Prognostic significance of MRI-detected extramural venous invasion according to grade and response to neo-adjuvant treatment in locally advanced rectal cancer A national cohort study after radiologic training and reassessment

Eline G. M. van Geffen; Joost Nederend; Tania C. Sluckin; Sanne-Marije J. A. Hazen; Karin Horsthuis; Regina G. H. Beets-Tan; Corrie A. M. Marijnen; Pieter J. Tanis; Miranda Kusters; the Dutch Snapshot Research Group

doi:10.1016/j.ejso.2024.108307

Prognostic significance of MRI-detected extramural venous invasion according to grade and response to neo-adjuvant treatment in locally advanced rectal cancer A national cohort study after radiologic training and reassessment

Eline G. M. van Geffen, Joost Nederend, Tania C. Sluckin, Sanne-Marije J. A. Hazen, Karin Horsthuis, Regina G. H. Beets-Tan, Corrie A. M. Marijnen, Pieter J. Tanis, Miranda Kusters^*, the Dutch Snapshot Research Group

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

3 Citations (Scopus)

Abstract

Background: Detection of grade 3–4 extra mural venous invasion (mrEMVI) on magnetic resonance imaging (MRI) is associated with an increased distant metastases (DM)-rate. This study aimed to determine the impact of different grades of mrEMVI and their disappearance after neoadjuvant therapy. Methods: A Dutch national retrospective cross-sectional study was conducted, including patients who underwent resection for rectal cancer in 2016 from 60/69 hospitals performing rectal surgery. Patients with a cT3-4 tumour ≤8 cm from the anorectal junction were selected and their MRI-scans were reassessed by trained abdominal radiologists. Positive mrEMVI grades (3 and 4) were analyzed in regard to 4-year local recurrence (LR), DM, disease-free survival (DFS) and overall survival (OS). Results: The 1213 included patients had a median follow-up of 48 months (IQR 30–54). Positive mrEMVI was present in 324 patients (27%); 161 had grade 3 and 163 had grade 4. A higher mrEMVI stage (grade 4 vs grade 3 vs no mrEMVI) increased LR-risk (21% vs 18% vs 7%, <0.001) and DM-risk (49% vs 30% vs 21%, p < 0.001) and decreased DFS (42% vs 55% vs 69%, p < 0.001) and OS (62% vs 76% vs 81%, p < 0.001), which remained independently associated in multivariable analysis. When mrEMVI had disappeared on restaging MRI, DM-rate was comparable to initial absence of mrEMVI (both 26%), whereas LR-rate remained high (22% vs 9%, p = 0.006). Conclusion: The negative oncological impact of mrEMVI on recurrence and survival rates was dependent on grading. Disappearance of mrEMVI on restaging MRI decreased the risk of DM, but not of LR.

Original language	English
Article number	108307
Journal	European journal of surgical oncology
Volume	50
Issue number	6
DOIs	https://doi.org/10.1016/j.ejso.2024.108307
Publication status	Published - 1 Jun 2024

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Geffen, E. G. M. V., Nederend, J., Sluckin, T. C., Hazen, S.-M. J. A., Horsthuis, K., Beets-Tan, R. G. H., Marijnen, C. A. M., Tanis, P. J., Kusters, M., & the Dutch Snapshot Research Group (2024). Prognostic significance of MRI-detected extramural venous invasion according to grade and response to neo-adjuvant treatment in locally advanced rectal cancer A national cohort study after radiologic training and reassessment. European journal of surgical oncology, 50(6), Article 108307. https://doi.org/10.1016/j.ejso.2024.108307

@article{843f8e2404484fe28d284e546f87f610,

title = "Prognostic significance of MRI-detected extramural venous invasion according to grade and response to neo-adjuvant treatment in locally advanced rectal cancer A national cohort study after radiologic training and reassessment",

abstract = "Background: Detection of grade 3–4 extra mural venous invasion (mrEMVI) on magnetic resonance imaging (MRI) is associated with an increased distant metastases (DM)-rate. This study aimed to determine the impact of different grades of mrEMVI and their disappearance after neoadjuvant therapy. Methods: A Dutch national retrospective cross-sectional study was conducted, including patients who underwent resection for rectal cancer in 2016 from 60/69 hospitals performing rectal surgery. Patients with a cT3-4 tumour ≤8 cm from the anorectal junction were selected and their MRI-scans were reassessed by trained abdominal radiologists. Positive mrEMVI grades (3 and 4) were analyzed in regard to 4-year local recurrence (LR), DM, disease-free survival (DFS) and overall survival (OS). Results: The 1213 included patients had a median follow-up of 48 months (IQR 30–54). Positive mrEMVI was present in 324 patients (27%); 161 had grade 3 and 163 had grade 4. A higher mrEMVI stage (grade 4 vs grade 3 vs no mrEMVI) increased LR-risk (21% vs 18% vs 7%, <0.001) and DM-risk (49% vs 30% vs 21%, p < 0.001) and decreased DFS (42% vs 55% vs 69%, p < 0.001) and OS (62% vs 76% vs 81%, p < 0.001), which remained independently associated in multivariable analysis. When mrEMVI had disappeared on restaging MRI, DM-rate was comparable to initial absence of mrEMVI (both 26%), whereas LR-rate remained high (22% vs 9%, p = 0.006). Conclusion: The negative oncological impact of mrEMVI on recurrence and survival rates was dependent on grading. Disappearance of mrEMVI on restaging MRI decreased the risk of DM, but not of LR.",

author = "Geffen, {Eline G. M. van} and Joost Nederend and Sluckin, {Tania C.} and Hazen, {Sanne-Marije J. A.} and Karin Horsthuis and Beets-Tan, {Regina G. H.} and Marijnen, {Corrie A. M.} and Tanis, {Pieter J.} and Miranda Kusters and {the Dutch Snapshot Research Group} and Aalbers, {Arend G. J.} and {van Aalten}, {Susanna M.} and Amelung, {Femke J.} and Marjolein Ankersmit and Antonisse, {Imogeen E.} and Ashruf, {Jesse F.} and Aukema, {Tjeerd S.} and Henk Avenarius and Bahadoer, {Renu R.} and Bakers, {Frans C. H.} and Bakker, {Ilsalien S.} and Fleur Bangert and Barendse, {Ren{\'e}e M.} and Beekhuis, {Heleen M. D.} and Beets, {Geerard L.} and Bemelman, {Willem A.} and Maaike Berb{\'e}e and {de Bie}, {Shira H.} and Bisschops, {Robert H. C.} and Blok, {Robin D.} and {van Bockel}, {Liselotte W.} and Boer, {Anniek H.} and {den Boer}, {Frank C.} and Boerma, {Evert-Jan G.} and Boogerd, {Leonora S. F.} and Jaap Borstlap and Borstlap, {Wernard A. A.} and Bouwman, {Johanna E.} and Braak, {Sicco J.} and Braat, {Manon N. G. J. A.} and Jennifer Bradshaw and Brandsma, {Amarins T. A.} and {van Breest Smallenburg}, Vivian and {van den Broek}, {Wim T.} and {van der Burg}, {Sjirk W.} and Burger, {Jacobus W. A.} and Burghgraef, {Thijs A.} and {ten Cate}, {David W. G.} and Ceha, {Heleen M.} and Cnossen, {Jeltsje S.} and {Coebergh van den Braak}, {Robert R. J.} and Consten, {Esther C. J.} and Maaike Corver and Crolla, {Rogier M. P. H.} and Sam Curutchet and Dani{\"e}ls-Gooszen, {Alette W.} and Davids, {Paul H. P.} and Dekker, {Emmelie N.} and Dekker, {Jan Willem T.} and Ahmet Demirkiran and Tyche Derksen and Diederik, {Arjen L.} and Dinaux, {Anne M.} and Kemal Dogan and {van Dop}, {Ilse M.} and {Droogh-de Greve}, {Kitty E.} and Duijsens, {Hanneke M. H.} and Dunker, {Michalda S.} and Johan Duyck and {van Duyn}, {Eino B.} and {van Egdom}, {Laurentine S. E.} and Bram Eijlers and Youssef el-Massoudi and {van Elderen}, Saskia and Emmen, {Anouk M. L. H.} and Marc Engelbrecht and {van Erp}, {Anne C.} and {van Essen}, {Jeroen A.} and Fabry, {Hans F. J.} and Thomas Fassaert and Feitsma, {Eline A.} and Feshtali, {Shirin S.} and Bas Frietman and Furn{\'e}e, {Edgar J. B.} and {van Geel}, {Anne M.} and Geijsen, {Elisabeth D.} and {van Geloven}, {Anna A. W.} and Gerhards, {Michael F.} and Hugo Gielkens and {van Gils}, {Renza A. H.} and Lucas Goense and Govaert, {Marc J. P. M.} and {van Grevenstein}, {Wilhelmina M. U.} and {Joline de Groof}, E. and {de Groot}, Irene and {de Haas}, {Robbert J.} and Hakkenbrak, {Nadia A. G.} and {den Hartogh}, {Mariska D.} and Vera Heesink and Heikens, {Joost T.} and Hendriksen, {Ellen M.} and {van den Hoek}, Sjoerd and {van der Hoeven}, {Erik J. R. J.} and Christiaan Hoff and Anna Hogewoning and Hogewoning, {Cornelis R. C.} and Stefan Hoogendoorn and {van Hoorn}, Francois and {van der Hul}, {Ren{\'e} L.} and {van Hulst}, Rieke and Farshad Imani and Bas Inberg and Intven, {Martijn P. W.} and Pedro Janssen and {de Jong}, {Chris E. J.} and Jacoline Jonkers and Daniela Jou-Valencia and Bas Keizers and Ketelaers, {Stijn H. J.} and Eva Kn{\"o}ps and {van Koeverden}, Sebastiaan and Sylvia Kok and Kolderman, {Stephanie E. M.} and {de Korte}, {Fleur I.} and Kortekaas, {Robert T. J.} and Korving, {Julie C.} and Koster, {Ingrid M.} and Jasenko Krdzalic and Pepijn Krielen and Kroese, {Leonard F.} and Krul, {Eveline J. T.} and Lahuis, {Derk H. H.} and Bas Lamme and {van Landeghem}, {An A. G.} and Leijtens, {Jeroen W. A.} and Leseman-Hoogenboom, {Mathilde M.} and {de Lijster}, {Manou S.} and Marsman, {Martijn S.} and MilouH. Martens and Ilse Masselink and {van der Meij}, Wout and Philip Meijnen and Jarno Melenhorst and {de Mey}, {Dietrich J. L.} and Julia Moelker-Galuzina and Linda Morsink and Mulder, {Erik J.} and Karin Muller and Musters, {Gijsbert D.} and Neijenhuis, {Peter A.} and {de Nes}, {Lindsey C. F.} and M. Nielen and {van den Nieuwboer}, {Jan B. J.} and Nieuwenhuis, {Jonanne F.} and Joost Nonner and Noordman, {Bo J.} and Stefi Nordkamp and Olthof, {Pim B.} and Oosterling, {Steven J.} and Daan Ootes and Vera Oppedijk and Pieter Ott and Ida Paulusma and Peeters, {Koen C. M. J.} and Pereboom, {Ilona T. A.} and Jan Peringa and Zo{\"e} Pironet and Plate, {Joost D. J.} and Fatih Polat and Poodt, {Ingrid G. M.} and Posma, {Lisanne A. E.} and Prette, {Jeroen F.} and Pultrum, {Bareld B.} and Qaderi, {Seyed M.} and {van Rees}, {Jan M.} and Rutger-Jan Renger and Rombouts, {Anouk J. M.} and Roosen, {Lodewijk J.} and {Roskott-ten Brinke}, {Ellen A.} and Joost Rothbarth and Rouw, {Dennis B.} and Tom Rozema and Heidi R{\"u}tten and Rutten, {Harm J. T.} and {van der Sande}, {Marit E.} and Schaafsma, {Boudewijn E.} and Schasfoort, {Renske A.} and Scheurkogel, {Merel M.} and {Schouten van der Velden}, {Arjan P.} and Schreurs, {Wilhelmina H.} and Schuivens, {Puck M. E.} and Colin Sietses and Simons, {Petra C. G.} and Slob, {Marjan J.} and Slooter, {Gerrit D.} and {van der Sluis}, Martsje and Smalbroek, {Bo P.} and Smits, {Anke B.} and Spillenaar-Bilgen, {Ernst J.} and Spruit, {Patty H.} and Stam, {Tanja C.} and Jaap Stoker and Talsma, {Aaldert K.} and Temmink, {Sofieke J. D.} and The, {G. Y. Mireille} and Tielbeek, {Jeroen A. W.} and {van Tilborg}, {Aukje A. J. M.} and {van Tilborg}, Fiek and {van Trier}, Doroth{\'e}e and Tuynman, {Jurriaan B.} and {van der Valk}, {Maxime J. M.} and Vanhooymissen, {Inge J. S.} and Vasbinder, {G. Boudewijn C.} and Veeken, {Cornelis J.} and Velema, {Laura A.} and {van de Ven}, {Anthony W. H.} and Verdaasdonk, {Emiel G. G.} and Verduin, {Wouter M.} and Tim Verhagen and Verheijen, {Paul M.} and Maarten Vermaas and Verrijssen, {An-Sofie E.} and Verschuur, {Anna V. D.} and Schaik, {Harmke Verwoerd-van} and Vliegen, {Roy F. A.} and Sophie Voets and Vogelaar, {F. Jeroen} and Vogelij, {Clementine L. A.} and Johanna Vos-Westerman and {de Vries}, Marianne and Vroemen, {Joy C.} and {van Vugt}, {Bas S. T.} and Wegdam, {Johannes A.} and {van Wely}, {Bob J.} and Marinke Westerterp and {van Westerveld}, {Paul P.} and {van Westreenen}, {Henderik L.} and Wijma, {Allard G.} and {de Wilt}, {Johannes H. W.} and {de Wit}, {Bart W. K.} and Fennie Wit and Karlijn Woensdregt and {van Woerden}, Victor and {van der Wolf}, {Floor S. W.} and {van der Wolk}, Sander and Wybenga, {Johannes M.} and {van der Zaag}, {Edwin S.} and Bobby Zamaray and Zandvoort, {Herman J. A.} and {van der Zee}, Dennis and Zeilstra, {Annette P.} and Zheng, {Kang J.} and Zimmerman, {David D. E.} and Marcel Zorgdrager",

note = "Publisher Copyright: {\textcopyright} 2024 The Author(s)",

year = "2024",

month = jun,

day = "1",

doi = "10.1016/j.ejso.2024.108307",

language = "English",

volume = "50",

journal = "European journal of surgical oncology",

issn = "0748-7983",

publisher = "W.B. Saunders Ltd",

number = "6",

}

Geffen, EGMV, Nederend, J, Sluckin, TC , Hazen, S-MJA , Horsthuis, K, Beets-Tan, RGH, Marijnen, CAM, Tanis, PJ , Kusters, M & the Dutch Snapshot Research Group 2024, 'Prognostic significance of MRI-detected extramural venous invasion according to grade and response to neo-adjuvant treatment in locally advanced rectal cancer A national cohort study after radiologic training and reassessment', European journal of surgical oncology, vol. 50, no. 6, 108307. https://doi.org/10.1016/j.ejso.2024.108307

Prognostic significance of MRI-detected extramural venous invasion according to grade and response to neo-adjuvant treatment in locally advanced rectal cancer A national cohort study after radiologic training and reassessment. / Geffen, Eline G. M. van; Nederend, Joost; Sluckin, Tania C. et al.
In: European journal of surgical oncology, Vol. 50, No. 6, 108307, 01.06.2024.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Prognostic significance of MRI-detected extramural venous invasion according to grade and response to neo-adjuvant treatment in locally advanced rectal cancer A national cohort study after radiologic training and reassessment

AU - Geffen, Eline G. M. van

AU - Nederend, Joost

AU - Sluckin, Tania C.

AU - Hazen, Sanne-Marije J. A.

AU - Horsthuis, Karin

AU - Beets-Tan, Regina G. H.

AU - Marijnen, Corrie A. M.

AU - Tanis, Pieter J.

AU - Kusters, Miranda

AU - the Dutch Snapshot Research Group

AU - Aalbers, Arend G. J.

AU - van Aalten, Susanna M.

AU - Amelung, Femke J.

AU - Ankersmit, Marjolein

AU - Antonisse, Imogeen E.

AU - Ashruf, Jesse F.

AU - Aukema, Tjeerd S.

AU - Avenarius, Henk

AU - Bahadoer, Renu R.

AU - Bakers, Frans C. H.

AU - Bakker, Ilsalien S.

AU - Bangert, Fleur

AU - Barendse, Renée M.

AU - Beekhuis, Heleen M. D.

AU - Beets, Geerard L.

AU - Bemelman, Willem A.

AU - Berbée, Maaike

AU - de Bie, Shira H.

AU - Bisschops, Robert H. C.

AU - Blok, Robin D.

AU - van Bockel, Liselotte W.

AU - Boer, Anniek H.

AU - den Boer, Frank C.

AU - Boerma, Evert-Jan G.

AU - Boogerd, Leonora S. F.

AU - Borstlap, Jaap

AU - Borstlap, Wernard A. A.

AU - Bouwman, Johanna E.

AU - Braak, Sicco J.

AU - Braat, Manon N. G. J. A.

AU - Bradshaw, Jennifer

AU - Brandsma, Amarins T. A.

AU - van Breest Smallenburg, Vivian

AU - van den Broek, Wim T.

AU - van der Burg, Sjirk W.

AU - Burger, Jacobus W. A.

AU - Burghgraef, Thijs A.

AU - ten Cate, David W. G.

AU - Ceha, Heleen M.

AU - Cnossen, Jeltsje S.

AU - Coebergh van den Braak, Robert R. J.

AU - Consten, Esther C. J.

AU - Corver, Maaike

AU - Crolla, Rogier M. P. H.

AU - Curutchet, Sam

AU - Daniëls-Gooszen, Alette W.

AU - Davids, Paul H. P.

AU - Dekker, Emmelie N.

AU - Dekker, Jan Willem T.

AU - Demirkiran, Ahmet

AU - Derksen, Tyche

AU - Diederik, Arjen L.

AU - Dinaux, Anne M.

AU - Dogan, Kemal

AU - van Dop, Ilse M.

AU - Droogh-de Greve, Kitty E.

AU - Duijsens, Hanneke M. H.

AU - Dunker, Michalda S.

AU - Duyck, Johan

AU - van Duyn, Eino B.

AU - van Egdom, Laurentine S. E.

AU - Eijlers, Bram

AU - el-Massoudi, Youssef

AU - van Elderen, Saskia

AU - Emmen, Anouk M. L. H.

AU - Engelbrecht, Marc

AU - van Erp, Anne C.

AU - van Essen, Jeroen A.

AU - Fabry, Hans F. J.

AU - Fassaert, Thomas

AU - Feitsma, Eline A.

AU - Feshtali, Shirin S.

AU - Frietman, Bas

AU - Furnée, Edgar J. B.

AU - van Geel, Anne M.

AU - Geijsen, Elisabeth D.

AU - van Geloven, Anna A. W.

AU - Gerhards, Michael F.

AU - Gielkens, Hugo

AU - van Gils, Renza A. H.

AU - Goense, Lucas

AU - Govaert, Marc J. P. M.

AU - van Grevenstein, Wilhelmina M. U.

AU - Joline de Groof, E.

AU - de Groot, Irene

AU - de Haas, Robbert J.

AU - Hakkenbrak, Nadia A. G.

AU - den Hartogh, Mariska D.

AU - Heesink, Vera

AU - Heikens, Joost T.

AU - Hendriksen, Ellen M.

AU - van den Hoek, Sjoerd

AU - van der Hoeven, Erik J. R. J.

AU - Hoff, Christiaan

AU - Hogewoning, Anna

AU - Hogewoning, Cornelis R. C.

AU - Hoogendoorn, Stefan

AU - van Hoorn, Francois

AU - van der Hul, René L.

AU - van Hulst, Rieke

AU - Imani, Farshad

AU - Inberg, Bas

AU - Intven, Martijn P. W.

AU - Janssen, Pedro

AU - de Jong, Chris E. J.

AU - Jonkers, Jacoline

AU - Jou-Valencia, Daniela

AU - Keizers, Bas

AU - Ketelaers, Stijn H. J.

AU - Knöps, Eva

AU - van Koeverden, Sebastiaan

AU - Kok, Sylvia

AU - Kolderman, Stephanie E. M.

AU - de Korte, Fleur I.

AU - Kortekaas, Robert T. J.

AU - Korving, Julie C.

AU - Koster, Ingrid M.

AU - Krdzalic, Jasenko

AU - Krielen, Pepijn

AU - Kroese, Leonard F.

AU - Krul, Eveline J. T.

AU - Lahuis, Derk H. H.

AU - Lamme, Bas

AU - van Landeghem, An A. G.

AU - Leijtens, Jeroen W. A.

AU - Leseman-Hoogenboom, Mathilde M.

AU - de Lijster, Manou S.

AU - Marsman, Martijn S.

AU - Martens, MilouH.

AU - Masselink, Ilse

AU - van der Meij, Wout

AU - Meijnen, Philip

AU - Melenhorst, Jarno

AU - de Mey, Dietrich J. L.

AU - Moelker-Galuzina, Julia

AU - Morsink, Linda

AU - Mulder, Erik J.

AU - Muller, Karin

AU - Musters, Gijsbert D.

AU - Neijenhuis, Peter A.

AU - de Nes, Lindsey C. F.

AU - Nielen, M.

AU - van den Nieuwboer, Jan B. J.

AU - Nieuwenhuis, Jonanne F.

AU - Nonner, Joost

AU - Noordman, Bo J.

AU - Nordkamp, Stefi

AU - Olthof, Pim B.

AU - Oosterling, Steven J.

AU - Ootes, Daan

AU - Oppedijk, Vera

AU - Ott, Pieter

AU - Paulusma, Ida

AU - Peeters, Koen C. M. J.

AU - Pereboom, Ilona T. A.

AU - Peringa, Jan

AU - Pironet, Zoë

AU - Plate, Joost D. J.

AU - Polat, Fatih

AU - Poodt, Ingrid G. M.

AU - Posma, Lisanne A. E.

AU - Prette, Jeroen F.

AU - Pultrum, Bareld B.

AU - Qaderi, Seyed M.

AU - van Rees, Jan M.

AU - Renger, Rutger-Jan

AU - Rombouts, Anouk J. M.

AU - Roosen, Lodewijk J.

AU - Roskott-ten Brinke, Ellen A.

AU - Rothbarth, Joost

AU - Rouw, Dennis B.

AU - Rozema, Tom

AU - Rütten, Heidi

AU - Rutten, Harm J. T.

AU - van der Sande, Marit E.

AU - Schaafsma, Boudewijn E.

AU - Schasfoort, Renske A.

AU - Scheurkogel, Merel M.

AU - Schouten van der Velden, Arjan P.

AU - Schreurs, Wilhelmina H.

AU - Schuivens, Puck M. E.

AU - Sietses, Colin

AU - Simons, Petra C. G.

AU - Slob, Marjan J.

AU - Slooter, Gerrit D.

AU - van der Sluis, Martsje

AU - Smalbroek, Bo P.

AU - Smits, Anke B.

AU - Spillenaar-Bilgen, Ernst J.

AU - Spruit, Patty H.

AU - Stam, Tanja C.

AU - Stoker, Jaap

AU - Talsma, Aaldert K.

AU - Temmink, Sofieke J. D.

AU - The, G. Y. Mireille

AU - Tielbeek, Jeroen A. W.

AU - van Tilborg, Aukje A. J. M.

AU - van Tilborg, Fiek

AU - van Trier, Dorothée

AU - Tuynman, Jurriaan B.

AU - van der Valk, Maxime J. M.

AU - Vanhooymissen, Inge J. S.

AU - Vasbinder, G. Boudewijn C.

AU - Veeken, Cornelis J.

AU - Velema, Laura A.

AU - van de Ven, Anthony W. H.

AU - Verdaasdonk, Emiel G. G.

AU - Verduin, Wouter M.

AU - Verhagen, Tim

AU - Verheijen, Paul M.

AU - Vermaas, Maarten

AU - Verrijssen, An-Sofie E.

AU - Verschuur, Anna V. D.

AU - Schaik, Harmke Verwoerd-van

AU - Vliegen, Roy F. A.

AU - Voets, Sophie

AU - Vogelaar, F. Jeroen

AU - Vogelij, Clementine L. A.

AU - Vos-Westerman, Johanna

AU - de Vries, Marianne

AU - Vroemen, Joy C.

AU - van Vugt, Bas S. T.

AU - Wegdam, Johannes A.

AU - van Wely, Bob J.

AU - Westerterp, Marinke

AU - van Westerveld, Paul P.

AU - van Westreenen, Henderik L.

AU - Wijma, Allard G.

AU - de Wilt, Johannes H. W.

AU - de Wit, Bart W. K.

AU - Wit, Fennie

AU - Woensdregt, Karlijn

AU - van Woerden, Victor

AU - van der Wolf, Floor S. W.

AU - van der Wolk, Sander

AU - Wybenga, Johannes M.

AU - van der Zaag, Edwin S.

AU - Zamaray, Bobby

AU - Zandvoort, Herman J. A.

AU - van der Zee, Dennis

AU - Zeilstra, Annette P.

AU - Zheng, Kang J.

AU - Zimmerman, David D. E.

AU - Zorgdrager, Marcel

PY - 2024/6/1

Y1 - 2024/6/1

N2 - Background: Detection of grade 3–4 extra mural venous invasion (mrEMVI) on magnetic resonance imaging (MRI) is associated with an increased distant metastases (DM)-rate. This study aimed to determine the impact of different grades of mrEMVI and their disappearance after neoadjuvant therapy. Methods: A Dutch national retrospective cross-sectional study was conducted, including patients who underwent resection for rectal cancer in 2016 from 60/69 hospitals performing rectal surgery. Patients with a cT3-4 tumour ≤8 cm from the anorectal junction were selected and their MRI-scans were reassessed by trained abdominal radiologists. Positive mrEMVI grades (3 and 4) were analyzed in regard to 4-year local recurrence (LR), DM, disease-free survival (DFS) and overall survival (OS). Results: The 1213 included patients had a median follow-up of 48 months (IQR 30–54). Positive mrEMVI was present in 324 patients (27%); 161 had grade 3 and 163 had grade 4. A higher mrEMVI stage (grade 4 vs grade 3 vs no mrEMVI) increased LR-risk (21% vs 18% vs 7%, <0.001) and DM-risk (49% vs 30% vs 21%, p < 0.001) and decreased DFS (42% vs 55% vs 69%, p < 0.001) and OS (62% vs 76% vs 81%, p < 0.001), which remained independently associated in multivariable analysis. When mrEMVI had disappeared on restaging MRI, DM-rate was comparable to initial absence of mrEMVI (both 26%), whereas LR-rate remained high (22% vs 9%, p = 0.006). Conclusion: The negative oncological impact of mrEMVI on recurrence and survival rates was dependent on grading. Disappearance of mrEMVI on restaging MRI decreased the risk of DM, but not of LR.

AB - Background: Detection of grade 3–4 extra mural venous invasion (mrEMVI) on magnetic resonance imaging (MRI) is associated with an increased distant metastases (DM)-rate. This study aimed to determine the impact of different grades of mrEMVI and their disappearance after neoadjuvant therapy. Methods: A Dutch national retrospective cross-sectional study was conducted, including patients who underwent resection for rectal cancer in 2016 from 60/69 hospitals performing rectal surgery. Patients with a cT3-4 tumour ≤8 cm from the anorectal junction were selected and their MRI-scans were reassessed by trained abdominal radiologists. Positive mrEMVI grades (3 and 4) were analyzed in regard to 4-year local recurrence (LR), DM, disease-free survival (DFS) and overall survival (OS). Results: The 1213 included patients had a median follow-up of 48 months (IQR 30–54). Positive mrEMVI was present in 324 patients (27%); 161 had grade 3 and 163 had grade 4. A higher mrEMVI stage (grade 4 vs grade 3 vs no mrEMVI) increased LR-risk (21% vs 18% vs 7%, <0.001) and DM-risk (49% vs 30% vs 21%, p < 0.001) and decreased DFS (42% vs 55% vs 69%, p < 0.001) and OS (62% vs 76% vs 81%, p < 0.001), which remained independently associated in multivariable analysis. When mrEMVI had disappeared on restaging MRI, DM-rate was comparable to initial absence of mrEMVI (both 26%), whereas LR-rate remained high (22% vs 9%, p = 0.006). Conclusion: The negative oncological impact of mrEMVI on recurrence and survival rates was dependent on grading. Disappearance of mrEMVI on restaging MRI decreased the risk of DM, but not of LR.

UR - http://www.scopus.com/inward/record.url?scp=85189787176&partnerID=8YFLogxK

U2 - 10.1016/j.ejso.2024.108307

DO - 10.1016/j.ejso.2024.108307

M3 - Article

C2 - 38581757

SN - 0748-7983

VL - 50

JO - European journal of surgical oncology

JF - European journal of surgical oncology

IS - 6

M1 - 108307

ER -

Geffen EGMV, Nederend J, Sluckin TC , Hazen SMJA , Horsthuis K, Beets-Tan RGH et al. Prognostic significance of MRI-detected extramural venous invasion according to grade and response to neo-adjuvant treatment in locally advanced rectal cancer A national cohort study after radiologic training and reassessment. European journal of surgical oncology. 2024 Jun 1;50(6):108307. doi: 10.1016/j.ejso.2024.108307

Prognostic significance of MRI-detected extramural venous invasion according to grade and response to neo-adjuvant treatment in locally advanced rectal cancer A national cohort study after radiologic training and reassessment

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