Skip to main content

Advertisement

SpringerLink
Log in

Occurrence of peritoneal carcinomatosis in patients with rectal cancer undergoing staging pelvic MRI: clinical observations

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Describe the cumulative incidence (CUIN) of peritoneal carcinomatosis (PC) and survival in patients presenting with advanced rectal cancer at staging pelvic MRI.

Methods

From 2013 to 2018, clinicopathologic records of patients with pretreatment rectal MRI clinical (c)T3c, cT3d, cT4a, and cT4b primary rectal adenocarcinoma were retrospectively reviewed by two radiologists. Standard MRI descriptors and pathologic stages were recorded. Recurrence-free (RFS) and overall survival (OS) were estimated using the Kaplan–Meier method. Development of PC was explored using competing risk analysis. Differences in survival were compared using the log-rank test. Gray’s test was used to test for differences in CUIN of PC.

Results

Three hundred forty-three patients (147 women; median age, 56 years) had MRI stages cT3cd, n = 170; cT4a, n = 40; and cT4b, n = 133. Median follow-up among survivors was 27 months (0.36–70 months). For M1 patients, OS differed only by cT stage (2-year OS: cT3 88.1%, cT4a 79.1%, cT4b 64.7%, p = 0.045). For M0 patients, OS and RFS differed only by pathological (p)T stage. We observed a statistically significant difference in the cumulative incidence of PC by cT stage (2-year CUIN: cT3 3.2%, cT4a 8.5%, cT4b 1.6%, p = 0.01), but not by pT stage. Seventy-nine patients (23%) presented with metastatic disease (M1), eight with PC (2.3%). Overall, eight patients presented with PC (cT4a: n = 4, other stages: n = 4) and 22 developed PC (cT4a: n = 5, other stages: n = 17).

Conclusions

PC is uncommon in rectal cancer. MRI–based T stage exhibited an overall association with the cumulative incidence of PC, and descriptively, cT4a stage appears to have the highest CUIN.

Key Points

• In a retrospective study of 343 patients with rectal cancer undergoing baseline MRI and clinical follow-up, we found that peritoneal carcinomatosis was rare.

• We observed a significant overall association between PC at presentation and cT stage that appeared to be driven by the higher proportion of cT4a patients presenting with PC.

• Among patients that did not present with PC, we observed a significant overall association between time to PC and cT stage that may be driven by the higher cumulative incidence of PC in cT4a patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

MRI:

Magnetic resonance imaging

NR:

Not reached

OS:

Overall survival

PC:

Peritoneal carcinomatosis

RFS:

Recurrence-free survival

TME:

Total mesorectal excision

VP:

Visceral peritoneum

References

  1. Gollub MJ, Maas M, Weiser M et al (2013) Recognition of the anterior peritoneal reflection at rectal MRI. AJR Am J Roentgenol 200:97–101

    Article  Google Scholar 

  2. Sigurdsson HK, Korner H, Dahl O, Skarstein A, Soreide JA, Norwegian Colorectal Cancer G (2009) Rectal cancer with macroscopic peritoneal involvement--clinical challenges and consequences. Color Dis 11:838–844

    Article  CAS  Google Scholar 

  3. Gunderson LL, Jessup JM, Sargent DJ, Greene FL, Stewart A (2010) Revised tumor and node categorization for rectal cancer based on surveillance, epidemiology, and end results and rectal pooled analysis outcomes. J Clin Oncol 28:256–263

    Article  Google Scholar 

  4. Mercury-Study-Group (2006) Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ 333:779

    Article  Google Scholar 

  5. Shihab OC, How P, West N et al (2011) Can a novel MRI staging system for low rectal cancer aid surgical planning? Dis Colon Rectum 54:1260–1264

    Article  Google Scholar 

  6. Taylor FG, Quirke P, Heald RJ et al (2011) Preoperative high-resolution magnetic resonance imaging can identify good prognosis stage I, II, and III rectal cancer best managed by surgery alone: a prospective, multicenter, European study. Ann Surg 253:711–719

    Article  Google Scholar 

  7. Merkel S, Mansmann U, Siassi M, Papadopoulos T, Hohenberger W, Hermanek P (2001) The prognostic inhomogeneity in pT3 rectal carcinomas. Int J Color Dis 16:298–304

    Article  CAS  Google Scholar 

  8. Jayne DG, Fook S, Loi C, Seow-Choen F (2002) Peritoneal carcinomatosis from colorectal cancer. Br J Surg 89:1545–1550

    Article  CAS  Google Scholar 

  9. Gollub MJ, Blazic I, Bates DDB et al (2019) Pelvic MRI after induction chemotherapy and before long-course chemoradiation therapy for rectal cancer: what are the imaging findings? Eur Radiol 29:1733–1742

    Article  Google Scholar 

  10. Beets-Tan RGH, Lambregts DMJ, Maas M et al (2017) Magnetic resonance imaging for clinical management of rectal cancer: updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol. https://doi.org/10.1007/s00330-017-5026-2

  11. Ogura A, Konishi T, Cunningham C et al (2018) Neoadjuvant (chemo)radiotherapy with total mesorectal excision only is not sufficient to prevent lateral local recurrence in enlarged nodes: results of the multicenter lateral node study of patients with low cT3/4 rectal cancer. J Clin Oncol. https://doi.org/10.1200/JCO.18.00032:JCO1800032

  12. Ogura A, Konishi T, Beets GL et al (2019) Lateral nodal features on restaging magnetic resonance imaging associated with lateral local recurrence in low rectal cancer after neoadjuvant chemoradiotherapy or radiotherapy. JAMA Surg. https://doi.org/10.1001/jamasurg.2019.2172:e192172

  13. Cercek A, Roxburgh CSD, Strombom P et al (2018) Adoption of total neoadjuvant therapy for locally advanced rectal cancer. JAMA Oncol 4:e180071

    Article  Google Scholar 

  14. Quah HM, Chou JF, Gonen M et al (2008) Pathologic stage is most prognostic of disease-free survival in locally advanced rectal cancer patients after preoperative chemoradiation. Cancer 113:57–64

    Article  Google Scholar 

  15. Hompes D, Tiek J, Wolthuis A et al (2012) HIPEC in T4a colon cancer: a defendable treatment to improve oncologic outcome? Ann Oncol 23:3123–3129

    Article  CAS  Google Scholar 

  16. Shepherd NA, Baxter KJ, Love SB (1995) Influence of local peritoneal involvement on pelvic recurrence and prognosis in rectal cancer. J Clin Pathol 48:849–855

    Article  CAS  Google Scholar 

  17. Wiliams GT QP, Shepherd NA. (2007) Dataset for colorectal cancer, 2nd revision.

  18. Mitchard JR, Love SB, Baxter KJ, Shepherd NA (2010) How important is peritoneal involvement in rectal cancer? A prospective study of 331 cases. Histopathology 57:671–679

    Article  Google Scholar 

  19. Benson AB 3rd, Venook AP, Al-Hawary MM et al (2018) Rectal cancer, version 2.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw 16:874–901

    Article  Google Scholar 

  20. Glynne-Jones R, Wyrwicz L, Tiret E et al (2017) Rectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 28:iv22-iv40

Download references

Acknowledgements

The authors thank Joanne Chin, MFA, ELS, for her editorial assistance on this paper.

Funding

This study has received funding by the National Cancer Institute Cancer Center Core Grant P30 CA008748.

Author information

Author notes

  1. Marc J. Gollub and Stephanie Lobaugh equally contributed to this work

Authors and Affiliations

  1. Department of Radiology, Memorial Sloan Kettering Cancer Center, Room H722, 1275 York Avenue, New York, NY, 10065, USA

    Marc J. Gollub, Jennifer S. Golia Pernicka, David D. B. Bates, J. Louis Fuqua III, Viktoriya Paroder & Iva Petkovska

  2. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Stephanie Lobaugh & Marinela Capanu

  3. Department of Radiology, Dunedin Hospital, Dunedin, 9016, New Zealand

    Cameron D. A. Simmers

  4. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Martin R. Weiser

Authors
  1. Marc J. Gollub
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephanie Lobaugh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jennifer S. Golia Pernicka
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cameron D. A. Simmers
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David D. B. Bates
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Louis Fuqua III
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Viktoriya Paroder
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Iva Petkovska
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Martin R. Weiser
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Marinela Capanu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marc J. Gollub.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Marc J. Gollub, MD.

Conflict of Interest

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

Two of the authors have significant statistical expertise (Stephanie Lobaugh, Marinela Capanu).

Informed Consent

Written informed consent was waived by the Institutional Review Board.

Ethical Approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

ESM 1

(DOCX 4783 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gollub, M.J., Lobaugh, S., Golia Pernicka, J.S. et al. Occurrence of peritoneal carcinomatosis in patients with rectal cancer undergoing staging pelvic MRI: clinical observations. Eur Radiol 32, 5097–5105 (2022). https://doi.org/10.1007/s00330-022-08694-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-022-08694-7

Keywords

Search

Navigation