-positive cases (p<0.001). In multivariable analysis, ctT4 (HR 2.95, 95% CI 1.73–5.02) and ctEMVI (2.97, 1.81–4.87) were independent factors associated with RFS. When stratifying TNM stages based on ctEMVI status, in N(+) (i.e., Stage III), ctEMVI-positive group had worse prognoses than negative group (5-year RFS rates; 52.0% vs. 78.5%, p=0.003). Similarly, in N(–) (i.e., Stage I and II), T3N0EMVI(+) cases had significantly worse prognoses than T3N0EMVI(–) and Stage I cases (50.6% vs. 89.3% and 90.1%) and were comparable to the T4N0 group (50.6% vs. 46.7%, p=0.844). Conclusions: Both ctEMVI and ctSpiculation are associated with RFS. ctEMVI is an independent predictor of recurrence and may be valuable in combination with preoperative TNM staging to identify patients at high risk for recurrence. [Table: see text]

Prognostic impact of extramural venous invasion detected by contrast-enhanced CT colonography in colon cancer.

The impact of computed tomography (CT)-detected extramural venous invasion on the recurrence of colon cancer is not fully understood. The aim of this study was to investigate the clinical significance of extramural venous invasion diagnosed before surgery by contrast-enhanced CT colonography using three-dimensional multiplanar reconstruction images. Patients with colon cancer staged greater than or equal to T2 and/or stage I-III who underwent contrast-enhanced CT colonography between 2013 and 2018 at the National Cancer Center Hospital in Japan were retrospectively investigated for CT-detected extramural venous invasion. Inter-observer agreement for the detection of CT-detected extramural venous invasion was evaluated and Kaplan-Meier survival curves were plotted for recurrence-free survival using CT-TNM staging and CT-detected extramural venous invasion. Preoperative clinical variables were analysed using Cox regression for recurrence-free survival. Out of 922 eligible patients, 544 cases were analysed (50 (9.2 per cent) were diagnosed as positive for CT-detected extramural venous invasion and 494 (90.8 per cent) were diagnosed as negative for CT-detected extramural venous invasion). The inter-observer agreement for CT-detected extramural venous invasion had a κ coefficient of 0.830. The group positive for CT-detected extramural venous invasion had a median follow-up of 62.1 months, whereas the group negative for CT-detected extramural venous invasion had a median follow-up of 60.7 months. When CT-TNM stage was stratified according to CT-detected extramural venous invasion status, CT-T3 N(-)extramural venous invasion(+) had a poor prognosis compared with CT-T3 N(-)extramural venous invasion(-) and CT-stage I (5-year recurrence-free survival of 50.6 versus 89.3 and 90.1 per cent respectively; P < 0.001). In CT-stage III, the group positive for CT-detected extramural venous invasion also had a poor prognosis compared with the group negative for CT-detected extramural venous invasion (5-year recurrence-free survival of 52.0 versus 78.5 per cent respectively; P = 0.003). Multivariable analysis revealed that recurrence was associated with CT-T4 (HR 3.10, 95 per cent c.i. 1.85 to 5.20; P < 0.001) and CT-detected extramural venous invasion (HR 3.08, 95 per cent c.i. 1.90 to 5.00; P < 0.001). CT-detected extramural venous invasion was found to be an independent predictor of recurrence and could be used in combination with preoperative TNM staging to identify patients at high risk of recurrence.

Diagnosis and prognostic significance of extramural venous invasion in neuroendocrine tumors of the small intestine

Extramural venous invasion (EMVI) is an established independent prognostic factor in colorectal carcinoma where it is linked to hematogenous spread (i.e., liver metastases), influencing the decision for adjuvant chemotherapy. However, its prognostic significance in small intestinal neuroendocrine tumors (NETs) has not been studied, nor is it routinely assessed or reported. We reviewed primary small bowel NETs (14 jejunum, 82 ileum, 8 not specified) from 104 patients (52 women; median age 60.5, range: 24–84). EMVI was identified in 58 cases (55.8%), including in 13 of 21 equivocal cases using an elastin stain. In univariate analysis, EMVI was associated with lymphovascular and perineural invasion, tumor stage, and lymph node and distant metastases, whereas in multivariate analysis, only distant metastases remained significant (p < 0.001). Liver metastases were present in 55 cases (52.9%) and were significantly associated in univariate analysis with lymphovascular and perineural invasion, tumor stage, lymph node metastases, and EMVI, whereas in multivariate analysis, only EMVI remained significant (p < 0.001; odds ratio (OR) = 59.42). Eight patients developed metachronous liver metastases during follow-up (mean 22.9 ± 22.0 months, range: 4.7–73.2) and all (100%) were positive for EMVI. In contrast, of 49 patients who never developed liver metastases over significantly longer follow-up (mean 71.0 ± 32.4 months, range: 6.6–150.4; p < 0.001), only 7 (14.3%) had EMVI (p < 0.001). In Kaplan–Meier analysis, 8 of 15 patients with EMVI (53.3%) developed metachronous liver metastases, compared with 0 of 42 patients without EMVI (p < 0.001). In contrast, nonhepatic distant metastases, seen in 26 (25.0%) patients, were not associated with EMVI in multivariate or Kaplan–Meier analyses. Our data demonstrate that EMVI is common in small bowel NETs and strongly correlates with development of liver metastases. Therefore, its evaluation is critical and should be assessed in combination with adjuvant techniques such as elastin staining, if necessary. Moreover, inclusion of EMVI in pathology reporting guidelines should be considered.

Prevalence and Prognostic Significance of Extramural Venous Invasion in Patients with Locally Advanced Esophageal Cancer

BackgroundExtramural venous invasion (EMVI) is a known adverse prognostic factor in patients with colorectal carcinoma. The prevalence and significance of EMVI in esophageal cancer (EC) patients is still unclear.MethodsFrom a prospectively maintained database, we retrospectively reviewed the resection specimens of patients with pathologic locally advanced (pT3/T4/N0-3) EC who were treated with curative intent between 2000 and 2015. Patients with previous malignancies and gastroesophageal junction (type II/III) tumors were excluded. Included were 81 patients who underwent surgery alone and 37 patients who underwent neoadjuvant chemoradiotherapy (nCRT). EMVI was assessed on hematoxylin and eosin slides and confirmed or excluded by additional Elastica van Gieson staining. Survival was analyzed using a multivariable Cox regression.ResultsEMVI was present in 23.5% (n = 19) of patients in the surgery-alone group and 21.6% (n = 8) of patients in the nCRT group. The prevalence of EMVI after surgery alone was significantly high in squamous cell carcinomas and among tumors located in the mid-esophagus, as well as those with lymphovascular invasion (p < 0.05). After nCRT, the presence of EMVI was significantly high in tumors with lymphovascular and perineural tumor growth (p = 0.034). EMVI status was an independent adverse prognostic factor for disease-free survival [hazard ratio (HR) 7.0, 95% confidence interval (CI) 2.3–21.8; p =0.001] and overall survival (HR 6.5, 95% CI 2.2–19.1; p = 0.001) in the surgery-alone group for node-positive tumors.ConclusionsIn this study of locally advanced > pT3/N0-3 EC patients, EMVI was present in 23.5% of patients in the surgery-alone group and in 21.6% of patients after nCRT. EMVI was an independent adverse prognostic factor in patients after surgery alone.

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.

Incidence and prognostic significance of extramural venous invasion in T3–4 esophageal cancer

44Background: Extra mural venous invasion (EMVI) is known as an adverse prognostic indicator of survival and an important predictor of systemic recurrences in colorectal carcinoma. However, the incidence and significance of EMVI in esophageal cancer (EC) have not been studied well. Aim: To estimate the incidence and the prognostic significance of EMVI in pathological stage T3-4 EC resection specimens without neoadjuvant chemoradiotherapy (nCRT) Methods: From a prospective maintained database we retrospectively review the resected specimens of patients with an EC. For adequate EMVI assessment we only included patients without nCRT and excluded patients without previous malignancies and patients with cardia/gastroesophageal junction tumors. A total of 76 patients were included between 2000 and 2012. EMVI was assessed on haematoxylin and eosin slides and for confirmation additional Elastica van Gieson staining was performed. Disease free survival was analyzed using a multivariable logistic regression and Kap...

Incidence and prognostic significance of extramural venous invasion in T3-4 esophageal cancer.

44 Background: Extra mural venous invasion (EMVI) is known as an adverse prognostic indicator of survival and an important predictor of systemic recurrences in colorectal carcinoma. However, the incidence and significance of EMVI in esophageal cancer (EC) have not been studied well. Aim: To estimate the incidence and the prognostic significance of EMVI in pathological stage T3-4 EC resection specimens without neoadjuvant chemoradiotherapy (nCRT) Methods: From a prospective maintained database we retrospectively review the resected specimens of patients with an EC. For adequate EMVI assessment we only included patients without nCRT and excluded patients without previous malignancies and patients with cardia/gastroesophageal junction tumors. A total of 76 patients were included between 2000 and 2012. EMVI was assessed on haematoxylin and eosin slides and for confirmation additional Elastica van Gieson staining was performed. Disease free survival was analyzed using a multivariable logistic regression and Kaplan-Meier method. Results: Evidence of EMVI was found in 18 patients (23.7%). The incidence of EMVI was significantly higher in squamous cell carcinomas (p &lt; 0.05) and among tumors located in the mid-esophagus (p &lt; 0.05). In the univariate analysis, pathological N- stage (HR 3.6 95%Cl: 1.5-8.5; p = 0.004) and positive circumferential resection margin (CRM) (HR 2.3 95% Cl: 1.2-4.5 p = 0.015) were independent prognostic factors. By stepwise multivariate Cox regression analysis, pathological tumor length (HR 2.5 95%Cl: 1.0-6.5 p = 0.05), pathological N- stage (HR 2.7 95%Cl: 1.3-6.2 p = 0.008), positive CRM (HR 2.3 95% Cl: 1.2-4.5 p = 0.009) and EMVI (HR 2.2 95% Cl: 1.0-4.5 p = 0.04) were shown to be independent prognostic factors for disease free survival. Conclusions: A search for EMVI may provide additional prognostic information in esophageal cancer, especially in squamous cell carcinoma.

The significance of extramural venous invasion in R1 positive rectal cancer.

Evidence has shown that a positive resection margin (R1) is a key determinant of subsequent local recurrence and a poor prognostic factor in rectal cancer. The aim of this study was to evaluate the outcomes and prognosticators in patients with R1 resection of rectal cancer. Retrospective study of all patients operatively managed within our institution between April 2008 and April 2013 for rectal cancer. Baseline demographics and multiple outcome measures recorded. Overall survival (OS), disease-free survival (DFS) and recurrence were the primary outcome measures. Overall, there were 306 primary rectal cancers. Seventy-six percent were grade T3/4 tumours. OS was 30months. R1 rate was 16% (48 patients). Thirty-one patients underwent APR and 17 AR. In patients who responded to neoadjuvant chemotherapy (NAC), overall survival was 55months, with no extramural venous invasion (EMV) seen in this cohort. In non-responders OS was 29months, with EMV in 48%. In patients who did not receive NAC, OS was 23months, with EMV in 74%. EMV is a strong predictor for poor survival following R1 (p=0.001). We also found a correlation between number of positive nodes and OS/DFS (p=0.004). In this small cohort of patients with R1 positive rectal cancers, response to NAC is the strongest predictor of poor overall and disease-free survival. In patients who respond to NAC, OS and DFS has been shown to be positive, with a reduced rate of EMV.

Prognostic significance of extramural venous invasion detected by multislice spiral computed tomography examination in stage III colon cancer

Objective To investigate the effect of extramural venous invasion (EMVI) detected by multislice spiral computed tomography (MSCT) on the overall prognosis in patients with stage Ⅲ colon cancer after radical resection. Methods The retrospective case-control study was adopted. The clinical data of 117 patients with stage Ⅲ colon cancer in Tangshan Gongren Hospital from March 2011 to March 2013 were collected. All the patients underwent MSCT examination preoperatively and the results were recorded from two radiologists′ double-blinded independent image-reading. According to the results of MSCT examination, positive ctEMVI patients were allocated to the positive ctEMVI group, and negative ctEMVI patients were allocated to the negative ctEMVI group. Observation indices: (1) ctEMVI consistency and comparison of clinicopathological information between the 2 groups. (2) Follow-up and prognosis situations. (3) Univariate and multivariate analyses of prognosis. Follow-up was performed by telephone interview and outpatient examination once every 3 months within a year and once every 6 months after one year. If the patients had tumor recurrence and metastasis, then the patients were followed up once every 3 months. The follow-up included tumor metastasis and recurrence and patients′ survival, and the follow-up time was up to March 2016. The consistency of the image quality assessment of 2 observers was analyzed by the k test. Count data were analyzed using chi-square test. Kaplan-Meier method was used to draw survival curve and calculate tumor-free survival rate and overall survival rate, and the survival rate was compared with Log-rank test. The univariate and multivariate analyses of prognosis were analyzed using COX regression model. Results (1) ctEMVI consistency and comparison of clinicopathological information between 2 groups: the results of the first observer were 35 cases in the positive ctEMVI group and 82 cases in the negative ctEMVI group; and the results of the second observer were 52 cases in the positive ctEMVI group and 65 cases in the negative ctEMVI group. Good interobservers agreement was found for the evaluation (k=0.689). The final results were reached with 42 cases in the positive ctEMVI group and 75 cases in the negative ctEMVI group after the disputed imaging of 17 patients evaluated by the third assessor. (2) Follow-up and prognosis situations: all the 117 patients were followed up for 6-73 months with an average time of 46 months. The 3-year recurrence and metastasis rate of positive ctEMVI group and negative ctEMVI group were 90.48% and 74.67%, respectively, with a significant difference (χ2=4.261, P T2, poor differentiation of tumor were independent risk factors affecting the 3-year cumulative survival rate of patients with stage Ⅲ colon cancer after radical resection (RR=4.411, 2.236, 5.029, 1.573, 2.412, 95% CI: 1.907-10.206, 1.409-3.548, 2.649-9.614, 1.045-2.369, 1.215-6.789, P<0.05). Conclusion Positive ctEMVI is an independent risk factor affecting the poor prognosis of patients with stage Ⅲ colon cancer after radical resection, and the prognosis of positive ctEMVI patients is worse than negative ctEMVI patients. Key words: Colonic neoplasms; Extramural venous invasion; Tomography, X-ray computed; Prognosis

The prognostic significance of extramural venous invasion detected by multiple-row detector computed tomography in stage III gastric cancer.

To determine the 1-year progression-free survival (PFS) of extramural venous invasion (EMVI), detected with contrast-enhanced multiple-row detector computed tomography (ceMDCT), in patients with stageIIIgastric cancer. Between January 2009 and December 2013, 117 patients with pathological-proved stageIIIgastric cancer based on the criteria of the AJCC 7th were included in this retrospective study. All patients underwent adjuvant chemotherapy postoperatively and had been monitored with the follow-up chest/abdomen/pelvis ceMDCT on 3, 6, and 12months post-operation. Two radiologists reviewed preoperative images regarding the presence of EMVI, categories of tumor and categories of lymph node. Conventional prognostic histological factors including pathological T/N status, tumor location/growth pattern, histological type/tumor differentiation, and tumor size were also recorded. Disease progression was defined as the presence of radiological or/and pathology-confirmed metachronous metastases, local recurrence, or gastric cancer-related death. The 1-year PFS for both EMVI-positive and EMVI-negative was calculated using the Kaplan-Meier product limit. Hazard ratios for 1-year PFS were generated using a Cox proportional hazard regression on ceMDCT tumor characteristics. The prevalence of EMVI detected with ceMDCT was 43.6% (51/117) in patients with stageIIIgastric cancer. The EMVI-positive patients had significantly lower 1-year PFS rates (45.1%), than the EMVI-negative patients (75.8%), (Log-rank test, P=0.0008). In a Cox proportional hazards regression analysis, EMVI and tumor location/growth pattern were identified as independent prognostic factors of 1-year PFS with hazard ratio of 2.272 (95% CI 1.133-4.556, P=0.021) and 1.982 (95% CI 1.040-3.780, P=0.039), respectively. EMVI status, detected with ceMDCT, could be used to counsel patients regarding ongoing risks of metastatic disease, implications for surveillance, and systemic chemotherapy.

The Prognostic Significance of Postchemoradiotherapy High-resolution MRI and Histopathology Detected Extramural Venous Invasion in Rectal Cancer

This study aimed to determine the prognostic significance of extramural venous invasion (EMVI) after chemoradiotherapy (CRT) by both magnetic resonance imaging (MRI) (ymrEMVI) and histopathology (ypEMVI). EMVI is a prognostic factor in rectal cancer but whether this remains so after CRT preoperative is unknown. Histopathological definitions of EMVI are variable and lead to underreporting particularly after CRT. All consecutive patients staged on initial MRI as EMVI-positive undergoing preoperative CRT and curative surgery between Jan 2006 and Jan 2012 were included. Posttreatment EMVI status (yEMVI) was reevaluated for both MRI and pathology. The primary endpoint of disease-free survival (DFS) for ymrEMVI and ypEMVI was calculated using the Kaplan-Meier product limit and compared with a Mantel-Cox log-rank test. A P < 0.05 was considered significant. Hazard ratios (HRs) for disease recurrence were generated using Cox proportional hazard regression for MRI and histopathology tumor characteristics. A total of 188 patients who had evidence of EMVI on initial baseline MRI staging were included. MRI detected significantly more patients with persistent EMVI than histopathology (53% vs 19%) but both were prognostic for worse survival-ymrEMVI (HR 1.97) and ypEMVI (HR 2.39). Patients with persistent ymrEMVI-positivity had significantly worse DFS at 3 years (42.7%) compared with ymrEMVI-negative tumors (79.8%); DFS for was 36.9% versus 65.9% positive and negative ypEMVI, respectively. Detection of EMVI post-CRT is prognostically significant whether detected by MRI or histopathology. EMVI status after treatment may be used to counsel patients regarding ongoing risks of metastatic disease, implications for surveillance, and systemic chemotherapy.