Department of Radiation Oncology, Tata Memorial Hospital and Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), E Borges Road, Parel, Mumbai, Maharashtra, India.
Department of Radiology, Tata Memorial Hospital and Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Parel, Mumbai, Maharashtra, India.
Abdom Radiol (NY). 2022 Nov;47(11):3671-3678. doi: 10.1007/s00261-022-03608-z. Epub 2022 Sep 9.
In rectal cancers, presence of extramural vascular invasion on MRI (mrEMVI) is associated with poor survival. The independent influence of mrEMVI in the presence of other prognostic factors has not been previously analyzed using match pair analysis.
Consecutive 92 patients having mrEMVI at presentation treated between January 2016 and December 2018 were matched with 92 patients (1:1) without mrEMVI. Matching parameters were T stage, mesorectal fascia involvement, and tumor differentiation. The presence and absence of mrEMVI were correlated to outcomes. An event was defined as locoregional failure or distant metastasis or poor response to chemoradiation rendering the rectal tumor as inoperable.
At 3 years, in the mrEMVI-positive cohort, 59% had an event and in the mrEMVI-negative cohort, 45% had an event (p = 0.026). Local control was 90.2% (12recurrences in 122 who underwent surgery), two recurrences in the mrEMVI-positive cohort and ten patients in the mrEMVI-negative cohort, which missed statistical significance (p = 0.06). Distant metastasis-free survival was significantly worse in the mrEMVI-positive cohort versus the mrEMVI-negative cohort (58.2% vs. 69.4%) (p = 0.022). Similarly, Overall survival was significantly inferior in mrEMVI-positive cohort compared to the mrEMVI-negative cohort (57% vs. 72.4%) (p = 0.02). The multivariate regression analysis confirmed the independent predictive value of mrEMVI. CONCLUSION: Extramural vascular invasion detected through MRI is an independent risk factor for distant metastasis in the locally advanced carcinoma rectum. Aggressive treatment regimens like total neoadjuvant treatment should be considered in these cases pending randomized control studies.
在直肠癌中，磁共振成像（mrEMVI）显示的外膜血管侵犯与生存不良有关。以前没有使用匹配对分析来分析 mrEMVI 在存在其他预后因素时的独立影响。
连续 92 例在 2016 年 1 月至 2018 年 12 月期间出现 mrEMVI 的患者与 92 例（1:1）无 mrEMVI 的患者进行了匹配。匹配参数为 T 分期、直肠系膜筋膜受累和肿瘤分化。分析 mrEMVI 的存在与否与结果的相关性。事件定义为局部复发、远处转移或对放化疗反应不佳导致直肠肿瘤无法手术。
在 mrEMVI 阳性组中，3 年时 59%的患者发生了事件，在 mrEMVI 阴性组中，45%的患者发生了事件（p=0.026）。局部控制率为 90.2%（122 例接受手术的患者中有 12 例复发），mrEMVI 阳性组中有 2 例复发，mrEMVI 阴性组中有 10 例复发，但差异无统计学意义（p=0.06）。mrEMVI 阳性组的远处无复发生存率明显低于 mrEMVI 阴性组（58.2% vs. 69.4%）（p=0.022）。同样，mrEMVI 阳性组的总生存率明显低于 mrEMVI 阴性组（57% vs. 72.4%）（p=0.02）。多变量回归分析证实了 mrEMVI 的独立预测价值。
磁共振成像检测到的外膜血管侵犯是局部晚期直肠癌远处转移的独立危险因素。在这些情况下，应考虑总新辅助治疗等积极的治疗方案，等待随机对照研究。
