Yang Seung Yoon, Bae Heejin, Seo Nieun, Han Kyunghwa, Han Yoon Dae, Cho Min Soo, Hur Hyuk, Min Byung Soh, Kim Nam Kyu, Lee Kang Young, Lim Joon Seok
Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Korea.
Department of Radiology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Korea.
Eur Radiol. 2024 Jun;34(6):3686-3698. doi: 10.1007/s00330-023-10300-3. Epub 2023 Nov 23.
This study evaluated pretreatment magnetic resonance imaging (MRI)-detected extramural venous invasion (pmrEMVI) as a predictor of survival after neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer (LARC).
Medical records of 1184 patients with rectal adenocarcinoma who underwent TME between January 2011 and December 2016 were reviewed. MRI data were collected from a computerized radiologic database. Cox proportional hazards analysis was used to assess local, systemic recurrence, and disease-free survival risk based on pretreatment MRI-assessed tumor characteristics. After propensity score matching (PSM) for pretreatment MRI features, nCRT therapeutic outcomes according to pmrEMVI status were evaluated. Cox proportional hazards analysis was used to identify risk factors for early recurrence in patients receiving nCRT.
Median follow-up was 62.8 months. Among all patients, the presence of pmrEMVI was significantly associated with worse disease-free survival (DFS; HR 1.827, 95% CI 1.285-2.597, p = 0.001) and systemic recurrence (HR 2.080, 95% CI 1.400-3.090, p < 0.001) but not local recurrence. Among patients with pmrEMVI, nCRT provided no benefit for oncological outcomes before or after PSM. Furthermore, pmrEMVI( +) was the only factor associated with early recurrence on multivariate analysis in patients receiving nCRT.
pmrEMVI is a poor prognostic factor for DFS and SR in patients with non-metastatic rectal cancer and also serves as a predictive biomarker of poor DFS and SR following nCRT in LARC. Therefore, for patients who are positive for pmrEMVI, consideration of alternative treatment strategies may be warranted.
This study demonstrated the usefulness of pmrEMVI as a predictive biomarker for nCRT, which may assist in initial treatment decision-making in patients with non-metastatic rectal cancer.
• Pretreatment MRI-detected extramural venous invasion (pmrEMVI) was significantly associated with worse disease-free survival and systemic recurrence in patients with non-metastatic rectal cancer. • pmrEMVI is a predictive biomarker of poor DFS following nCRT in patients with LARC. • The presence of pmrEMVI was the only factor associated with early recurrence on multivariate analysis in patients receiving nCRT.
本研究评估了新辅助放化疗（nCRT）前磁共振成像（MRI）检测到的壁外静脉侵犯（pmrEMVI）作为局部晚期直肠癌（LARC）患者新辅助放化疗后生存预测指标的价值。
回顾性分析2011年1月至2016年12月期间接受全直肠系膜切除术（TME）的1184例直肠腺癌患者的病历。从计算机放射学数据库中收集MRI数据。采用Cox比例风险分析，根据治疗前MRI评估的肿瘤特征评估局部、全身复发及无病生存风险。在对治疗前MRI特征进行倾向评分匹配（PSM）后，评估根据pmrEMVI状态的nCRT治疗结果。采用Cox比例风险分析确定接受nCRT患者早期复发的危险因素。
中位随访时间为62.8个月。在所有患者中，pmrEMVI的存在与较差的无病生存（DFS；风险比[HR]1.827，95%置信区间[CI]1.285 - 2.597，p = 0.001）和全身复发（HR 2.080，95% CI 1.400 - 3.090，p < 0.001）显著相关，但与局部复发无关。在pmrEMVI患者中，nCRT在PSM前后对肿瘤学结局均无益处。此外，在接受nCRT的患者中，多因素分析显示pmrEMVI(+)是与早期复发相关的唯一因素。
pmrEMVI是转移性直肠癌患者DFS和SR的不良预后因素，也是LARC患者nCRT后DFS和SR不良的预测生物标志物。因此，对于pmrEMVI阳性的患者，可能有必要考虑替代治疗策略。
本研究证明了pmrEMVI作为nCRT预测生物标志物的有用性，这可能有助于非转移性直肠癌患者的初始治疗决策。
• 治疗前MRI检测到的壁外静脉侵犯（pmrEMVI）与非转移性直肠癌患者较差的无病生存和全身复发显著相关。• pmrEMVI是LARC患者nCRT后DFS不良的预测生物标志物。• 在接受nCRT的患者中，多因素分析显示pmrEMVI的存在是与早期复发相关的唯一因素。
