Preoperative MRI-findings to predict recurrence in rectal cancer
Anna Davidsson, Eva Angenete, Koen Simons, Marie-Louise Lydrup, Martin Rutegård, Zena Salih, Jennifer ParkAbstract
Introduction
It has been suggested that mrEMVI (extramural venous invasion) and mrTD (tumour deposits) have important predictive roles in recurrence after rectal cancer treatment. The aim of this study was to investigate whether mrEMVI and mrTD on preoperative MRI have predictive value for the risk of distant recurrence.
Methods
This study builds on the Rectoleak study, a retrospective national multicetre study including patients who underwent rectal resection anastomosis between 2014 and 2018. Pelvic MRI images from patients at three hospitals were centrally reviewed for T- and N-stage, mesorectal fascia (MRF) involvement, mrEMVI and mrTD. Data on distant recurrence were obtained from the Swedish Colorectal Cancer Registry. Logistic regression was used to evaluate the predictive value of the variables.
Results
In total, 458 patients were included (39% women, mean age 64 years) of whom 219 (48%) received neoadjuvant treatment. Eighty-three patients (18%) developed distant recurrence, during a mean follow-up time of 4.2 years. Thirthy-eight patients (8%) had positive mrTD and 71 (16%) had positive mrEMVI. Among the variables analyzed, the strongest predictive value was observed for mrTD, HR 2.03 (95% c.i. 0.96–4.28). The corresponding value for mrEMVI was HR 1.80 (95% c.i. 0.92–3.50).
Discussion
The findings suggest that mrTD and mrEMVI on preoperative MRI may have additional predictive value for the risk of distant recurrence after rectal resection, with mrTD appearing to be the stronger predictor.