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Double Negativity of MRI-Detected and Pathologically-Diagnosed Extramural Venous Invasion is a Favorable Prognostic Factor for Rectal Cancer

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Extramural venous invasion (EMVI) is a prognostic factor in rectal cancer. There are two types: EMVI detected by magnetic resonance imaging (MRI) (mr-EMVI) and EMVI detected by pathology (p-EMVI). They have been separately evaluated, but they have not yet been concurrently evaluated. We therefore evaluate both mr-EMVI and p-EMVI in rectal cancer at the same time and clarify their association with prognosis.

Patients and Methods

Included were the 186 consecutive patients who underwent complete radical resection of tumors ≤ stage III at Wakayama Medical University Hospital, Japan, between 2010 and 2018. All underwent preoperative MRI examination, and were reassessed for EMVI by a radiologist. Surgically resected specimens were then reassessed for EMVI by a pathologist. We assessed the correlation between positivity of mr-EMVI and p-EMVI and prognosis, and the clinicopathological background behind them.

Results

Patients with double negativity for mr-EMVI and p-EMVI had better prognosis than patients with mr-EMVI or p-EMVI positivity (p < 0.0001). Positivity for mr-EMVI or p-EMVI was a poor independent prognostic factor in multivariate analysis.

Conclusions

Combined analysis of mr-EMVI and p-EMVI may enable prediction of postoperative prognosis of rectal cancer. Patients with double negativity of mr-EMVI and p-EMVI had better prognosis than patients with some form of positivity. Stated differently, patients with positivity of mr-EMVI, p-EMVI, or both had a poorer prognosis than those with double negativity. Postoperative adjuvant chemotherapy may improve poor prognosis. Combined evaluation of mr-EMVI and p-EMVI may be used to predict clinical outcomes and may be an effective prognostic predictor of rectal cancer.

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Acknowledgment

We gratefully acknowledge the work of past and present members of the Departments of Human Pathology and Radiology at Wakayama Medical University, Wakayama, Japan. We acknowledge proofreading and editing by Benjamin Phillis at the Clinical Study Support Center, Wakayama Medical University, Wakayama, Japan.

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Authors and Affiliations

  1. Second Department of Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan

    Toshihiro Sakanaka MD, Hiromitsu Iwamoto MD, PhD, Kenji Matsuda MD, PhD, Yasuyuki Mitani MD, PhD, Yuki Nakamura MD, PhD, Daisuke Murakami MD, Norio Takemoto MD, Masato Tamiya MD, Takahiko Hyo MD & Manabu Kawai MD, PhD

  2. Department of Human Pathology, Wakayama Medical University, Wakayama, Japan

    Ibu Matsuzaki MSc, IAC, Yuichi Kinoshita PhD, CF, IAC, Hirokazu Nagai CT, IAC, Ryuta Iwamoto MD, Yuichi Takahashi MD, Fumiyoshi Kojima MD, PhD & Shin-ichi Murata MD, PhD

  3. Department of Radiology, Wakayama Medical University, Wakayama, Japan

    Akira Ikoma MD, PhD & Tetsuro Sonomura MD, PhD

Authors
  1. Toshihiro Sakanaka MD
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  2. Hiromitsu Iwamoto MD, PhD
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  6. Daisuke Murakami MD
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  9. Takahiko Hyo MD
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  10. Ibu Matsuzaki MSc, IAC
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  11. Yuichi Kinoshita PhD, CF, IAC
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  12. Hirokazu Nagai CT, IAC
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  13. Akira Ikoma MD, PhD
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  14. Ryuta Iwamoto MD
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  15. Yuichi Takahashi MD
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  16. Fumiyoshi Kojima MD, PhD
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  17. Shin-ichi Murata MD, PhD
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  18. Tetsuro Sonomura MD, PhD
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  19. Manabu Kawai MD, PhD
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Corresponding author

Correspondence to Hiromitsu Iwamoto MD, PhD.

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Sakanaka, T., Iwamoto, H., Matsuda, K. et al. Double Negativity of MRI-Detected and Pathologically-Diagnosed Extramural Venous Invasion is a Favorable Prognostic Factor for Rectal Cancer. Ann Surg Oncol 31, 2425–2438 (2024). https://doi.org/10.1245/s10434-023-14830-4

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  • DOI: https://doi.org/10.1245/s10434-023-14830-4

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