Retrospective Cohort Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2025; 17(1): 98263
Published online Jan 27, 2025. doi: 10.4240/wjgs.v17.i1.98263
Evaluating the predictive value of endoscopic findings for residual colorectal cancer following neoadjuvant combination immunotherapy
Yue-Gang Li, Cheng-Cheng Han, Meng Zhuang, Wei Zhao, Gang Hu, Wen-Long Qiu, Xi-Shan Wang, Jian-Qiang Tang
Yue-Gang Li, Meng Zhuang, Wei Zhao, Gang Hu, Wen-Long Qiu, Xi-Shan Wang, Jian-Qiang Tang, Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Cheng-Cheng Han, Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Co-first authors: Yue-Gang Li and Cheng-Cheng Han.
Co-corresponding authors: Xi-Shan Wang and Jian-Qiang Tang.
Author contributions: All authors contributed to the study’s conception and design, and approved the submitted version; Li YG, Han CC, Zhuang M, Zhao W, Hu G, and Qiu WL drafted the work and revised it; Wang XS and Tang JQ final approved the version to be published; Li YG and Han CC contributed equally as co-first authors, including study design, data analysis, and manuscript drafting; Wang XS and Tang JQ made equal contributions as co-corresponding authors, including study design, data interpretation, and final revision of the manuscript.
Supported by the National Natural Science Foundation of China, No. 82072732.
Institutional review board statement: The study was approved by the Ethics Committee of the Cancer Hospital of the Chinese Academy of Medical Sciences (approval No. 23/535–4278).
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: The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and 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-Qiang Tang, MD, Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. doc_tjq@hotmail.com
Received: June 22, 2024
Revised: October 16, 2024
Accepted: November 11, 2024
Published online: January 27, 2025
Processing time: 188 Days and 4.4 Hours
Abstract
BACKGROUND

Endoscopy allows for the direct observation of primary tumor characteristics and responses after neoadjuvant treatment. However, reports on endoscopic evaluation following neoadjuvant immunotherapy remain limited.

AIM

To examine the predictive value of endoscopic findings of primary tumors for responses to neoadjuvant immunotherapy.

METHODS

This retrospective study, conducted at a tertiary center in China, evaluated 74 patients with colorectal cancer, including 17 with deficient mismatch repair (dMMR) and 15 with proficient mismatch repair (pMMR) tumors. Patients underwent neoadjuvant immunotherapy followed by surgery. Endoscopic findings before and after neoadjuvant immunotherapy were reviewed and compared with the pathology of the resected specimens.

RESULTS

In the pMMR group (n = 57 evaluable patients), endoscopy identified 11/17 patients who achieved a complete response (CR), while misidentifying 1/40 patients with residual disease as CR (64.7% vs 2.5%, P < 0.01). Conversely, 22/40 patients with residual disease were accurately identified as achieving a partial response (PR), with 1/17 patients who achieved CR misclassified as PR (55.0% vs 5.9%, P < 0.01). The sensitivity, specificity, and accuracy of endoscopic diagnosis for pathological CR were 64.7%, 97.5%, and 87.7%, respectively. In the dMMR cohort, endoscopy classified 9/17 patients as CR and 2 of the remaining patients with residual tumors as PR (64.3% vs 66.7%, P = 0.73). The method demonstrated 100% sensitivity and 82.4% accuracy in diagnosing pathological CR.

CONCLUSION

Endoscopic evidence of CR or PR was well correlated with postoperative pathological outcomes in the pMMR cohort. Despite endoscopic indications of tumor residue, a complete pathological response post-surgery was possible in the dMMR cohort.

Keywords: Colorectal neoplasms; Endoscopy; Neoadjuvant combination immunotherapy; Response evaluation; Mismatch repair status

Core Tip: Endoscopy demonstrated strong predictive value for postoperative pathological outcomes in the proficient mismatch repair (MMR) cohort. Despite endoscopic indications of tumor residue in the deficient MMR cohort, a complete pathological response post-surgery was still possible. This study highlights the significant role of endoscopy in predicting responses to neoadjuvant immunotherapy, particularly in both proficient MMR and deficient MMR patient groups, providing valuable information for clinical decision-making.