Predictors of Pathologic Complete Response in Rectal Cancer Patients Undergoing Total Mesorectal Excision after Preoperative Chemoradiation

Yoon Dae Han, Woo Ram Kim, Seung Wan Park, Min Soo Cho, Hyuk Hur, Byung Soh Min, Seung Hyuk Baik, Kang Young Lee, Namkyu Kim

Research output: Contribution to journalArticle

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Abstract

Preoperative chemoradiotherapy (CRT) is the standard of care for patients with stage II and III rectal cancer. This strategy leads to pathologic complete response (pCR) in a significant number of patients. Factors predictive of pCR are currently being extensively investigated. The aim of this study was to analyze clinical factors that might be predictive of pCR. This study was a retrospective analysis of rectal cancer patients from January 2004 through December 2012. A total of 332 stage II and III patients with middle and low rectal cancer (≤10cm) who received CRT and underwent curative total mesorectal excision were eligible. The median radiation dose was 50.4Gy, and 72.6% of patients received infusional 5-fluorouracil with leucovorin, whereas 19.6% of patients received TS-1 with irinotecan, and 7.8% of patients received xeloda only. Pathologic complete response was confirmed by using pathologic specimens and analyzed based on predictive clinical factors. Among the 332 patients, 27.4% (n=91) achieved pCR. Age, sex, body mass index, clinical T and N stages, tumor differentiation, the chemotherapy agent for CRT, and the time interval between CRT and surgery did not differ between the pCR and non-pCR groups. Carcinoembryogenic antigen (CEA) levels before CRT were 4.61±7.38ng/mL in the pCR group and 10.49±23.83ng/mL in the non-pCR group (P=0.035). Post-CRT CEA levels were 1.4±1.07ng/mL in the pCR group and 2.16±2.8ng/mL in the non-pCR group (P=0.014), and the proportion of middle rectal cancer patients was higher in pCR group (54.9%, P=0.028). The results from multivariate logistic regression analysis indicated that higher tumor location (odds ratio 2.151; P=0.003) and low post-CRT CEA level (odds ratio 0.789; P=0.04) were independent predictive factors for pCR. Tumor location and post-CRT CEA level were predictive factors in pCR for rectal cancer patients. Therefore, these factors may be important determinants in achieving pCR, and may also be used to predict oncologic outcomes.

Original languageEnglish
Pages (from-to)e1971
JournalMedicine (United States)
Volume94
Issue number45
DOIs
Publication statusPublished - 2015 Nov 1

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Rectal Neoplasms
Chemoradiotherapy
Antigens
irinotecan
Odds Ratio
Neoplasms
Leucovorin
Standard of Care
Fluorouracil
Statistical Factor Analysis
Body Mass Index
Logistic Models
Regression Analysis
Radiation
Drug Therapy

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Han, Yoon Dae ; Kim, Woo Ram ; Park, Seung Wan ; Cho, Min Soo ; Hur, Hyuk ; Min, Byung Soh ; Baik, Seung Hyuk ; Lee, Kang Young ; Kim, Namkyu. / Predictors of Pathologic Complete Response in Rectal Cancer Patients Undergoing Total Mesorectal Excision after Preoperative Chemoradiation. In: Medicine (United States). 2015 ; Vol. 94, No. 45. pp. e1971.
@article{4964cc7b33704a3c8519e78f22e09f5d,
title = "Predictors of Pathologic Complete Response in Rectal Cancer Patients Undergoing Total Mesorectal Excision after Preoperative Chemoradiation",
abstract = "Preoperative chemoradiotherapy (CRT) is the standard of care for patients with stage II and III rectal cancer. This strategy leads to pathologic complete response (pCR) in a significant number of patients. Factors predictive of pCR are currently being extensively investigated. The aim of this study was to analyze clinical factors that might be predictive of pCR. This study was a retrospective analysis of rectal cancer patients from January 2004 through December 2012. A total of 332 stage II and III patients with middle and low rectal cancer (≤10cm) who received CRT and underwent curative total mesorectal excision were eligible. The median radiation dose was 50.4Gy, and 72.6{\%} of patients received infusional 5-fluorouracil with leucovorin, whereas 19.6{\%} of patients received TS-1 with irinotecan, and 7.8{\%} of patients received xeloda only. Pathologic complete response was confirmed by using pathologic specimens and analyzed based on predictive clinical factors. Among the 332 patients, 27.4{\%} (n=91) achieved pCR. Age, sex, body mass index, clinical T and N stages, tumor differentiation, the chemotherapy agent for CRT, and the time interval between CRT and surgery did not differ between the pCR and non-pCR groups. Carcinoembryogenic antigen (CEA) levels before CRT were 4.61±7.38ng/mL in the pCR group and 10.49±23.83ng/mL in the non-pCR group (P=0.035). Post-CRT CEA levels were 1.4±1.07ng/mL in the pCR group and 2.16±2.8ng/mL in the non-pCR group (P=0.014), and the proportion of middle rectal cancer patients was higher in pCR group (54.9{\%}, P=0.028). The results from multivariate logistic regression analysis indicated that higher tumor location (odds ratio 2.151; P=0.003) and low post-CRT CEA level (odds ratio 0.789; P=0.04) were independent predictive factors for pCR. Tumor location and post-CRT CEA level were predictive factors in pCR for rectal cancer patients. Therefore, these factors may be important determinants in achieving pCR, and may also be used to predict oncologic outcomes.",
author = "Han, {Yoon Dae} and Kim, {Woo Ram} and Park, {Seung Wan} and Cho, {Min Soo} and Hyuk Hur and Min, {Byung Soh} and Baik, {Seung Hyuk} and Lee, {Kang Young} and Namkyu Kim",
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Predictors of Pathologic Complete Response in Rectal Cancer Patients Undergoing Total Mesorectal Excision after Preoperative Chemoradiation. / Han, Yoon Dae; Kim, Woo Ram; Park, Seung Wan; Cho, Min Soo; Hur, Hyuk; Min, Byung Soh; Baik, Seung Hyuk; Lee, Kang Young; Kim, Namkyu.

In: Medicine (United States), Vol. 94, No. 45, 01.11.2015, p. e1971.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Predictors of Pathologic Complete Response in Rectal Cancer Patients Undergoing Total Mesorectal Excision after Preoperative Chemoradiation

AU - Han, Yoon Dae

AU - Kim, Woo Ram

AU - Park, Seung Wan

AU - Cho, Min Soo

AU - Hur, Hyuk

AU - Min, Byung Soh

AU - Baik, Seung Hyuk

AU - Lee, Kang Young

AU - Kim, Namkyu

PY - 2015/11/1

Y1 - 2015/11/1

N2 - Preoperative chemoradiotherapy (CRT) is the standard of care for patients with stage II and III rectal cancer. This strategy leads to pathologic complete response (pCR) in a significant number of patients. Factors predictive of pCR are currently being extensively investigated. The aim of this study was to analyze clinical factors that might be predictive of pCR. This study was a retrospective analysis of rectal cancer patients from January 2004 through December 2012. A total of 332 stage II and III patients with middle and low rectal cancer (≤10cm) who received CRT and underwent curative total mesorectal excision were eligible. The median radiation dose was 50.4Gy, and 72.6% of patients received infusional 5-fluorouracil with leucovorin, whereas 19.6% of patients received TS-1 with irinotecan, and 7.8% of patients received xeloda only. Pathologic complete response was confirmed by using pathologic specimens and analyzed based on predictive clinical factors. Among the 332 patients, 27.4% (n=91) achieved pCR. Age, sex, body mass index, clinical T and N stages, tumor differentiation, the chemotherapy agent for CRT, and the time interval between CRT and surgery did not differ between the pCR and non-pCR groups. Carcinoembryogenic antigen (CEA) levels before CRT were 4.61±7.38ng/mL in the pCR group and 10.49±23.83ng/mL in the non-pCR group (P=0.035). Post-CRT CEA levels were 1.4±1.07ng/mL in the pCR group and 2.16±2.8ng/mL in the non-pCR group (P=0.014), and the proportion of middle rectal cancer patients was higher in pCR group (54.9%, P=0.028). The results from multivariate logistic regression analysis indicated that higher tumor location (odds ratio 2.151; P=0.003) and low post-CRT CEA level (odds ratio 0.789; P=0.04) were independent predictive factors for pCR. Tumor location and post-CRT CEA level were predictive factors in pCR for rectal cancer patients. Therefore, these factors may be important determinants in achieving pCR, and may also be used to predict oncologic outcomes.

AB - Preoperative chemoradiotherapy (CRT) is the standard of care for patients with stage II and III rectal cancer. This strategy leads to pathologic complete response (pCR) in a significant number of patients. Factors predictive of pCR are currently being extensively investigated. The aim of this study was to analyze clinical factors that might be predictive of pCR. This study was a retrospective analysis of rectal cancer patients from January 2004 through December 2012. A total of 332 stage II and III patients with middle and low rectal cancer (≤10cm) who received CRT and underwent curative total mesorectal excision were eligible. The median radiation dose was 50.4Gy, and 72.6% of patients received infusional 5-fluorouracil with leucovorin, whereas 19.6% of patients received TS-1 with irinotecan, and 7.8% of patients received xeloda only. Pathologic complete response was confirmed by using pathologic specimens and analyzed based on predictive clinical factors. Among the 332 patients, 27.4% (n=91) achieved pCR. Age, sex, body mass index, clinical T and N stages, tumor differentiation, the chemotherapy agent for CRT, and the time interval between CRT and surgery did not differ between the pCR and non-pCR groups. Carcinoembryogenic antigen (CEA) levels before CRT were 4.61±7.38ng/mL in the pCR group and 10.49±23.83ng/mL in the non-pCR group (P=0.035). Post-CRT CEA levels were 1.4±1.07ng/mL in the pCR group and 2.16±2.8ng/mL in the non-pCR group (P=0.014), and the proportion of middle rectal cancer patients was higher in pCR group (54.9%, P=0.028). The results from multivariate logistic regression analysis indicated that higher tumor location (odds ratio 2.151; P=0.003) and low post-CRT CEA level (odds ratio 0.789; P=0.04) were independent predictive factors for pCR. Tumor location and post-CRT CEA level were predictive factors in pCR for rectal cancer patients. Therefore, these factors may be important determinants in achieving pCR, and may also be used to predict oncologic outcomes.

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