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Extramural vascular invasion as an independent prognostic marker in locally advanced rectal cancer: propensity score match pair analysis

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Abstract

Background

In rectal cancers, presence of extramural vascular invasion on MRI (mrEMVI) is associated with poor survival. The independent influence of mrEMVI in the presence of other prognostic factors has not been previously analyzed using match pair analysis.

Patients and methods

Consecutive 92 patients having mrEMVI at presentation treated between January 2016 and December 2018 were matched with 92 patients (1:1) without mrEMVI. Matching parameters were T stage, mesorectal fascia involvement, and tumor differentiation. The presence and absence of mrEMVI were correlated to outcomes. An event was defined as locoregional failure or distant metastasis or poor response to chemoradiation rendering the rectal tumor as inoperable.

Results

At 3 years, in the mrEMVI-positive cohort, 59% had an event and in the mrEMVI-negative cohort, 45% had an event (p = 0.026). Local control was 90.2% (12recurrences in 122 who underwent surgery), two recurrences in the mrEMVI-positive cohort and ten patients in the mrEMVI-negative cohort, which missed statistical significance (p = 0.06). Distant metastasis-free survival was significantly worse in the mrEMVI-positive cohort versus the mrEMVI-negative cohort (58.2% vs. 69.4%) (p = 0.022). Similarly, Overall survival was significantly inferior in mrEMVI-positive cohort compared to the mrEMVI-negative cohort (57% vs. 72.4%) (p = 0.02). The multivariate regression analysis confirmed the independent predictive value of mrEMVI. 

Conclusion

Extramural vascular invasion detected through MRI is an independent risk factor for distant metastasis in the locally advanced carcinoma rectum. Aggressive treatment regimens like total neoadjuvant treatment should be considered in these cases pending randomized control studies.

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Authors and Affiliations

  1. Department of Radiation Oncology, Tata Memorial Hospital and Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), E Borges Road, Parel, Mumbai, Maharashtra, India

    Sonz Paul, Supriya Chopra & Reena Engineer

  2. Department of Radiology, Tata Memorial Hospital and Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Parel, Mumbai, Maharashtra, India

    Supreeta Arya, Akshay Baheti & Suman Kumar

  3. Department of Surgical Oncology, Tata Memorial Hospital and Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Parel, Mumbai, Maharashtra, India

    Avanish Saklani, Ashwin deSouza & Mufaddal Kazi

  4. Department of Medical Oncology, Tata Memorial Hospital and Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Parel, Mumbai, Maharashtra, India

    Anant Ramaswamy & Vikas Ostwal

  5. Department of Biostatistics, Tata Memorial Hospital and Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Parel, Mumbai, Maharashtra, India

    Smruti Mokul

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  1. Sonz Paul
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Paul, S., Arya, S., Mokul, S. et al. Extramural vascular invasion as an independent prognostic marker in locally advanced rectal cancer: propensity score match pair analysis. Abdom Radiol 47, 3671–3678 (2022). https://doi.org/10.1007/s00261-022-03608-z

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