Department of Surgery, St-Paul's Hospital, University of British Columbia, 1081 Burrard Street, Third Floor, Burrard Building, Vancouver, BC V6Z 1Y6, Canada.
Department of Radiology, St-Paul's Hospital, University of British Columbia, 1081 Burrard Street, Third Floor, Burrard Building, Vancouver, BC V6Z 1Y6, Canada.
Ann Surg. 2022 Feb 1;275(2):303-314. doi: 10.1097/SLA.0000000000004636.
The role of MRI-detected EMVI (mrEMVI) as a reliable prognostic factor in rectal cancer has been emphasized in recent years but this finding remains underreported by many institutions.
This review aimed to demonstrate the importance of pre- and post-treatment MRI-detected EMVI as independent prognostic factors of adverse oncologic outcomes in patients undergoing neoadjuvant therapy followed by total mesorectal excision.
This review was designed using the PRISMA guidelines. The following electronic databases were searched from January 2002 to January 2020: CENTRAL, Ovid MEDLINE, PubMed, and Ovid Embase. Main outcomes included DFS and overall survival (OS). Other outcomes of interest comprised positive resection margin and synchronous metastases.
Seventeen studies involving a total of 3821 patients were included for data synthesis. For preneoadjuvant treatment mrEMVI, pooled hazard ratio (HR) estimate for DFS was 2.30 (95% confidence intervals (CI) 1.54-3.44) for higher recurrence in mrEMVI-positive patients. mrEMVI-positive patients were found to have a lower OS with a pooled HR of 1.68 (95%CI 1.27-2.22). Pooled risk ratio for synchronous metastasis was 4.11 (95%CI 2.80-6.02) for mrEMVI-positivity. For postneoadjuvant treatment EMVI (ymrEMVI), positive status showed a lower DFS with a pooled HR of 2.04 (95%CI 1.55-2.69). Risk ratio of having a positive resection margin status was 2.95 (95%CI 1.75-4.98) for ymrEMVI-positive patients.
This review showed that oncologic outcomes are significantly worse for both pre- and post-neoadjuvant treatment mrEMVI-positive patients. MRI-detected EMVI should be consistently reported in rectal cancer staging and may provide guidance for the targeted use of additional systemic therapy.
近年来，MRI 检测到的 EMVI（mrEMVI）作为直肠癌可靠的预后因素的作用已得到强调，但许多机构对此的报道仍较少。
本综述旨在展示新辅助治疗后行全直肠系膜切除术的患者中，术前和术后 MRI 检测到的 EMVI 作为不良肿瘤学结局的独立预后因素的重要性。
本综述采用 PRISMA 指南设计。从 2002 年 1 月至 2020 年 1 月，我们检索了以下电子数据库：CENTRAL、Ovid MEDLINE、PubMed 和 Ovid Embase。主要结局包括无病生存率（DFS）和总生存率（OS）。其他感兴趣的结局包括阳性切缘和同步转移。
共纳入 17 项研究，总计 3821 例患者的数据进行了综合分析。对于新辅助治疗前的 mrEMVI，mrEMVI 阳性患者的 DFS 合并危险比（HR）估计值为 2.30（95%置信区间[CI] 1.54-3.44），提示复发风险较高。MR 阳性患者 OS 较低，合并 HR 为 1.68（95%CI 1.27-2.22）。mrEMVI 阳性患者同步转移的合并风险比（RR）为 4.11（95%CI 2.80-6.02）。对于新辅助治疗后 EMVI（ymrEMVI），阳性状态的 DFS 较低，合并 HR 为 2.04（95%CI 1.55-2.69）。yrEMVI 阳性患者阳性切缘状态的 RR 为 2.95（95%CI 1.75-4.98）。
本综述表明，新辅助治疗前和新辅助治疗后 mrEMVI 阳性患者的肿瘤学结局明显较差。MRI 检测到的 EMVI 应在直肠癌分期中持续报告，并可能为靶向使用额外的全身治疗提供指导。
