Extranodal extension status and its changes on MRI predicts prognosis of locally advanced rectal cancer patients

Motivation: MRI could detect extranodal extension (ENE) in rectal cancer, a feature of metastatic lymph nodes, but its prognostic implication has not been fully demonstrated. Goal(s): To explore the impact of ENE status and its changes before and after neoadjuvant therapy (NAT) on the prognosis of patients with locally advanced rectal cancer. Approach: Potential risk factors were evaluated on pre- and post-NAT MRI in a retrospective cohort and their association with prognosis was determined. Results: ENE status was the only independent risk factor on both pre- and post-NAT MRI, and changes in ENE status allowed stratification of patients with different prognoses. Impact: Extranodal extension status and its changes on MRI have strong prognostic implications in locally advanced rectal cancer patients, which may become a new indicator for the selection of appropriate treatment regimens in the future.