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Predictive factors of complete pathological response in patients with locally advanced rectal cancer

Abstract

Purpose

Patients with locally advanced rectal cancer who achieve pathologic complete response (pCR) following neoadjuvant therapy have better long-term outcomes and could be spared from the perioperative and long-term morbidity of rectal resection. The aim of this study was to identify factors that predict the ability to achieve pCR at completion of conventional neoadjuvant therapy, therefore determining their suitability for non-surgical management.

Methods

A retrospective analysis was performed on data obtained from a prospectively maintained colorectal neoplasia database. Patients treated for biopsy-proven primary rectal adenocarcinoma between January 1, 2010, and February 28, 2018, who received neoadjuvant radiotherapy or chemoradiotherapy and had undergone surgical resection, were included in this study. Five-year oncologic outcome data was also obtained for 144 patients. Clinicopathological tumour characteristics and treatment regimens were analysed for correlation to clinical outcome.

Results

Three hundred fifty-four patients met inclusion criteria for this study. We identified significant differences between patients achieving a pCR and those that did not for tumour type (adenocarcinoma vs. mucinous/signet ring; p = 0.008), pre-treatment serum CEA level (</≥ 2.5 μg/L; p = 0.003), neoadjuvant therapy type (short-course radiotherapy and long-course chemoradiotherapy; p = 0.008) and preoperative lymph node status (node-negative versus node-positive disease; p = 0.031). Additionally, this is the first report to our knowledge to identify a significant correlation with pCR and the degree of tumour fixity (mobile vs. fixed/tethered; p = 0.038).

Conclusions

This retrospective analysis identified factors that significantly impact a patients’ ability to achieve a pCR, which may prove useful for prospectively selecting patients suitable for non-surgical management of disease.

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Acknowledgements

We thank the colorectal surgeons at Cabrini Hospital, Alfred Hospital and the Avenue Hospital for their contributions to this study.

Funding

These studies are funded in part by the “Let’s Beat Bowel Cancer” (www.letsbeatbowelcancer.com.au), a benevolent fund raising and public awareness foundation, and the Collie Foundation.

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Authors and Affiliations

Authors

Contributions

RME, KO, CK, RY and PJM participated in the conceptualization and study design; KO performed the data collection; RME performed the data analysis; RME, KO, CK and PJM participated in writing—original draft; RME, KO, CK, RY and PJM participated in writing—review and editing. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Rebekah M. Engel.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethics approval for this study was granted by the Cabrini Human Research Ethics Committee (Reference #02-10-04-06 and #09-29-10-18).

Consent to participate

Informed consent was obtained for all individual patients included on the database.

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Engel, R.M., Oliva, K., Koulis, C. et al. Predictive factors of complete pathological response in patients with locally advanced rectal cancer. Int J Colorectal Dis 35, 1759–1767 (2020). https://doi.org/10.1007/s00384-020-03633-8

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  • DOI: https://doi.org/10.1007/s00384-020-03633-8

Keywords

  • Rectal adenocarcinoma
  • Neoadjuvant therapy
  • Chemoradiotherapy
  • Pathological response