Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Feb 15, 2022; 14(2): 525-532
Published online Feb 15, 2022. doi: 10.4251/wjgo.v14.i2.525
Predictive value of serum alpha-fetoprotein for tumor regression after preoperative chemotherapy for rectal cancer
Da-Kui Zhang, Jun Qiao, Shao-Xuan Chen, Zhi-Yong Hou, Jian-Zheng Jie
Da-Kui Zhang, Shao-Xuan Chen, Zhi-Yong Hou, Jian-Zheng Jie, Department of General Surgery, China-Japan Friendship Hospital, Beijing 100029, China
Jun Qiao, Department of General Surgery, Inner Mongolia International Mongolian Hospital, Hohhot 010020, Inner Mongolia Autonomous Region, China
Author contributions: Jie JZ and Zhang DK designed the research study; Qiao J, Chen SX and Hou ZY performed the research.
Supported by Youth Foundation of China–Japan Friendship Hospital, No. 2019-1-QN-42
Institutional review board statement: The study was reviewed and approved by the China-Japan Friendship Hospital Institutional Review Board, No. 2021-117-K75.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
STROBE statement: All authors have read the STROBE statement checklist of items. The manuscript was prepared and revised according to the STROBE statement checklist of items.
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: Jian-Zheng Jie, MD, Doctor, Department of General Surgery, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Beijing 100029, China. dakuizhang2021@126.com
Received: August 12, 2021
Peer-review started: August 12, 2021
First decision: November 8, 2021
Revised: November 20, 2021
Accepted: January 19, 2022
Article in press: January 19, 2022
Published online: February 15, 2022
Processing time: 182 Days and 6.4 Hours
ARTICLE HIGHLIGHTS
Research background

Preoperative therapy can improve local control of rectal cancer. Some tumors regress after preoperative therapy. Few indicators can predict the effect accurately. In this study, we try to find how to predict which patients will be sensitive to preoperative therapy.

Research motivation

The motivation is to find the effective indicators to predict the effect of preoperative therapy. It may screen out sensitive patients to receive preoperative therapy, and the others to receive surgery directly.

Research objectives

The objective is investigating whether the increase in serum α-fetoprotein (AFP) can predict better efficacy of preoperative chemotherapy. It will guide the treatment of rectal cancer after further research.

Research methods

We retrospectively analyzed 125 patients admitted between 2017 and 2019 with locally advanced rectal cancer. All patients received preoperative chemotherapy (mFOLFOX6 every 2 wk). Patients were divided into two groups (AFP risen and AFP normal). Serum AFP of 26 patients rose slightly after three or four cycles of chemotherapy, and fell to normal again within 2 mo. Among them, the median increase in serum AFP was 33.41 (range 15.62–85.73) ng/mL. The other 99 patients had a normal level of serum AFP during chemotherapy. All patients underwent total mesorectal excision. Tumor regression grade (TRG) and complete response rate were both compared between the two groups.

Research results

Patients in the AFP risen group achieved better TRG (0/1) than those in the AFP normal group. The increase in AFP was a significant predictor for better tumor regression. In the AFP risen group, the complete response rate was 30.8%, which was also higher than in the AFP normal group. It provides an indicator to predict the efficacy of chemotherapy. However, the proportion of these patients is low. Other effective indicators are needed.

Research conclusions

Patients with an increase in serum AFP during preoperative chemotherapy can achieve better tumor regression. They are more likely to achieve pathological complete response. These patients should be recommended to receive preoperative chemotherapy.

Research perspectives

In this study, we could predict efficacy of chemotherapy by detecting changes in AFP. In future studies, we forces on finding more effective indicators. It is also needed to investigate whether they can be applied simultaneously to improve sensitivity.