MRI-detected extramural vascular invasion (mrEMVI) as the best predictive factor to identify candidates to total neoadjuvant therapy in locally advanced rectal cancer.
TNT
colorectal surgery
distant metastases
Journal
Journal of surgical oncology
ISSN: 1096-9098
Titre abrégé: J Surg Oncol
Pays: United States
ID NLM: 0222643
Informations de publication
Date de publication:
May 2022
May 2022
Historique:
received:
24
12
2021
accepted:
02
02
2022
pubmed:
16
2
2022
medline:
13
4
2022
entrez:
15
2
2022
Statut:
ppublish
Résumé
Chemotherapy in locally advanced rectal cancer (LARC) is shifting from an adjuvant setting to a total neoadjuvant therapy (TNT) strategy, that relies on distant metastases (DM) risk prediction. This study aims to assess the accuracy of magnetic resonance imaging-detected extramural vascular invasion (mrEMVI) as predictive factor for DM in LARC, compared with other MRI-detected and pathologic factors. This retrospective single-center study analyzed data extracted from a series of consecutive patients curatively resected for rectal cancer at Mauriziano Hospital in Turin (Italy) from January 2013 to December 2018. Data from 69 patients were analyzed. MrEMVI was detected in 31 (44.9%) cases. Median follow-up was 39.9 months. DM and local recurrence occurred in 19 (27.5%) and 4 (5.8%) patients. One- and 3-year cumulative incidence of DM were 32.3% (95% confidence interval [CI]: 0.17-0.49) and 56.8% (95% CI: 0.35-0.74) in the mrEMVI-positive group and 5.4% (95% CI: 0.01-0.16) and 14.0% (95% CI: 0.05-0.27) in the mrEMVI-negative group (log-rank test, p < 0.001). In the multivariate analysis of MRI factors, mrEMVI was the only independent predictor of DM (HR: 3.59, CI: 1.21-10.69, p = 0.02). This study confirmed that mrEMVI is a powerful predictor of DM in LARC. It should be routinely reported and considered during multidisciplinary care strategy planning.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
Chemotherapy in locally advanced rectal cancer (LARC) is shifting from an adjuvant setting to a total neoadjuvant therapy (TNT) strategy, that relies on distant metastases (DM) risk prediction. This study aims to assess the accuracy of magnetic resonance imaging-detected extramural vascular invasion (mrEMVI) as predictive factor for DM in LARC, compared with other MRI-detected and pathologic factors.
METHODS
METHODS
This retrospective single-center study analyzed data extracted from a series of consecutive patients curatively resected for rectal cancer at Mauriziano Hospital in Turin (Italy) from January 2013 to December 2018.
RESULTS
RESULTS
Data from 69 patients were analyzed. MrEMVI was detected in 31 (44.9%) cases. Median follow-up was 39.9 months. DM and local recurrence occurred in 19 (27.5%) and 4 (5.8%) patients. One- and 3-year cumulative incidence of DM were 32.3% (95% confidence interval [CI]: 0.17-0.49) and 56.8% (95% CI: 0.35-0.74) in the mrEMVI-positive group and 5.4% (95% CI: 0.01-0.16) and 14.0% (95% CI: 0.05-0.27) in the mrEMVI-negative group (log-rank test, p < 0.001). In the multivariate analysis of MRI factors, mrEMVI was the only independent predictor of DM (HR: 3.59, CI: 1.21-10.69, p = 0.02).
CONCLUSIONS
CONCLUSIONS
This study confirmed that mrEMVI is a powerful predictor of DM in LARC. It should be routinely reported and considered during multidisciplinary care strategy planning.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1024-1031Informations de copyright
© 2022 Wiley Periodicals LLC.
Références
Van Gijn W, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol. 2011;12:575-582.
Battersby NJ, How P, Moran B, et al. Prospective validation of a low rectal cancer magnetic resonance imaging staging system and development of a local recurrence risk stratification model: the mercury II study. Ann Surg. 2016;263:751-760.
Benson AB, Venook AP, Al-Hawary MM, et al. Rectal cancer, version 2.2018 clinical practice guidelines in Oncology. JNCCN J Natl Compr Cancer Netwk. 2018;16:874-901.
Glynne-Jones R, Wyrwicz L, Tiret E, et al. Rectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017;28(suppl_4):iv22-iv40.
Brown G, Radcliffe AG, Newcombe RG, Dallimore NS, Bourne MW, Williams GT. Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging. Br J Surg. 2003;90:355-364.
Sauer R, Liersch T, Merkel S, et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: Results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol. 2012;30:1926-1933.
Hong YS, Kim SY, Lee JS, et al. Oxaliplatin-based adjuvant chemotherapy for rectal cancer after preoperative chemoradiotherapy (ADORE): long-term results of a randomized controlled trial. J Clin Oncol. 2019;37:3011-3123.
Carvalho C, Glynne-Jones R. Challenges behind proving efficacy of adjuvant chemotherapy after preoperative chemoradiation for rectal cancer. Lancet Oncol. 2017;18:e354-e363.
Rahma OE, Yothers G, Hong TS, et al. Use of total neoadjuvant therapy for locally advanced rectal cancer. JAMA Oncology. 2021;7:1225-1230.
Vanderwalde N, Grothey A. Personalizing treatment for rectal cancer: total neoadjuvant therapy is leading the way. JAMA Network Open. 2020;3:e2030508.
Riesco-Martinez MC, Fernandez-Martos C, Gravalos-Castro C, et al. Impact of total neoadjuvant therapy vs. standard chemoradiotherapy in locally advanced rectal cancer: a systematic review and meta-analysis of randomized trials. Cancers. 2020;12:3655.
Kasi A, Abbasi S, Handa S, et al. Total neoadjuvant therapy vs standard therapy in locally advanced rectal cancer: a systematic review and meta-analysis. JAMA Network Open. 2020;3:e2030097.
Petrelli F, Trevisan F, Cabiddu M, et al. Total neoadjuvant therapy in rectal cancer: a systematic review and meta-analysis of treatment outcomes. Ann Surg. 2020;271:440-448.
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;95:229-236.
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;116:1513-1519.
Rouleau Fournier F, Motamedi MAK, Brown CJ, et al. Oncologic outcomes associated with MRI-detected extramural venous invasion (mrEMVI) in rectal cancer: a systematic review and meta-analysis. Ann Surg. 2022;275:303-314.
Cho MS, Park YY, Yoon J, et al. MRI-based EMVI positivity predicts systemic recurrence in rectal cancer patients with a good tumor response to chemoradiotherapy followed by surgery. J Surg Oncol. 2018;117:1823-1832.
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;28:1465-1475.
Santiago I, Figueiredo N, Parés O, Matos C. MRI of rectal cancer-relevant anatomy and staging key points. Insights Imaging. 2020;11:100.
D'souza N, Lord A, Shaw A, et al. The sigmoid take-off: an anatomical imaging definition of the rectum validated on specimen analysis. Eur J Surg Oncol. 2020;46:1668-1672.
Zinicola R, Pedrazzi G, Haboubi N, Nicholls RJ. The degree of extramural spread of T3 rectal cancer: an appeal to the American Joint Committee on Cancer. Colorectal Disease. 2017;19:8-15.
Horvat N, Carlos Tavares Rocha C, Clemente Oliveira B, Petkovska I, Gollub MJ. MRI of rectal cancer: Tumor staging, imaging techniques, and management. Radiographics. 2019;39:367-387.
Kreis ME, Ruppert R, Ptok H, et al. Use of preoperative magnetic resonance imaging to select patients with rectal cancer for neoadjuvant chemoradiation-interim analysis of the German OCUM Trial (NCT01325649). J Gastrointest Surg. 2016;20:25-32.
Smith NJ, Shihab O, Arnaout A, Swift RI, Brown G. MRI for detection of extramural vascular invasion in rectal cancer. Am J Roentgenol. 2008;191:1517-1522.
Volinsky CT, Madigan D, Raftery AE, Kronmal RA. Bayesian model averaging in proportional hazard models: assessing the risk of a stroke. Applied Statistics. 1997;46:433-448.
Wang D, Zhang W, Bakhai A. Comparison of Bayesian model averaging and stepwise methods for model selection in logistic regression. Stat Med. 2004;23:3451-3467.
Collins GS, Reitsma JB, Altman DG, Moons KGM. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD Statement. Ann Intern Med. 2015;162:55-63.
Taylor FG, Quirke P, Heald RJ, et al. Preoperative magnetic resonance imaging assessment of circumferential resection margin predicts disease-free survival and local recurrence: 5-Year follow-up results of the MERCURY Study. J Clin Oncol. 2014;32:34-43.
Al-Sukhni E, Milot L, Fruitman M, et al. Diagnostic accuracy of MRI for assessment of T category, lymph node metastases, and circumferential resection margin involvement in patients with rectal cancer: a systematic review and meta-analysis. Ann Surg Oncol. 2012;19:2212-2223.
Lord AC, Dʼsouza N, Shaw A, et al. MRI-diagnosed tumour deposits and EMVI status have superior prognostic accuracy to current clinical TNM staging in rectal cancer. Ann Surg. 2020. doi:10.1097/SLA.0000000000004499
Tan JJ, Carten RV, Babiker A, Abulafi M, Lord AC, Brown G. Prognostic importance of MRI detected extramural venous invasion in rectal cancer: a literature review and systematic meta-analysis. Int J Radiat Oncol*Biol*Phys. 2021;111:385-394.
Chand M, Evans J, Swift RI, et al. The prognostic significance of postchemoradiotherapy high-resolution MRI and histopathology detected extramural venous invasion in rectal cancer. Ann Surg. 2015;261:473479.
Bahadoer RR, Dijkstra EA, van Etten B, et al. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncol. 2021;22:29-42.
Conroy T, Bosset JF, Etienne PL, et al. Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol. 2021;22:702-715.
Giuliante F, Viganò L, de Rose AM, et al. Liver-first approach for synchronous colorectal metastases: analysis of 7360 patients from the LiverMetSurvey Registry. Ann Surg Oncol. 2021;28:8198-8208.
Torzilli G, Adam R, Viganò L, et al. Surgery of colorectal liver metastases: pushing the limits. Liver Cancer. 2016;6:80-89.
Quirke P, Steele R, Monson J, et al. Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet. 2009;373:821-828.