Published online Jun 15, 2024. doi: 10.4251/wjgo.v16.i6.2520
Revised: March 18, 2024
Accepted: April 24, 2024
Published online: June 15, 2024
Processing time: 114 Days and 1.4 Hours
Colorectal cancer is currently the third most common malignant tumor and the second leading cause of cancer-related death worldwide. Neoadjuvant chemoradiotherapy (nCRT) is standard for locally advanced rectal cancer (LARC). Except for pathological examination after resection, it is not known exactly whether LARC patients have achieved pathological complete response (pCR) before surgery. To date, there are no clear clinical indicators that can predict the efficacy of nCRT and patient outcomes.
To investigate the indicators that can predict pCR and long-term outcomes foll
Clinical data of 128 LARC patients admitted to our hospital between September 2013 and November 2022 were retrospectively analyzed. Patients were categorized into pCR and non-pCR groups. Univariate analysis (using the χ2 test or Fisher’s exact test) and logistic multivariate regression analysis were used to study clinical predictors affecting pCR. The 5-year disease-free survival (DFS) and overall survival (OS) rates were calculated using Kaplan-Meier analysis, and differences in survival curves were assessed with the log-rank test.
Univariate analysis showed that pretreatment carcinoembryonic antigen (CEA) level, lymphocyte-monocyte ratio (LMR), time interval between neoadjuvant therapy completion and total mesorectal excision, and tumor size were correlated with pCR. Multivariate results showed that CEA ≤ 5 ng/mL (P = 0.039), LMR > 2.73 (P = 0.023), and time interval > 10 wk (P = 0.039) were independent predictors for pCR. Survival analysis demonstrated that patients in the pCR group had significantly higher 5-year DFS rates (94.7% vs 59.7%, P = 0.002) and 5-year OS rates (95.8% vs 80.1%, P = 0.019) compared to the non-pCR group. Tumor deposits (TDs) were significantly correlated with shorter DFS (P = 0.002) and OS (P < 0.001).
Pretreatment CEA, LMR, and time interval contribute to predicting nCRT efficacy in LARC patients. Achieving pCR demonstrates longer DFS and OS. TDs correlate with poor prognosis.
Core Tip: At present, there are no clinical indicators clearly related to the efficacy and long-term outcomes of neoadjuvant chemoradiotherapy (nCRT) for locally advanced rectal cancer (LARC). In this study, inflammation-related markers and tumor deposits (TDs) were added. The final results showed that pretreatment carcinoembryonic antigen ≤ 5 ng/mL, lymphocyte-monocyte ratio > 2.73, and time interval between neoadjuvant therapy completion and total mesorectal excision > 10 wk are independent predictors of nCRT efficacy in LARC patients. Patients achieving pCR have longer disease-free survival and overall survival. Among patients without pCR, TDs are positively correlated with poor prognosis.