Risk factors for distant recurrence in patients with rectal cancer supporting selection for total neoadjuvant therapy

Area of Science:

• Oncology
• Radiology
• Surgical Oncology

Background:

• Distant recurrence is a significant challenge in locally advanced rectal cancer.
• Total neoadjuvant therapy (TNT) is used to mitigate recurrence risk.
• Identifying predictive factors for distant recurrence is crucial for personalized treatment selection.

Purpose of the Study:

• To identify magnetic resonance imaging (MRI) features that predict distant recurrence in rectal cancer patients.
• To aid in selecting appropriate patients for treatments like TNT.

Main Methods:

• Retrospective national cohort study of 648 rectal cancer patients (2016-2020).
• Patients received neoadjuvant radiotherapy followed by surgery.
• MRI features analyzed: cT-stage, cN-stage, clinical extramural vascular invasion (cEMVI), distance to mesorectal fascia (MRF), and tumor deposit.

Main Results:

• Advanced cT-stage (cT3c/d, cT4), positive cEMVI, and a short distance to MRF (≤2 mm) were significantly associated with increased distant recurrence risk.
• cN-stage did not show a significant association with distant recurrence.
• Tumor deposit data was inconclusive due to missing information.

Conclusions:

• cT-stage, cEMVI status, and distance to MRF are valuable prognostic indicators for risk stratification in rectal cancer patients undergoing neoadjuvant radiotherapy.
• These MRI-derived features can inform patient selection for intensified treatment strategies like TNT.