Clinical Predictive Factors of Tumor Response after Preoperative Chemoradiotherapy in Rectal Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 CHENGang ,  LIShi-yong , YUBo , CUIWei , YUANQiang

Center of General Surgery, General Hospital of Beijing Command of PLA, Beijing 100700, China;

Corresponding author：

LIShi-yong, Email: lsybz@126.com

Keywords：

Rectal cancer; Chemoradiotherapy; Tumor regression

DOI：

10.7507/1007-9424.20140041

Video：

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Objective To analyze the clinical predictive factors of tumor pathological response to preoperative chemoradiotherapy for rectal cancer. Methods One hundred and seven patients treated with preoperative capecitabine and pelvic conformal radiotherapy and underwent total mesorectal excision from January 2005 to December 2012 in this hospital were analyzed retrospectively.Tumor response according to tumor regression grade was evaluated.The correlation of clinicopathologic factors with tumor response was analyzed by logistic regression analysis. Results The single factor analysis results showed that the age, gender, distance of tumor from anal verge, differentiation degree of tumor, infiltration depth of tumor, and pretreatment CA19-9 level were not correlated with rectal cancer pathological response to preoperative chemoradiotherapy (P > 0.05).The tumor circumferential extent, tumor mobilit, lymph node metastasis, pretreatment carcinoembryonic antigen (CEA) level, and pretreatment hemoglobin level were correlated with it (P < 0.05).The logistic regression analysis results showed that non-fixed tumor (P=0.015), pretreatment CEA level≤5.0μg/L (P=0.012), and pretreatment hemoglobin level > 10 g/L (P=0.007) independently predicted a good pathologic response rate. Conclusion Tumor mobility, pretreatment CEA level, and hemoglobin level are important predictors of pathological response to preoperative chemoradiotherapy in rectal cancer.

Citation： CHENGang, LIShi-yong, YUBo, CUIWei, YUANQiang. Clinical Predictive Factors of Tumor Response after Preoperative Chemoradiotherapy in Rectal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(2): 177-181. doi: 10.7507/1007-9424.20140041 Copy

1.	Scott NA, Susnerwala S, Gollins S, et al.Preoperative neo-adju-vant therapy for curable rectal cancer-reaching a consensus 2008[J].Colorectal Dis, 2009, 11(3):245-248.
2.	Sauer R, Liersch T, Merkel S, et al.Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer:results of the German CAO/ARO/AIO-94 randomized phaseⅢtrial after a median follow-up of 11 years[J].J Clin Oncol, 2012, 30(16):1926-1933.
3.	Kuremsky JG, Tepper JE, McLeod HL.Biomarkers for response to neoadjuvant chemoradiation for rectal cancer[J].Int J Radiat Oncol Biol Phys, 2009, 74(3):673-688.
4.	崔伟, 陈纲, 左富义, 等.末端回肠双腔造口与横结肠双腔造口的对比研究[J].中国普通外科杂志, 2011, 20(10):1098-1100.
5.	Mandard AM, Dalibard F, Mandard JC, et al.Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma.Clinicopathologic correlations[J].Cancer, 1994, 73(11):2680-2686.
6.	Korkeila EA, Syrjanen K, Bendardaf R, et al.Preoperative radiotherapy modulates ezrin expression and its value as a predictive marker in patients with rectal cancer[J].Hum Pathol, 2011, 42(3):384-392.
7.	Shinto E, Hashiquchi Y, Ueno H, et al.Pretreatment C D133 and cyclooxygenase-2 expression as the predictive markers of the pathological effect of chemoradiotherapy in rectal cancer patients[J].Dis Colon Rectum, 2011, 54(9):1006-1098.
8.	Hu-Lieskovan S, Vallbohmer D, Zhang W, et al.EGF61 polymor-phism predicts complete pathologic response to cetuximabbased chemoradiation independent of KRAS status in locally advanced rectal cancer patients[J].Clin Cancer Res, 2011, 17(15):5161-5169.
9.	Yoon SM, Kim DY, Kim TH, et al.Clinical parameters predicting pathologic tumor response after preoperative chemoradiotherapy for rectal cancer[J].Int J Radiat Oncol Biol Phys, 2007, 69(4):1167-1172.
10.	Park YA, Sohn SK, Seong J, et al.Serum CEA as a predictor for the response to preoperative chemoradiation in rectal cancer[J].J Surg Oncol, 2006, 93(2):145-150.
11.	Yoon WS, Park W, Choi DH, et al.Importance of the circumferential extent of tumors and clinical lymph node status as prognostic factors after preoperative chemoradiotherapy and surgery in patients with rectal cancer[J].Tumori, 2010, 96(4):568-576.
12.	Suárez J, Vera R, Balén E, et al.Pathologic response assessed by Mandard grade is a better prognostic factor than down staging for disease-free survival after preoperative radiochemotherapy for advanced rectal cancer[J].Colorectal Dis, 2008, 10(6):563-568.
13.	Ryu YJ, Kim CH, Kim HJ, et al.Clinical significance of serial serum carcinoembryonic antigen values for treating rectal cancer with preoperative chemoradiotherapy[J].J Korean Soc Coloproctol, 2012, 28(4):205-212.
14.	Ishihara S, Watanabe T, Kiyomatsu T, et al.Prognostic signifi-cance of response to preoperative radiotherapy, lymph node metas-tasis, and CEA level in patients undergoing total mesorectal excision of rectal cancer[J].Int J Colorectal Dis, 2010, 25(12):1417-1425.
15.	吴文铭, 邱辉忠, 吴斌, 等.临床病理指标预测直肠癌新辅助治疗效果初探[J].中华外科杂志, 2010, 48(5):348-352.
16.	Lee JH, Kim SH, Jang HS, et al.Preoperative elevation of carci-noembryonic antigen predicts poor tumor response and frequent distant recurrence for patients with rectal cancer who receive preoperative chemoradiotherapy and total mesorectal excision:a multi-institutional analysis in an Asian population[J].Int J Colorectal Dis, 2013, 28(4):511-517.
17.	Das P, Skibber JM, Rodriguez-Bigas MA, et al.Predictors of tumor response and downstaging in patients who receive preoper-ative chemoradiation for rectal cancer[J].Cancer, 2007, 109(9):1750-1755.
18.	Yasuda H.Solid tumor physiology and hypoxia-induced chemo/radio-resistance:novel strategy for cancer therapy:nitric oxide donor as a therapeutic enhancer[J].Nitric Oxide, 2008, 19(2):205-216.
19.	Lee SD, Park JW, Park KS, et al.Influence of anemia on tumor response to preoperative chemoradiotherapy for locally advanced rectal cancer[J].Int J Colorectal Dis, 2009, 24(12):1451-1458.

1. Scott NA, Susnerwala S, Gollins S, et al.Preoperative neo-adju-vant therapy for curable rectal cancer-reaching a consensus 2008[J].Colorectal Dis, 2009, 11(3):245-248.
2. Sauer R, Liersch T, Merkel S, et al.Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer:results of the German CAO/ARO/AIO-94 randomized phaseⅢtrial after a median follow-up of 11 years[J].J Clin Oncol, 2012, 30(16):1926-1933.
3. Kuremsky JG, Tepper JE, McLeod HL.Biomarkers for response to neoadjuvant chemoradiation for rectal cancer[J].Int J Radiat Oncol Biol Phys, 2009, 74(3):673-688.
4. 崔伟, 陈纲, 左富义, 等.末端回肠双腔造口与横结肠双腔造口的对比研究[J].中国普通外科杂志, 2011, 20(10):1098-1100.
5. Mandard AM, Dalibard F, Mandard JC, et al.Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma.Clinicopathologic correlations[J].Cancer, 1994, 73(11):2680-2686.
6. Korkeila EA, Syrjanen K, Bendardaf R, et al.Preoperative radiotherapy modulates ezrin expression and its value as a predictive marker in patients with rectal cancer[J].Hum Pathol, 2011, 42(3):384-392.
7. Shinto E, Hashiquchi Y, Ueno H, et al.Pretreatment C D133 and cyclooxygenase-2 expression as the predictive markers of the pathological effect of chemoradiotherapy in rectal cancer patients[J].Dis Colon Rectum, 2011, 54(9):1006-1098.
8. Hu-Lieskovan S, Vallbohmer D, Zhang W, et al.EGF61 polymor-phism predicts complete pathologic response to cetuximabbased chemoradiation independent of KRAS status in locally advanced rectal cancer patients[J].Clin Cancer Res, 2011, 17(15):5161-5169.
9. Yoon SM, Kim DY, Kim TH, et al.Clinical parameters predicting pathologic tumor response after preoperative chemoradiotherapy for rectal cancer[J].Int J Radiat Oncol Biol Phys, 2007, 69(4):1167-1172.
10. Park YA, Sohn SK, Seong J, et al.Serum CEA as a predictor for the response to preoperative chemoradiation in rectal cancer[J].J Surg Oncol, 2006, 93(2):145-150.
11. Yoon WS, Park W, Choi DH, et al.Importance of the circumferential extent of tumors and clinical lymph node status as prognostic factors after preoperative chemoradiotherapy and surgery in patients with rectal cancer[J].Tumori, 2010, 96(4):568-576.
12. Suárez J, Vera R, Balén E, et al.Pathologic response assessed by Mandard grade is a better prognostic factor than down staging for disease-free survival after preoperative radiochemotherapy for advanced rectal cancer[J].Colorectal Dis, 2008, 10(6):563-568.
13. Ryu YJ, Kim CH, Kim HJ, et al.Clinical significance of serial serum carcinoembryonic antigen values for treating rectal cancer with preoperative chemoradiotherapy[J].J Korean Soc Coloproctol, 2012, 28(4):205-212.
14. Ishihara S, Watanabe T, Kiyomatsu T, et al.Prognostic signifi-cance of response to preoperative radiotherapy, lymph node metas-tasis, and CEA level in patients undergoing total mesorectal excision of rectal cancer[J].Int J Colorectal Dis, 2010, 25(12):1417-1425.
15. 吴文铭, 邱辉忠, 吴斌, 等.临床病理指标预测直肠癌新辅助治疗效果初探[J].中华外科杂志, 2010, 48(5):348-352.
16. Lee JH, Kim SH, Jang HS, et al.Preoperative elevation of carci-noembryonic antigen predicts poor tumor response and frequent distant recurrence for patients with rectal cancer who receive preoperative chemoradiotherapy and total mesorectal excision:a multi-institutional analysis in an Asian population[J].Int J Colorectal Dis, 2013, 28(4):511-517.
17. Das P, Skibber JM, Rodriguez-Bigas MA, et al.Predictors of tumor response and downstaging in patients who receive preoper-ative chemoradiation for rectal cancer[J].Cancer, 2007, 109(9):1750-1755.
18. Yasuda H.Solid tumor physiology and hypoxia-induced chemo/radio-resistance:novel strategy for cancer therapy:nitric oxide donor as a therapeutic enhancer[J].Nitric Oxide, 2008, 19(2):205-216.
19. Lee SD, Park JW, Park KS, et al.Influence of anemia on tumor response to preoperative chemoradiotherapy for locally advanced rectal cancer[J].Int J Colorectal Dis, 2009, 24(12):1451-1458.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Predictive Factors of Tumor Response after Preoperative Chemoradiotherapy in Rectal Cancer

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