scholarly journals An Integrated Model of Pathological Complete Response and Postoperative CEA Predicts Survival and Benefit of Adjuvant Chemotherapy for Locally Advanced Rectal Cancer

2021 ◽  
Author(s):  
Shu-Biao Ye ◽  
Dong-Wen Chen ◽  
Pei-Si Li ◽  
Zhen-Sen Lin ◽  
Jia-Hui Long ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Pathological Complete Response ◽  
Locally Advanced ◽  
Biological Response ◽  
Complete Response ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Integrated Model ◽  
Free Survival

Abstract Background: Pathological complete response (pCR) and postoperative carcinoembryonic antigen (CEA) respectively represent pathological and biological response to treatment and prognostic indictors for locally advanced rectal cancer. However, the prognostic significance of integrated pCR and postoperative CEA model is rarely investigated. Methods: This big-data intelligence platform-based cohort biomarker study extracted clinicopathological characteristics and postoperative CEA of 919 locally advanced (clinical stage II-III) rectal cancer patients receiving neoadjuvant treatment from 6125 cases between April 2011 through September 2018 at Sun Yat-sen University, the Sixth Affiliated Hospital. An integrated model was constructed using pCR combined with the cut-off value of postoperative CEA generated from the receiver operating characteristic (ROC) curve. The model stratified locally advanced rectal cancer patients into four groups. Results: Both pathological response-pCR and biological response-postoperative CEA were independent prognostic indicators. In all patients, the 3-year distant metastasis-free survival (DMFS) (70.0%) and disease-free survival (DFS) (64.8%) rates were significantly lower in patients without pCR and postoperative CEA > 2.78 ng/ml (all p values < 0.05). Among patients treated with < 3 months of postoperative adjuvant chemotherapy (ACT), all others had higher 3-year DMFS and DFS rates. Among patients receiving ≥ 3 months of ACT, those without pCR had similar 3-year DMFS rates regardless of postoperative CEA level. Conclusions: The response integrated model with pCR and postoperative CEA not just effectively predict DMFS and DFS in locally advanced rectal cancer patients, but also was a predictive tool to potentially modify the optimal duration of ACT for locally advanced rectal cancer patients.

scholarly journals A panel of tumor biomarkers to predict complete pathological response to neo-adjuvant treatment in Locally Advanced Rectal Cancer

2021 ◽  
Author(s):  
Chiara Dalle Fratte ◽  
Silvia Mezzalira ◽  
Jerry Polesel ◽  
Elena De Mattia ◽  
Antonio Palumbo ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Pathological Complete Response ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Complete Response ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Classification And Regression Tree ◽  
Pre Treatment

Pathological complete response after neoadjuvant chemoradiotherapy in locally advanced rectal cancer patients is related to a favorable prognosis. The identification of early biomarkers predictive of pathological complete response would help to optimize the multimodality management of the patients. A panel of 11 tumor-related proteins was investigated by immunohistochemistry in the pre-treatment biopsy of a group of locally advanced rectal cancer patients, to identify early biomarkers of pathological complete response to neoadjuvant chemoradiotherapy. A mono-institutional retrospective cohort of 95 stage II/III locally advanced rectal cancer patients treated with neoadjuvant chemoradiotherapy and surgery was selected based on clinical-pathological characteristics and the availability of a pre-treatment tumor biopsy. Eleven selected protein markers expression (MLH1, GLUT1, Ki67, CA-IX, CXCR4, COX2, CXCL12, HIF1, VEGF, CD44, and RAD51) was investigated. The optimal cut-off values were calculated by receiver operating characteristic curve analysis. Classification and regression tree analysis was performed to investigate the biomarkers interaction. Patients presenting either Ki67, HIF1 or RAD51 below the cut-off value, or CXCR4 or COX2 above the cut-off value, were more likely to get a pathological complete response. Classification and regression tree analysis identified three groups of patients resulting from the combination of Ki67 and CXCR4 expression. Patients with high expression of Ki67 had the lowest chance to get a pathological complete response (18%), as compared to patients with low expression of both Ki67 and CXCR4 (29%), and patients with low Ki67 and high CXCR4 expression (70%). Pre-treatment Ki67, CXCR4, COX2, HIF1, RAD51 in tumor biopsies are associated with pathological complete response after neoadjuvant chemoradiotherapy in locally advanced rectal cancer. A combined evaluation of Ki67 and CXCR4 would increase their predictive potential. If validated, their optimal cut-off could be used to select patients for a tailored multi-modality treatment.

Can PET CT predict response in locally advanced rectal cancer patients treated with induction FOLFOX?

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e14696-e14696
Author(s):  
Seyda Gunduz ◽  
Hasan Senol Coskun ◽  
Sema Sezgin Goksu ◽  
Deniz Arslan ◽  
Ali Murat Tatli ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Induction Chemotherapy ◽  
Pathological Complete Response ◽  
Locally Advanced ◽  
Complete Response ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Pet Ct ◽  
Folfox Chemotherapy

e14696 Background: The aim of this study was to determine the pathological complete response rates in a group of locally advanced rectal cancer patients who underwent chemoradiotherapy after treatment with induction FOLFOX chemotherapy and the relationship between the complete response and Positron emission tomography - computed tomography (PET-CT). Methods: The files of 239 patients who were diagnosed with rectal cancer between January 2008 and January 2012 were evaluated retrospectively. Of these, there were 24 locally advanced rectal cancer patients who met the following criteria: they were administered chemoradiotherapy after receiving four courses induction oxaliplatin, folinic acid and 5-Florouracil (FOLFOX) and they underwent PET-CT for staging and for the evaluation of their response to FOLFOX treatment. Of these 24 patients, 20 operable patients were included in the study. Results: The pathological complete response was obtained in 7 patients (35%) who were operated on, and then given induction four courses FOLFOX chemotherapy and chemoradiotherapy. We determined that age, gender, clinical stage at diagnosis, and PET-CT before and after induction chemotherapy were not predictive of the pathological complete response to tumor fluorodeoxyglucose (FDG) uptake activity. Conclusions: The rates of pathological complete response were increased in locally advanced rectal cancer patients who underwent short-term induction chemotherapy. Although the PET-CT has retained its importance in predicting pathological complete response, there is still a need for studies with a larger number of patients and long-term follow-ups.

scholarly journals Pathological complete response after chemoradiotherapy in locally advanced rectal cancer: Capecitabine or 5-fluorouracil? Which is better?

2018 ◽  
Vol 29 ◽  
pp. v85
Author(s):  
X. Hernández-Yagüe ◽  
E. Canals-Subirats ◽  
G. Mateu Esquerda ◽  
C. Auñón Sanz ◽  
A. Maroto Genover ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Pathological Complete Response ◽  
Locally Advanced ◽  
Complete Response ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer

Intensification of neoadjuvant therapy in patients with locally advanced rectal cancer

2021 ◽  
Vol 11 (2) ◽  
pp. 19-28
Author(s):  
Z. Z. Mamedli ◽  
A. V. Polynovskiy ◽  
D. V. Kuzmichev ◽  
S. I. Tkachev ◽  
A. A. Aniskin
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Disease Free Survival ◽  
Complete Response ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Control Group ◽  
Free Survival ◽  
Disease Free

The aim of the study: to increase the frequency of achieving pathologic complete response and increase disease-free survival in the investigational group of patients with locally advanced rectal cancer T3(MRF+)–4N0–2M0 by developing a new strategy for neoadjuvant therapy.Materials and methods. In total, 414 patients were assigned to treatment. Control group I included 89 patients who underwent radiotherapy (RT) 52–56 Gy/26–28 fractions with concurrent capecitabine twice daily 5 days per week. Control group II included 160 patients who underwent RT 52–56 Gy/26–28 fractions with concurrent capecitabine twice daily 5 days per week and oxaliplatin once a week, during the course of RT. Study group III consisted of 165 patients. This group combined RT 52–56 Gy/26–28 fractions with concurrent capecitabine twice daily 5 days per week and additional consecutive CapOx cycles. This group was divided into 2 subgroups: subgroup IIIa included 106 patients with consolidating chemotherapy (after CRT); subgroup IIIb included 59 patients who underwent “sandwich” treatment. Therapy consisted of conducting from 1 to 2 cycles of induction CapOx (up to CRT) and from 1 to 2 cycles of consolidating CapOx with an interval of 7 days. In the interval between the courses of drug therapy, RT 52–56 Gy/26–28 fractions was performed. According to the results of the control examination, further treatment tactics were determined. The primary end points were 5-year disease-free survival and the achievement of a pathologic complete response.Results. Pathologic complete response was significantly more often recorded in patients in the investigational group III (17.48 %; p = 0.021) compared with control groups (7.95 % in the I group and 8.28 % in the II group). 5-year disease-free survival in patients in the study groups was: 71.5 % in the III group, 65.6 % in the II group and 56.9 % in the I group.Conclusion. The shift in emphasis on strengthening the neoadjuvant effect on the tumor and improving approaches to drug therapy regimens have significantly improved disease-free survival of patients with locally advanced rectal cancer.

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