Abstract
The aim of this study is to investigate the influencing factors associated with no/low response to preoperative concurrent chemoradiotherapy (CCRT) for locally advanced rectal cancer (LARC) patients. A total of 79 patients were included in this prospective study. Fifteen factors that might affect the resistance to CCRT were included in this logistic regression analysis, these factors include the general clinical data of patients, the expression status of tumor stem cell marker CD44v6 and the volumetric imaging parameters of primary tumor lesions. We found that the no/low response status to preoperative CCRT was positively correlated with the real tumor volume (RTV), the total surface area of tumor (TSA), and CD44v6 expression, whereas negatively correlated with the tumor compactness (TC). According to the results of logistic regression analysis, two formulas that could predict whether or not no/low response to preoperative CCRT were established. The Area Under Curve (AUC) of the two formulas and those significant measurement data (RTV, TC, TSA) were 0.900, 0.858, 0.771, 0.754, 0.859, the sensitivity were 95.8%, 79.17%, 62.50%, 95.83%, 62.5%, the specificity were 70.9%, 74.55%, 83.64%,47.27%, 96.36%, the positive predictive values were 58.96%, 57.58%, 62.51%,44.23%, 88.23%, the negative predictive values were 97.48%, 89.13%, 83.64%, 96.29%, and 85.48%, respectively.
Highlights
Preoperative concurrent chemoradiotherapy (CCRT), as an important part of the comprehensive treatment of locally advanced rectal cancer (LARC), has been widely applied in clinical practice with an effective rate of approximately 40–80% [1,2,3,4]
The rectal cancer regression grade (RCRG) status of enrolled patients has been reported in our previous study [30] as follows: 20 (25.32%) cases for RCRG 1, 35(44.30%) for RCRG 2, 24 (30.38%) for RCRG 3, resulting in 24 patients showing no/low response to preoperative CCRT
Collinearity analysis for all variables were performed before logistic regression analysis, and the results show that the variance inflation factor (VIF) 7, including real tumor volume (RTV) (8.124) and approximate tumor volume (ATV) (7.391), were thought to be highly correlated with at least one of the other factors in the regression model
Summary
Preoperative concurrent chemoradiotherapy (CCRT), as an important part of the comprehensive treatment of locally advanced rectal cancer (LARC), has been widely applied in clinical practice with an effective rate of approximately 40–80% [1,2,3,4]. There are many patients who cannot benefit from this type of treatment. Preoperative CCRT may result in pelvic connective tissue fibrosis, radiation enteritis, along with other side effects that can lead to postoperative complications such as anastomotic leakage, and defects in wound. No/low response to preoperative CCRT in LARC
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