Clinical predictors of pathological good response in locally advanced rectal cancer

Kongfeng Shao,Rong Zheng,Xiaobo Li,Anchuan Li,Benhua Xu

doi:10.1186/s13014-020-01741-x

Kongfeng Shao, Rong Zheng + Show 3 more

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https://doi.org/10.1186/s13014-020-01741-x

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Abstract

PurposeThe 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 materialsA 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.ResultsOf 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.ConclusionsThe 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.

Highlights

Since the results of the phase III clinical trial (CAO/ARO/ AIO-94) comparing the timing of concurrent chemoradiotherapy were published [1], preoperative fluorouracilbased neoadjuvant chemoradiotherapy followed by total mesorectal excision (TME) combined with postoperative adjuvant chemotherapy has become the standard treatment for locally advanced rectal cancer (LARC).Radical surgery may cause morbidity and various forms of functional impairment, such as defecation [2, 3], urinary [4] and sexual dysfunction [5]
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
Patients were categorized into two groups according to the different tumor responses of surgical pathology: stage ypT0–1N0 was defined as the group with pathological good response (PGR), and stage ypT2– 4N0/ypTanyN + was the pathological poor response (PPR) group

Summary

Introduction

Since the results of the phase III clinical trial (CAO/ARO/ AIO-94) comparing the timing of concurrent chemoradiotherapy were published [1], preoperative fluorouracilbased neoadjuvant chemoradiotherapy (nCRT) followed by total mesorectal excision (TME) combined with postoperative adjuvant chemotherapy has become the standard treatment for locally advanced rectal cancer (LARC).Radical surgery may cause morbidity and various forms of functional impairment, such as defecation [2, 3], urinary [4] and sexual dysfunction [5]. Since the results of the phase III clinical trial (CAO/ARO/ AIO-94) comparing the timing of concurrent chemoradiotherapy were published [1], preoperative fluorouracilbased neoadjuvant chemoradiotherapy (nCRT) followed by total mesorectal excision (TME) combined with postoperative adjuvant chemotherapy has become the standard treatment for locally advanced rectal cancer (LARC). Some surgeons selected local excision (LE) rather than TME for patients who responded well to nCRT to preserve organs and improve the quality of life after operation. A retrospective multicenter study reported that patients with LE alone had a better quality of life and bowel function than those who underwent TME or LE followed by TME [6]. The CARTS study found an improved emotional functioning score for patients undergoing transanal endoscopic microsurgery according to the QLQ-C30 questionnaire [7].

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