Clinical factors of post-chemoradiotherapy as valuable indicators for pathological complete response in locally advanced rectal cancer

Abstract

OBJECTIVES:Pathological complete response has shown a better prognosis for patients with locally advanced rectal cancer after preoperative chemoradiotherapy. However, correlations between post-chemoradiotherapy clinical factors and pathologic complete response are not well confirmed. The aim of the current study was to identify post-chemoradiotherapy clinical factors that could serve as indicators of pathologic complete response in locally advanced rectal cancer.METHODS:This study retrospectively analyzed 544 consecutive patients with locally advanced rectal cancer treated at Sun Yat-sen University Cancer Center from December 2003 to June 2014. All patients received preoperative chemoradiotherapy followed by surgery. Univariate and multivariate regression analyses were performed to identify post-chemoradiotherapy clinical factors that are significant indicators of pathologic complete response.RESULTS:In this study, 126 of 544 patients (23.2%) achieved pathological complete response. In multivariate analyses, increased pathological complete response rate was significantly associated with the following factors: post-chemoradiotherapy clinical T stage 0-2 (odds ratio=2.098, 95% confidence interval=1.023-4.304, p=0.043), post-chemoradiotherapy clinical N stage 0 (odds ratio=2.011, 95% confidence interval=1.264-3.201, p=0.003), interval from completion of preoperative chemoradiotherapy to surgery of >7 weeks (odds ratio=1.795, 95% confidence interval=1.151-2.801, p=0.010) and post-chemoradiotherapy carcinoembryonic antigen ≤2 ng/ml (odds ratio=1.579, 95% confidence interval=1.026-2.432, p=0.038).CONCLUSIONS:Post-chemoradiotherapy clinical T stage 0-2, post-chemoradiotherapy clinical N stage 0, interval from completion of chemoradiotherapy to surgery of >7 weeks and post-chemoradiotherapy carcinoembryonic antigen ≤2 ng/ml were independent clinical indicators for pathological complete response. These findings demonstrate that post-chemoradiotherapy clinical factors could be valuable for post-operative assessment of pathological complete response.

Predictive Value of FOLFOX-Based Regimen, Long Interval, Hemoglobin Levels and Clinical Negative Nodal Status, and Postchemoradiotherapy CEA Levels for Pathological Complete Response in Patients with Locally Advanced Rectal Cancer after Neoadjuvant Chemoradiotherapy

“…Rombouts et al studied 1073 patients with LARC and revealed that radiotherapy-surgery intervals of 9 to 12 weeks resulted in a high pCR rate [37]. Some studies have reported that post-CRT clinical factors were associated with pCR [23,38]. In the current study, several post-CRT variables were analyzed and post-CRT CEA ≤2 ng/mL was an independent predictor of increased pCR rates.…”

“…CEA is associated with prognosis and treatment response in patients with LARC treated with neoadjuvant CRT [39]. Deceased post-CRT CEA levels have been reported to be associated with increased pCR rates in LARC patients following neoadjuvant CRT [38,40]. Lowering post-CRT CEA levels might imply decreased tumor burdens and therefore, a favorable response to CRT was achieved.…”

Machine Learning for Predicting Pathological Complete Response in Patients with Locally Advanced Rectal Cancer after Neoadjuvant Chemoradiotherapy

“…Several studies have shown predictive value of post-CRT CEA levels in patients with LARC treated with neoadjuvant CRT. Peng et al [25] revealed that a post-CRT CEA levels ≤ 2 ng/ml was an independent predictors for pCR (OR = 1.57, 95% confidence interval [CI],…”

Prognostic impact of acellular mucin pools towards the patients with locally advanced rectal cancer achieving pathological complete response after preoperative chemoradiotherapy

“…3,4 In addition, 20-30% of patients successfully achieve pathological complete response (pCR) after preoperative CRT, which indicates a favorable prognosis. [5][6][7] Nevertheless, pCR does not absolutely represent disease-free survival (DFS) after radical treatment, in that 7.7-11% of patients ultimately develop distant metastasis postoperatively. 8,9 Accurate pathological staging is important to determine the recurrence risk and thus provide guidance for postoperative treatment decisions.…”