Predictive Factors of Pathologic Complete Response after Preoperative Chemoradiation in Rectal Cancer

Authors

  • Thitipong Setthalikhit Department of Surgery, Surin Hospital
  • Chairat Supsamutchai Division of General Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
  • Chumpon Wilasrusmee Division of General Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
  • Tharin Thampongsa Division of General Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
  • Jakrapan Jirasiritham Division of General Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
  • Jirat Teerapradith Division of General Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
  • Pattawia Choikrua Division of General Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University

Keywords:

Pathologic complete response, Preoperative chemoradiation, Locally advanced, Rectal cancer, Predictive factors

Abstract

Background: Some rectal cancer patients may present with locally advanced disease requiring preoperative concurrent chemoradiation (CCRT) before radical surgery. But there is uncertainty as to what constitute predictors for pathologic complete response (pCR) after preoperative CCRT.

Objectives: To identify potential predictors of pCR after preoperative CCRT in rectal cancer.

Materials and Methods: A single-center retrospective cohort study of locally advanced rectal cancer patients who underwent preoperative CCRT followed by radical surgery at a tertiary care hospital between 1 January 2011 and 31 December 2017 was performed. Patients were categorized as having pCR or non-pCR. There were two chemotherapy regimens, 5-fluorouracil-based or Oxaliplatin-based regimens, in the present study. The radiotherapy dose to the pelvis was 50.4 Gy.

Result: A total of 145 patients were included; 25 (17%) patients in the pCR group, 120 (83%) in the non-pCR group. On univariable analysis, pretreatment tumor length less than 5 cm seen on computed tomography (CT) scan (p=0.018) and total harvested lymph nodes less than 12 nodes (p=0.02) were significantly associated with pCR, while initial carcinoembryonic antigen concentration of less than 5.0 ng/dL (p=0.078), clinical stage T2 (p=0.151), and circumferential tumor involvement (p=0.209) were marginally significant. On multivariable analysis, only pretreatment tumor length (p=0.0039), and total lymph nodes harvested (p=0.036) were significantly associated with pCR.

Conclusion: Our study showed that the pretreatment tumor length < 5 cm as seen on CT scan and total lymph nodes harvested < 12 are predictors of pCR after preoperative CCRT in patients with rectal cancer.

References

Rawla P, Sunkara T, Barsouk A. Epidemiology of colorectal cancer: incidence, mortality, survival, and risk factors. Prz Gastroenterol. 2019;14:89-103.

Moghimi-Dehkordi B, Safaee A. An overview of colorectal cancer survival rates and prognosis in Asia. World J Gastrointest Oncol 2012;4:71-5.

Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004;351:1731-40.

Bosset JF, Collette L, Calais G, et al. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 2006;355:1114-23.

Roh MS, Colangelo LH, O'Connell MJ, et al. Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R-03. J Clin Oncol 2009;27:5124-30.

Glynne-Jones R, Wyrwicz L, Tiret E, et al. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2017;28(suppl_4):iv22-iv40.

Crucitti F, Sofo L, Doglietto GB, et al. Prognostic factors in colorectal cancer: current status and new trends. J Surg Oncol Suppl 1991;2:76-82.

Gunderson LL, Sargent DJ, Tepper JE, et al. Impact of T and N stage and treatment on survival and relapse in adjuvant rectal cancer: a pooled analysis. J Clin Oncol 2004;22:1785-96.

Quirke P, Steele R, Monson J, et al. Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet 2009;373:821-8.

Rödel C, Martus P, Papadoupolos T, et al. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol 2005;23:8688-96.

Maas M, Nelemans PJ, Valentini V, et al. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol 2010;11:835-44.

Choi E, Kim JH, Kim OB, et al. Predictors of pathologic complete response after preoperative concurrent chemoradiotherapy of rectal cancer: a single center experience. Radiat Oncol J 2016;34:106-12.

Wilkins S, Haydon A, Porter I, et al. Complete pathological response after neoadjuvant long-course chemoradiotherapy for rectal cancer and its relationship to the degree of T3 mesorectal invasion. Dis Colon Rectum 2016;59:361-8.

Iskander O, Courtot L, Tabchouri N, et al. Complete pathological response following radiochemotherapy for locally advanced rectal cancer: short and long-term outcome. Anticancer Res 2019;39:5105-13.

Huh JW, Kim HR, Kim YJ. Clinical prediction of pathological complete response after preoperative chemoradiotherapy for rectal cancer. Dis Colon Rectum 2013;56:698-703.

Wasmuth HH, Rekstad LC, Tranø G. The outcome and the frequency of pathological complete response after neoadjuvant radiotherapy in curative resections for advanced rectal cancer: a population-based study. Colorectal Dis 2016;18:67-72.

Das P, Skibber JM, Rodriguez-Bigas MA, et al. Predictors of tumor response and downstaging in patients who receive preoperative chemoradiation for rectal cancer. Cancer 2007;109:1750-5.

Restivo A, Zorcolo L, Cocco IM, et al. Elevated CEA levels and low distance of the tumor from the anal verge are predictors of incomplete response to chemoradiation in patients with rectal cancer. Ann Surg Oncol 2013;20:864-71.

Krauthamer M, Rouvinov K, Ariad S, et al. A study of inflammation-based predictors of tumor response to neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Oncology 2013;85:27-32.

Carlomagno C, Pepe S, D'Armiento FP, et al. Predictive factors of complete response to neoadjuvant chemoradiotherapy in patients with rectal cancer. Oncology 2010;78:369-75.

Chen MB, Wu XY, Yu R, et al. P53 status as a predictive biomarker for patients receiving neoadjuvant radiation-based treatment: a meta-analysis in rectal cancer. PLoS One 2012;7:e45388.

Park YA, Lee KY, Kim NK, et al. Prognostic effect of perioperative change of serum carcinoembryonic antigen level: a useful tool for detection of systemic recurrence in rectal cancer. Ann Surg Oncol 2006;13:645-50.

Wu ZY, Wan J, Zhao G, et al. Risk factors for local recurrence of middle and lower rectal carcinoma after curative resection. World J Gastroenterol 2008;14:4805-9.

Primrose JN, Perera R, Gray A, et al. Effect of 3 to 5 years of scheduled CEA and CT follow-up to detect recurrence of colorectal cancer: the FACS randomized clinical trial. JAMA 2014;311:263-70.

Fahy BN. Follow-up after curative resection of colorectal cancer. Ann Surg Oncol 2014;21:738-46.

Steele SR, Chang GJ, Hendren S, et al. Practice guideline for the surveillance of patients after curative treatment of colon and rectal cancer. Dis Colon Rectum 2015;58:713-25.

Wolthuis AM, Penninckx F, Haustermans K, et al. Impact of interval between neoadjuvant chemoradiotherapy and TME for locally advanced rectal cancer on pathologic response and oncologic outcome. Ann Surg Oncol 2012;19:2833-41.

Lichthardt S, Wagner J, Löb S, et al. Pathological complete response due to a prolonged time interval between preoperative chemoradiation and surgery in locally advanced rectal cancer: analysis from the German StuDoQ|Rectalcarcinoma registry. BMC Cancer 2020;20:49.

Garland ML, Vather R, Bunkley N, et al. Clinical tumour size and nodal status predict pathologic complete response following neoadjuvant chemoradiotherapy for rectal cancer. Int J Colorectal Dis 2014;29:301-7.

Bustamante-Lopez LA, Nahas CSR, Nahas SC, et al. Pathologic complete response implies a fewer number of lymph nodes in specimen of rectal cancer patients treated by neoadjuvant therapy and total mesorectal excision. Int J Surg 2018;56:283-7.

Khan AA, Klonizakis M, Shabaan A, Glynne-Jones R. Association between pretreatment haemoglobin levels and morphometric characteristics of the tumour, response to neoadjuvant treatment and long-term outcomes in patients with locally advanced rectal cancers. Colorectal Dis 2013;15:1232-7.

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Published

2021-03-30

How to Cite

1.
Setthalikhit T, Supsamutchai C, Wilasrusmee C, Thampongsa T, Jirasiritham J, Teerapradith J, Choikrua P. Predictive Factors of Pathologic Complete Response after Preoperative Chemoradiation in Rectal Cancer. Thai J Surg [Internet]. 2021 Mar. 30 [cited 2024 Dec. 23];42(1):14-22. Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/244978

Issue

Vol. 42 No. 1 (2021): January - March

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Original Articles

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