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

• Published in: European journal of surgical oncology Vol. 50; no. 6; p. 108307
• Main Authors: Geffen, Eline G.M. van, Nederend, Joost, Sluckin, Tania C., Hazen, Sanne-Marije J.A., Aalbers, Arend G.J., van Aalten, Susanna M., Amelung, Femke J., Ashruf, Jesse F., Bakers, Frans C.H., Barendse, Renée M., Beets, Geerard L., Blok, Robin D., van Bockel, Liselotte W., den Boer, Frank C., Boogerd, Leonora S.F., Borstlap, Wernard A.A., Bouwman, Johanna E., Bradshaw, Jennifer, Burger, Jacobus W.A., Cnossen, Jeltsje S., Coebergh van den Braak, Robert R.J., Corver, Maaike, Crolla, Rogier M.P.H., Daniëls-Gooszen, Alette W., Demirkiran, Ahmet, Derksen, Tyche, van Dop, Ilse M., Droogh-de Greve, Kitty E., Dunker, Michalda S., Duyck, Johan, van Duyn, Eino B., van Egdom, Laurentine S.E., Eijlers, Bram, van Erp, Anne C., van Essen, Jeroen A., Fabry, Hans F.J., Feitsma, Eline A., Frietman, Bas, van Geel, Anne M., Govaert, Marc J.P.M., de Haas, Robbert J., den Hartogh, Mariska D., Hogewoning, Cornelis R.C., van der Hul, René L., van Hulst, Rieke, Imani, Farshad, Keizers, Bas, Kortekaas, Robert T.J., Lahuis, Derk H.H., Martens, MilouH, Meijnen, Philip, Muller, Karin, Musters, Gijsbert D., de Nes, Lindsey C.F., Nonner, Joost, Noordman, Bo J., Nordkamp, Stefi, Olthof, Pim B., Oosterling, Steven J., Ootes, Daan, Oppedijk, Vera, Peeters, Koen C.M.J., Pereboom, Ilona T.A., Peringa, Jan, Polat, Fatih, Renger, Rutger-Jan, Rombouts, Anouk J.M., Roskott-ten Brinke, Ellen A., Rouw, Dennis B., Rozema, Tom, Schasfoort, Renske A., Scheurkogel, Merel M., Schuivens, Puck M.E., Slob, Marjan J., van der Sluis, Martsje, Smalbroek, Bo P., Tielbeek, Jeroen A.W., van Tilborg, Fiek, van Trier, Dorothée, van der Valk, Maxime J.M., Vanhooymissen, Inge J.S., Vasbinder, G. Boudewijn C., Velema, Laura A., Verduin, Wouter M., Verhagen, Tim, Verrijssen, An-Sofie E., Vliegen, Roy F.A., Voets, Sophie, de Vries, Marianne, van Vugt, Bas S.T., Wegdam, Johannes A., van Wely, Bob J., Westerterp, Marinke, Woensdregt, Karlijn, van der Wolk, Sander, Zamaray, Bobby, Zandvoort, Herman J.A., Zheng, Kang J., Zimmerman, David D.E., Zorgdrager, Marcel
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.06.2024
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2024.108307

Detection 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. A 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). The 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). The 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.