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; 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

Eur J Surg Oncol. 2024 Mar 29;50(6):108307. doi: 10.1016/j.ejso.2024.108307. Online ahead of print.

Authors

Eline G M van Geffen¹, Joost Nederend², Tania C Sluckin¹, Sanne-Marije J A Hazen¹, Karin Horsthuis³, Regina G H Beets-Tan⁴, Corrie A M Marijnen⁵, Pieter J Tanis⁶, Miranda Kusters⁷; Dutch Snapshot Research Group

Collaborators

Dutch Snapshot Research Group:
Arend G J Aalbers, Susanna M van Aalten, Femke J Amelung, Marjolein Ankersmit, Imogeen E Antonisse, Jesse F Ashruf, Tjeerd S Aukema, Henk Avenarius, Renu R Bahadoer, Frans C H Bakers, Ilsalien S Bakker, Fleur Bangert, Renée M Barendse, Heleen M D Beekhuis, Geerard L Beets, Willem A Bemelman, Maaike Berbée, Shira H de Bie, Robert H C Bisschops, Robin D Blok, Liselotte W van Bockel, Anniek H Boer, Frank C den Boer, Evert-Jan G Boerma, Leonora S F Boogerd, Jaap Borstlap, Wernard A A Borstlap, Johanna E Bouwman, Sicco J Braak, Manon N G J A Braat, Jennifer Bradshaw, Amarins T A Brandsma, Vivian van Breest Smallenburg, Wim T van den Broek, Sjirk W van der Burg, Jacobus W A Burger, Thijs A Burghgraef, David W G Ten Cate, Heleen M Ceha, Jeltsje S Cnossen, Robert R J Coebergh van den Braak, Esther C J Consten, Maaike Corver, Rogier M P H Crolla, Sam Curutchet, Alette W Daniëls-Gooszen, Paul H P Davids, Emmelie N Dekker, Jan Willem T Dekker, Ahmet Demirkiran, Tyche Derksen, Arjen L Diederik, Anne M Dinaux, Kemal Dogan, Ilse M van Dop, Kitty E Droogh-de Greve, Hanneke M H Duijsens, Michalda S Dunker, Johan Duyck, Eino B van Duyn, Laurentine S E van Egdom, Bram Eijlers, Youssef El-Massoudi, Saskia van Elderen, Anouk M L H Emmen, Marc Engelbrecht, Anne C van Erp, Jeroen A van Essen, Hans F J Fabry, Thomas Fassaert, Eline A Feitsma, Shirin S Feshtali, Bas Frietman, Edgar J B Furnée, Anne M van Geel, Elisabeth D Geijsen, Anna A W van Geloven, Michael F Gerhards, Hugo Gielkens, Renza A H van Gils, Lucas Goense, Marc J P M Govaert, Wilhelmina M U van Grevenstein, E Joline de Groof, Irene de Groot, Robbert J de Haas, Nadia A G Hakkenbrak, Mariska D den Hartogh, Vera Heesink, Joost T Heikens, Ellen M Hendriksen, Sjoerd van den Hoek, Erik J R J van der Hoeven, Christiaan Hoff, Anna Hogewoning, Cornelis R C Hogewoning, Stefan Hoogendoorn, Francois van Hoorn, René L van der Hul, Rieke van Hulst, Farshad Imani, Bas Inberg, Martijn P W Intven, Pedro Janssen, Chris E J de Jong, Jacoline Jonkers, Daniela Jou-Valencia, Bas Keizers, Stijn H J Ketelaers, Eva Knöps, Sebastiaan van Koeverden, Sylvia Kok, Stephanie E M Kolderman, Fleur I de Korte, Robert T J Kortekaas, Julie C Korving, Ingrid M Koster, Jasenko Krdzalic, Pepijn Krielen, Leonard F Kroese, Eveline J T Krul, Derk H H Lahuis, Bas Lamme, An A G van Landeghem, Jeroen W A Leijtens, Mathilde M Leseman-Hoogenboom, Manou S de Lijster, Martijn S Marsman, MilouH Martens, Ilse Masselink, Wout van der Meij, Philip Meijnen, Jarno Melenhorst, Dietrich J L de Mey, Julia Moelker-Galuzina, Linda Morsink, Erik J Mulder, Karin Muller, Gijsbert D Musters, Peter A Neijenhuis, Lindsey C F de Nes, M Nielen, Jan B J van den Nieuwboer, Jonanne F Nieuwenhuis, Joost Nonner, Bo J Noordman, Stefi Nordkamp, Pim B Olthof, Steven J Oosterling, Daan Ootes, Vera Oppedijk, Pieter Ott, Ida Paulusma, Koen C M J Peeters, Ilona T A Pereboom, Jan Peringa, Zoë Pironet, Joost D J Plate, Fatih Polat, Ingrid G M Poodt, Lisanne A E Posma, Jeroen F Prette, Bareld B Pultrum, Seyed M Qaderi, Jan M van Rees, Rutger-Jan Renger, Anouk J M Rombouts, Lodewijk J Roosen, Ellen A Roskott-Ten Brinke, Joost Rothbarth, Dennis B Rouw, Tom Rozema, Heidi Rütten, Harm J T Rutten, Marit E van der Sande, Boudewijn E Schaafsma, Renske A Schasfoort, Merel M Scheurkogel, Arjan P Schouten van der Velden, Wilhelmina H Schreurs, Puck M E Schuivens, Colin Sietses, Petra C G Simons, Marjan J Slob, Gerrit D Slooter, Martsje van der Sluis, Bo P Smalbroek, Anke B Smits, Ernst J Spillenaar-Bilgen, Patty H Spruit, Tanja C Stam, Jaap Stoker, Aaldert K Talsma, Sofieke J D Temmink, G Y Mireille The, Jeroen A W Tielbeek, Aukje A J M van Tilborg, Fiek van Tilborg, Dorothée van Trier, Jurriaan B Tuynman, Maxime J M van der Valk, Inge J S Vanhooymissen, G Boudewijn C Vasbinder, Cornelis J Veeken, Laura A Velema, Anthony W H van de Ven, Emiel G G Verdaasdonk, Wouter M Verduin, Tim Verhagen, Paul M Verheijen, Maarten Vermaas, An-Sofie E Verrijssen, Anna V D Verschuur, Harmke Verwoerd-van Schaik, Roy F A Vliegen, Sophie Voets, F Jeroen Vogelaar, Clementine L A Vogelij, Johanna Vos-Westerman, Marianne de Vries, Joy C Vroemen, Bas S T van Vugt, Johannes A Wegdam, Bob J van Wely, Marinke Westerterp, Paul P van Westerveld, Henderik L van Westreenen, Allard G Wijma, Johannes H W de Wilt, Bart W K de Wit, Fennie Wit, Karlijn Woensdregt, Victor van Woerden, Floor S W van der Wolf, Sander van der Wolk, Johannes M Wybenga, Edwin S van der Zaag, Bobby Zamaray, Herman J A Zandvoort, Dennis van der Zee, Annette P Zeilstra, Kang J Zheng, David D E Zimmerman, Marcel Zorgdrager

Affiliations

¹ Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, De Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Treatment and Quality of Life and Imaging and Biomarkers, Amsterdam, the Netherlands.
² Catharina Hospital, Department of Radiology, Michelangelolaan 2, Eindhoven, the Netherlands.
³ Cancer Center Amsterdam, Treatment and Quality of Life and Imaging and Biomarkers, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, De Boelelaan 1117, Amsterdam, the Netherlands.
⁴ The Netherlands Cancer Institute, Department of Radiology, Plesmanlaan 121, Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology, University of Maastricht, Universiteitssingel 40, Maastricht, the Netherlands; Department of Radiology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Campusvej 55, DK-5230, Odense, Denmark.
⁵ LUMC, Department of Radiation Oncology, Albinusdreef 2, Leiden, the Netherlands; The Netherlands Cancer Institute, Department of Radiation Oncology, Plesmanlaan 121, Amsterdam, the Netherlands.
⁶ Cancer Center Amsterdam, Treatment and Quality of Life and Imaging and Biomarkers, Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Surgery, Meibergdreef 9, Amsterdam, the Netherlands; Erasmus MC, Department of Surgical Oncology and Gastrointestinal Surgery, Rotterdam, the Netherlands.
⁷ Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Surgery, De Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Treatment and Quality of Life and Imaging and Biomarkers, Amsterdam, the Netherlands. Electronic address: m.kusters@amsterdamumc.nl.

PMID: 38581757
DOI: 10.1016/j.ejso.2024.108307

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.