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The prognostic value of MRI-detected extramural vascular invasion (mrEMVI) for rectal cancer patients treated with neoadjuvant therapy: a meta-analysis

  • Oncology
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Abstract

Objectives

The purpose of this meta-analysis was to evaluate the prognostic value of MRI-detected extramural vascular invasion (mrEMVI) and mrEMVI after neoadjuvant therapy (ymrEMVI) in rectal cancer patients receiving neoadjuvant therapy.

Methods

A systematic search of the PubMed, Web of Science, Embase, and Cochrane Library databases was carried out up to June 2020. Studies that evaluated mrEMVI, used treatment with neoadjuvant therapy, and reported survival were included. The time-to-event outcomes (OS and DFS rates) are expressed as hazard ratios (HRs) with 95% confidence intervals (CIs). If the HR was not reported in the study, it was calculated from the survival curve using methods according to Parmar’s recommendation. The Newcastle-Ottawa scale was used to assess the methodological quality of the studies included in the meta-analysis.

Results

A total of 2237 patients from 11 studies were included, and the pooled analysis of the overall results from eight studies showed that patients who were mrEMVI positive at baseline had significantly worse disease-free survival (DFS) (random-effects model: HR = 2.50 [1.84, 3.14]; Z = 5.83, p < 0.00001). The pooled analysis of the overall results from six studies showed that patients who were ymrEMVI positive following neoadjuvant therapy had significantly worse DFS (random-effects model: HR = 2.24 [1.73, 2.90], Z = 6.12, p < 0.00001). Patients with mrEMVI positivity at baseline were also associated with worse overall survival (OS) (random-effects model: HR = 1.93 [1.36, 2.73]; Z = 3.71, p < 0.00001).

Conclusion

mrEMVI and ymrEMVI positivity are poor prognostic factors for rectal cancer patients treated with neoadjuvant therapy. The precise evaluation of EMVI may contribute to designing individualised treatments and improving patient outcomes.

Key Points

• Extramural vascular invasion (EMVI) is a prognostic factor for rectal cancer.

• MRI can be used to evaluate EMVI status before (mrEMVI) and after neoadjuvant therapy (ymrEMVI).

• The evaluation of mrEMVI and ymrEMVI in neoadjuvant therapy would provide an early assessment of patient prognosis.

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Abbreviations

DFS:

Disease-free survival

EMVI:

Extramural vascular invasion

HR:

Hazard ratio

LARC:

Locally advanced rectal cancer

mrEMVI:

MRI-detected extramural vascular invasion

OS:

Overall survival

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

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Funding

This study has received funding from the Capital Funds for Health Improvement and Research(2020-1-4021), Fundamental Research Funds for the Central Universities (3332019055), and National Natural Science Foundation of China (81871509)

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Authors and Affiliations

  1. Department of Radiation Oncology, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China

    Silin Chen, Ning Li, Yuan Tang, Jinming Shi, Ying Zhao, Huiying Ma, Shulian Wang, Ye-xiong Li & Jing Jin

  2. Department of Radiation Oncology, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital &Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China

    Jing Jin

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  1. Silin Chen
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Correspondence to Jing Jin.

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The scientific guarantor of this publication is Jing Jin.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Ning Li) has significant statistical expertise.

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Written informed consent was not required for this study because this study is meta-analysis.

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Chen, S., Li, N., Tang, Y. et al. The prognostic value of MRI-detected extramural vascular invasion (mrEMVI) for rectal cancer patients treated with neoadjuvant therapy: a meta-analysis. Eur Radiol 31, 8827–8837 (2021). https://doi.org/10.1007/s00330-021-07981-z

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