Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2024; 16(6): 2520-2530
Published online Jun 15, 2024. doi: 10.4251/wjgo.v16.i6.2520
Prediction of pathological complete response and prognosis in locally advanced rectal cancer
Yi-Jun Xu, Dan Tao, Song-Bing Qin, Xiao-Yan Xu, Kai-Wen Yang, Zhong-Xu Xing, Ju-Ying Zhou, Yang Jiao, Li-Li Wang
Yi-Jun Xu, Song-Bing Qin, Xiao-Yan Xu, Kai-Wen Yang, Zhong-Xu Xing, Ju-Ying Zhou, Li-Li Wang, Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
Dan Tao, Department of Radiation Oncology, The Fourth Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
Yang Jiao, School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou 215123, Jiangsu Province, China
Co-first authors: Yi-Jun Xu and Dan Tao.
Co-corresponding authors: Yang Jiao and Li-Li Wang.
Author contributions: Xu YJ and Tao D contributed equally to this work as co-first authors. Xu YJ and Tao D designed and performed the research and wrote the paper; Xu XY, Yang KW, and Xing ZX designed the research and contributed to the analysis; Qin SB and Zhou JY provided clinical advice; Jiao Y and Wang LL contributed equally to this work as co-corresponding authors. They supervised the study project, contributed to the conception and design of the study, and played an important role in supervising the manuscript. We believe that designating Jiao Y and Wang LL as co-corresponding authors is fitting for our manuscript as it accurately reflects our team’s collaborative spirit, equal contributions, and diversity. and all the authors reviewed the various drafts of the manuscript and have approved the final version of the manuscript.
Supported by the National Natural Science Foundation of China, No. 82073476; the National Key R&D Program of China, No. 2022YFC2503700 and No. 2022YFC2503703; Jiangsu Provincial Medical Key Discipline, No. ZDXK202235; Innovation Research Project of Medical and Industrial Cooperation in Suzhou, No. SLJ2021005.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Soochow University, approval No. 2023-559.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Li Wang, MD, Chief Physician, Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou 215006, Jiangsu Province, China. wanglili@suda.edu.cn
Received: February 22, 2024
Revised: March 18, 2024
Accepted: April 24, 2024
Published online: June 15, 2024
Processing time: 114 Days and 1.4 Hours
Abstract
BACKGROUND

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.

AIM

To investigate the indicators that can predict pCR and long-term outcomes following nCRT in patients with LARC.

METHODS

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.

RESULTS

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).

CONCLUSION

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.

Keywords: Locally advanced rectal cancer, Neoadjuvant chemoradiotherapy, Pathological complete response, Carcinoembryonic antigen, Inflammation-related markers, Tumor deposit, 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.