TY - JOUR
T1 - MRI Assessment of Extramural Venous Invasion Before and After Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer and Its Association with Disease-Free and Overall Survival
AU - Thompson, Hannah M.
AU - Bates, David D.B.
AU - Pernicka, Jennifer Golia
AU - Park, Sun Jin
AU - Nourbakhsh, Mahra
AU - Fuqua, James L.
AU - Fiasconaro, Megan
AU - Lavery, Jessica A.
AU - Wei, Iris H.
AU - Pappou, Emmanouil P.
AU - Smith, J. Joshua
AU - Nash, Garrett M.
AU - Weiser, Martin R.
AU - Paty, Philip B.
AU - Garcia-Aguilar, Julio
AU - Widmar, Maria
N1 - Publisher Copyright:
© 2023, Society of Surgical Oncology.
PY - 2023/7
Y1 - 2023/7
N2 - Background: Extramural venous invasion (EMVI) on baseline MRI is associated with poor prognosis in patients with locally advanced rectal cancer. This study investigated the association of persistent EMVI after total neoadjuvant therapy (TNT) (chemoradiotherapy and systemic chemotherapy) with survival. Methods: Baseline MRI, post-TNT MRI, and surgical pathology data from 175 patients with locally advanced rectal cancer who underwent TNT and total mesorectal excision between 2010 and 2017 were retrospectively analyzed for evidence of EMVI. Two radiologists assessed EMVI status with disagreement adjudicated by a third. Pathologic EMVI status was assessed per departmental standards. Cox regression models evaluated the associations between EMVI and disease-free and overall survival. Results: EMVI regression on both post-TNT MRI and surgical pathology was associated with disease-free survival (hazard ratio, 0.17; 95% confidence interval (CI), 0.04–0.64) and overall survival (hazard ratio, 0.11; 95% CI, 0.02–0.68). In an exploratory analysis of 35 patients with EMVI on baseline MRI, only six had EMVI on pathology compared with 18 on post-TNT MRI; these findings were not associated (p = 0.2). Longer disease-free survival was seen with regression on both modalities compared with remaining positive. Regression on pathology alone, independent of MRI EMVI status, was associated with similar improvements in survival. Conclusions: Baseline EMVI is associated with poor prognosis even after TNT. EMVI regression on surgical pathology is common even with persistent EMVI on post-TNT MRI. EMVI regression on surgical pathology is associated with improved DFS, while the utility of post-TNT MRI EMVI persistence for decision-making and prognosis remains unclear.
AB - Background: Extramural venous invasion (EMVI) on baseline MRI is associated with poor prognosis in patients with locally advanced rectal cancer. This study investigated the association of persistent EMVI after total neoadjuvant therapy (TNT) (chemoradiotherapy and systemic chemotherapy) with survival. Methods: Baseline MRI, post-TNT MRI, and surgical pathology data from 175 patients with locally advanced rectal cancer who underwent TNT and total mesorectal excision between 2010 and 2017 were retrospectively analyzed for evidence of EMVI. Two radiologists assessed EMVI status with disagreement adjudicated by a third. Pathologic EMVI status was assessed per departmental standards. Cox regression models evaluated the associations between EMVI and disease-free and overall survival. Results: EMVI regression on both post-TNT MRI and surgical pathology was associated with disease-free survival (hazard ratio, 0.17; 95% confidence interval (CI), 0.04–0.64) and overall survival (hazard ratio, 0.11; 95% CI, 0.02–0.68). In an exploratory analysis of 35 patients with EMVI on baseline MRI, only six had EMVI on pathology compared with 18 on post-TNT MRI; these findings were not associated (p = 0.2). Longer disease-free survival was seen with regression on both modalities compared with remaining positive. Regression on pathology alone, independent of MRI EMVI status, was associated with similar improvements in survival. Conclusions: Baseline EMVI is associated with poor prognosis even after TNT. EMVI regression on surgical pathology is common even with persistent EMVI on post-TNT MRI. EMVI regression on surgical pathology is associated with improved DFS, while the utility of post-TNT MRI EMVI persistence for decision-making and prognosis remains unclear.
UR - http://www.scopus.com/inward/record.url?scp=85150625232&partnerID=8YFLogxK
U2 - 10.1245/s10434-023-13225-9
DO - 10.1245/s10434-023-13225-9
M3 - Article
C2 - 37085657
AN - SCOPUS:85150625232
SN - 1068-9265
VL - 30
SP - 3957
EP - 3965
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 7
ER -