Silin Chen1, Ning Li1, Yuan Tang1, Jinming Shi1, Ying Zhao1, Huiying Ma1, Shulian Wang1, Ye-Xiong Li1, Jing Jin2,3. 1. Department of Radiation Oncology, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China. 2. Department of Radiation Oncology, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China. jinjing@csco.org.cn. 3. Department of Radiation Oncology, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital &Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China. jinjing@csco.org.cn.
Abstract
OBJECTIVES: The purpose of this meta-analysis was to evaluate the prognostic value of MRI-detected extramural vascular invasion (mrEMVI) and mrEMVI after neoadjuvant therapy (ymrEMVI) in rectal cancer patients receiving neoadjuvant therapy. METHODS: A systematic search of the PubMed, Web of Science, Embase, and Cochrane Library databases was carried out up to June 2020. Studies that evaluated mrEMVI, used treatment with neoadjuvant therapy, and reported survival were included. The time-to-event outcomes (OS and DFS rates) are expressed as hazard ratios (HRs) with 95% confidence intervals (CIs). If the HR was not reported in the study, it was calculated from the survival curve using methods according to Parmar's recommendation. The Newcastle-Ottawa scale was used to assess the methodological quality of the studies included in the meta-analysis. RESULTS: A total of 2237 patients from 11 studies were included, and the pooled analysis of the overall results from eight studies showed that patients who were mrEMVI positive at baseline had significantly worse disease-free survival (DFS) (random-effects model: HR = 2.50 [1.84, 3.14]; Z = 5.83, p < 0.00001). The pooled analysis of the overall results from six studies showed that patients who were ymrEMVI positive following neoadjuvant therapy had significantly worse DFS (random-effects model: HR = 2.24 [1.73, 2.90], Z = 6.12, p < 0.00001). Patients with mrEMVI positivity at baseline were also associated with worse overall survival (OS) (random-effects model: HR = 1.93 [1.36, 2.73]; Z = 3.71, p < 0.00001). CONCLUSION: mrEMVI and ymrEMVI positivity are poor prognostic factors for rectal cancer patients treated with neoadjuvant therapy. The precise evaluation of EMVI may contribute to designing individualised treatments and improving patient outcomes. KEY POINTS: • Extramural vascular invasion (EMVI) is a prognostic factor for rectal cancer. • MRI can be used to evaluate EMVI status before (mrEMVI) and after neoadjuvant therapy (ymrEMVI). • The evaluation of mrEMVI and ymrEMVI in neoadjuvant therapy would provide an early assessment of patient prognosis.
OBJECTIVES: The purpose of this meta-analysis was to evaluate the prognostic value of MRI-detected extramural vascular invasion (mrEMVI) and mrEMVI after neoadjuvant therapy (ymrEMVI) in rectal cancerpatients receiving neoadjuvant therapy. METHODS: A systematic search of the PubMed, Web of Science, Embase, and Cochrane Library databases was carried out up to June 2020. Studies that evaluated mrEMVI, used treatment with neoadjuvant therapy, and reported survival were included. The time-to-event outcomes (OS and DFS rates) are expressed as hazard ratios (HRs) with 95% confidence intervals (CIs). If the HR was not reported in the study, it was calculated from the survival curve using methods according to Parmar's recommendation. The Newcastle-Ottawa scale was used to assess the methodological quality of the studies included in the meta-analysis. RESULTS: A total of 2237 patients from 11 studies were included, and the pooled analysis of the overall results from eight studies showed that patients who were mrEMVI positive at baseline had significantly worse disease-free survival (DFS) (random-effects model: HR = 2.50 [1.84, 3.14]; Z = 5.83, p < 0.00001). The pooled analysis of the overall results from six studies showed that patients who were ymrEMVI positive following neoadjuvant therapy had significantly worse DFS (random-effects model: HR = 2.24 [1.73, 2.90], Z = 6.12, p < 0.00001). Patients with mrEMVI positivity at baseline were also associated with worse overall survival (OS) (random-effects model: HR = 1.93 [1.36, 2.73]; Z = 3.71, p < 0.00001). CONCLUSION: mrEMVI and ymrEMVI positivity are poor prognostic factors for rectal cancerpatients treated with neoadjuvant therapy. The precise evaluation of EMVI may contribute to designing individualised treatments and improving patient outcomes. KEY POINTS: • Extramural vascular invasion (EMVI) is a prognostic factor for rectal cancer. • MRI can be used to evaluate EMVI status before (mrEMVI) and after neoadjuvant therapy (ymrEMVI). • The evaluation of mrEMVI and ymrEMVI in neoadjuvant therapy would provide an early assessment of patient prognosis.
Entities:
Keywords:
Magnetic resonance imaging; Neoadjuvant therapy; Prognosis; Rectal neoplasms
Authors: Adrian Cote; Florin Graur Florin; Emil Mois; Radu Elisei; Radu Badea; Codruta Mare; Nadim All Hajjar; Cornel Iancu; Andrei Lebovici Journal: Ann Ital Chir Date: 2018 Impact factor: 0.766