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Review
. 2017 Jun 6;116(12):1513-1519.
doi: 10.1038/bjc.2017.99. Epub 2017 Apr 27.

A meta-analysis comparing the risk of metastases in patients with rectal cancer and MRI-detected extramural vascular invasion (mrEMVI) vs mrEMVI-negative cases

Muhammed R S Siddiqui  1   2 , Constantinos Simillis  3 , Chris Hunter  1   2 , Manish Chand  1   2 , Jemma Bhoday  1   2 , Aurelie Garant  4 , Te Vuong  4 , Giovanni Artho  4 , Shahnawaz Rasheed  3 , Paris Tekkis  3 , Al-Mutaz Abulafi  1 , Gina Brown  2
Affiliations
Review

A meta-analysis comparing the risk of metastases in patients with rectal cancer and MRI-detected extramural vascular invasion (mrEMVI) vs mrEMVI-negative cases

Muhammed R S Siddiqui et al. Br J Cancer. .

Abstract

Background: Pathological extramural vascular invasion (EMVI) is an independent prognostic factor in rectal cancer, but can also be identified on MRI-detected extramural vascular invasion (mrEMVI). We perform a meta-analysis to determine the risk of metastatic disease at presentation and after surgery in mrEMVI-positive patients compared with negative tumours.

Methods: Electronic databases were searched from January 1980 to March 2016. Conventional meta-analytical techniques were used to provide a summative outcome. Quality assessment of the studies was performed.

Results: Six articles reported on mrEMVI in 1262 patients. There were 403 patients in the mrEMVI-positive group and 859 patients in the mrEMVI-negative group. The combined prevalence of mrEMVI-positive tumours was 0.346(range=0.198-0.574). Patients with mrEMVI-positive tumours presented more frequently with metastases compared to mrEMVI-negative tumours (fixed effects model: odds ratio (OR)=5.68, 95% confidence interval (CI) (3.75, 8.61), z=8.21, df=2, P<0.001). Patients who were mrEMVI-positive developed metastases more frequently during follow-up (random effects model: OR=3.91, 95% CI (2.61, 5.86), z=6.63, df=5, P<0.001).

Conclusions: MRI-detected extramural vascular invasion is prevalent in one-third of patients with rectal cancer. MRI-detected extramural vascular invasion is a poor prognostic factor as evidenced by the five-fold increased rate of synchronous metastases, and almost four-fold ongoing risk of developing metastases in follow-up after surgery.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The proportion of patients with rectal cancer who have extramural vascular invasion identified on MRI at the time of presentation.
Figure 2
Figure 2
The proportion of patients with metastases at the time of presentation who have mrEMVI-positive tumours vs mrEMVI-negative tumours.
Figure 3
Figure 3
The proportion of patients who develop metastases after surgery who had mrEMVI-positive tumours before surgery vs mrEMVI-negative tumours before surgery.
See this image and copyright information in PMC

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