Clinical predictors of pathological good response in locally advanced rectal cancer

Abstract

Purpose The aim of this study was to identify the clinical predictors of pathological good response (PGR) after neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer (LARC) to clarify the indications for local excision. Methods and materials A total of 173 patients with LARC (cT3–4/N +) who were treated with nCRT followed by surgery were enrolled in our retrospective study. Patients were categorized into two groups according to the different tumor responses of surgical pathology. Stage ypT0–1N0 was defined as the group with PGR, and stage ypT2–4N0/ypTanyN + was the defined as the pathological poor response (PPR) group, and the potential predictors were compared. Results Of 173 patients, PGR was achieved in 57 patients (32.95%). The distance from the inferior margin of the tumor to the anal verge, cT classification, pretreatment carcinoembryonic antigen (CEA) and the interval from the end of radiation to surgery were correlated with pathological response. In the multivariate analysis, the distance from anal verge < 5 cm (OR = 0.443, p = 0.019), pretreatment CEA < 5 ng/mL (OR = 0.412, p = 0.015) and the interval from the end of radiation to surgery ≥ 84 days (OR = 2.652, p = 0.005) were independent predictors of PGR. Conclusions The distance from the inferior margin of the tumor to the anal verge, pretreatment CEA and the interval from the end of radiation to surgery were significant predictors of PGR in LARC. A prospective study is needed to further validate these results in the future.

Predicting response to neoadjuvant chemoradiotherapy in rectal cancer: from biomarkers to tumor models

“…In a retrospective study comprising 173 LARC patients, a DTAV <5 cm was significantly associated with favorable pathological response (defined as ypT0-1N0). 66 Similarly, a positive correlation of DTAV <3 cm with complete response was reported by other investigators. 57 However, these findings could not be confirmed by other studies, 59 , 67 and even opposite results were described.…”

Selecting Candidates for Organ‐Preserving Strategies After Neoadjuvant Chemoradiotherapy for Rectal Cancer: Development and Validation of a Model Integrating MRI Radiomics and Pathomics

“…Three tumor size-related variables based on MRI (pretreatment MTL, posttreatment MTL, and posttreatment MTT) showed significant differences between patients with pGR and non-pGR in the univariable analysis; however, all of them lost predictive potential after multivariable analysis for the multiscale model. In addition, some studies have reported that pretreatment and posttreatment carcinoembryonic antigen levels were associated with pGR, 17,40 but the current study found no differences. The ability of tumor size-related variables and carcinoembryonic antigen level to predict pGR is controversial and needs to be investigated further.…”

Associations between Response to Commonly Used Neo-Adjuvant Schedules in Rectal Cancer and Routinely Collected Clinical and Imaging Parameters

“…The achievement of a complete remission provides the possibility for organ-preserving surgery or a non-operative, watch-and-wait (W&W) approach. Research efforts have been directed toward identification of clinical and other parameters that could help predict pCR after preoperative treatment [ 14 , 15 , 16 , 17 , 18 , 19 ]. However, several unclear issues, particularly related to the importance of clinical T-stage (cT-stage), tumour length, presence of extramural vascular invasion (cEMVI+), mesorectal fascia (cMRF+) involvement, and clinical laboratory values need to be clarified [ 14 , 15 , 16 , 17 , 18 , 19 ].…”