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Published on: January 19, 2018
Does Extramural Vascular Invasion Predict Response to Neoadjuvant Therapy in Locally Advanced Rectal Cancer?
Neal Bhutiani1, Mahmoud Mg Yousef2, Abdelrahman Mg Yousef2
1Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Surgery, Division of Surgical Oncology, University of Louisville School of Medicine, Louisville, KY.
Extramural vascular invasion (EMVI) in rectal cancer indicates a poorer response to neoadjuvant therapy. Identifying EMVI is crucial for tailoring treatment strategies and improving outcomes for locally advanced rectal adenocarcinomas.
Area of Science:
- Oncology
- Radiology
- Surgical Pathology
Background:
- Extramural vascular invasion (EMVI) is linked to recurrence in rectal cancer.
- Its role in predicting response to neoadjuvant therapy for locally advanced rectal adenocarcinomas (LARCs) requires further understanding.
Purpose of the Study:
- To investigate the association between EMVI and tumor/nodal downstaging after neoadjuvant therapy in LARCs.
- To evaluate EMVI as a predictive marker for treatment response.
Main Methods:
- Retrospective analysis of LARC patients with EMVI on initial MRI who received neoadjuvant therapy and surgery.
- Comparison of clinicopathologic variables and treatment response between EMVI-positive and EMVI-negative groups.
- Patients received either chemoradiation or total neoadjuvant therapy (TNT).
Main Results:
- EMVI correlated with higher rates of lymphovascular invasion and perineural invasion.
- EMVI was associated with more advanced clinical T and N stage (cT4, cN+).
- EMVI-positive tumors showed significantly lower rates of pathologic complete/near-complete response and downstaging.
Conclusions:
- Rectal tumors with EMVI exhibit higher clinical stage and poorer response to neoadjuvant therapy, even with TNT.
- EMVI identifies patients with high-risk features for recurrence.
- Disease biology, indicated by EMVI, should guide treatment decisions, necessitating novel therapeutic strategies.
