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MRI‐based EMVI positivity predicts systemic recurrence in rectal cancer patients with a good tumor response to chemoradiotherapy followed by surgery
Author(s) -
Cho Min Soo,
Park Youn Young,
Yoon Jiho,
Yang Seung Yoon,
Baik Seung Hyuk,
Lee Kang Young,
Kim Ik Yong,
Kim Nam Kyu
Publication year - 2018
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25064
Subject(s) - medicine , colorectal cancer , chemoradiotherapy , magnetic resonance imaging , multivariate analysis , medical record , oncology , cancer , surgery , gastroenterology , radiology
Background This study aimed to determine the prognostic value of baseline magnetic resonance imaging‐based extramural vascular invasion status (EMVI) among rectal cancer patients with a good tumor response to standard chemoradiotherapy followed by surgery. Methods A total of 359 patients with ypT0‐2/N0 disease from The Yonsei Multicenter Colorectal Cancer Electronic Database were retrospectively included between January 2000 and December 2014. Magnetic resonance images and medical records were reviewed to investigate risk factors for tumor recurrence. Results When we compared patients without and with EMVI, significant differences were observed in the 5‐year disease‐free survival rate (DFS) (80.8% vs 57.8%, P = 0.005) and in the 5‐year systemic recurrence‐free survival rate (SRFS) (86.9% vs 64.3%, P = 0.007). In the multivariate analysis, both mrEMVI and APR independently predicted overall DFS (APR; HR 2.088, 95% CI: 1.082‐4.031, P = 0.028, mrEMVI; HR: 2.729, 95% CI: 1.230‐6.058, P = 0.014). mrEMVI was only independent prognostic factor for systemic recurrence with statistical significance (HR: 3.321, 95% CI: 1.185‐9.309, P = 0.022). Conclusion Even in rectal cancer patients with a good response to chemoradiotherapy followed by curative surgery, extramural vascular invasion and APR may predict poor disease‐free survival outcomes. Intensified treatment strategy should be considered.