Abstract
Purpose
To investigate the role of biomarkers including serum tissue inhibitor of metalloproteinases-1 (TIMP-1), urokinase plasminogen activator receptor, vascular endothelial growth factor, and epidermal growth factor receptor in predicting pathologic response to neoadjuvant chemoradiation (NACRT) for rectal cancer.
Methods
Between 2007 and 2009, 50 clinical TNM stage II or III patients were analyzed in this prospective study. Pre- and post-NACRT serum levels of biomarkers were assessed using ELISAs. The primary and secondary endpoints were pathologic complete response (pCR) and Mandard regression grade (MRG).
Results
The pCR was reported in 5 patients (10.0 %). According to the MRG, fifteen patients (30.0 %) were divided into group A (Grade I–II), the others in group B (Grade III–V). On univariate analysis, post-NACRT TIMP-1 showed notable significance with pCR (P = 0.092) and significant correlation with MRG group A (P = 0.003). Post-NACRT TIMP-1 ≤ 204.5 ng/mL as cut-off value by ROC curve was associated with more pCR and MRG group A patients (P = 0.016 and 0.002). Interval between NACRT and surgery was related to pCR with approached trend levels of significance (P = 0.05) and to MRG group A significantly on univariate analysis of clinical factors (P = 0.031). On multivariate analysis, post-NACRT TIMP-1 was not significantly related to pCR (P = 0.187), while it was significantly associated with MRG (P = 0.009). Among clinical responders, post-NACRT TIMP-1 level ≤ 204.5 ng/mL was significantly associated with pCR (P = 0.021) and MRG group A (P = 0.003).
Conclusions
Post-NACRT serum TIMP-1 could be used as a predictive marker of pathologic response to NACRT in rectal cancer, even in patients with clinical response.
Similar content being viewed by others
References
Birgisson H, Nielsen HJ, Christensen IJ, Glimelius B, Brunner N (2010) Preoperative plasma TIMP-1 is an independent prognostic indicator in patients with primary colorectal cancer: a prospective validation study. Eur J Cancer 46:3323–3331. doi:10.1016/j.ejca.2010.06.009
Capirci C, Valentini V, Cionini L, De Paoli A, Rodel C, Glynne-Jones R, Coco C, Romano M, Mantello G, Palazzi S, Mattia FO, Friso ML, Genovesi D, Vidali C, Gambacorta MA, Buffoli A, Lupattelli M, Favretto MS, La Torre G (2008) Prognostic value of pathologic complete response after neoadjuvant therapy in locally advanced rectal cancer: long-term analysis of 566 ypCR patients. Int J Radiat Oncol Biol Phys 72:99–107. doi:10.1016/j.ijrobp.2007.12.019
Chan AK, Wong A, Jenken D, Heine J, Buie D, Johnson D (2005) Posttreatment TNM staging is a prognostic indicator of survival and recurrence in tethered or fixed rectal carcinoma after preoperative chemotherapy and radiotherapy. Int J Radiat Oncol Biol Phys 61:665–677. doi:10.1016/j.ijrobp.2004.06.206
Edge SB, American Joint Committee on Cancer (AJCC), American Cancer Society (2010) AJCC cancer staging handbook: from the AJCC cancer staging manual, 7th edn. Springer, New York
Francois Y, Nemoz CJ, Baulieux J, Vignal J, Grandjean JP, Partensky C, Souquet JC, Adeleine P, Gerard JP (1999) Influence of the interval between preoperative radiation therapy and surgery on downstaging and on the rate of sphincter-sparing surgery for rectal cancer: the Lyon R90-01 randomized trial. J Clin Oncol 17:2396
Gavioli M, Luppi G, Losi L, Bertolini F, Santantonio M, Falchi AM, D’Amico R, Conte PF, Natalini G (2005) Incidence and clinical impact of sterilized disease and minimal residual disease after preoperative radiochemotherapy for rectal cancer. Dis Colon Rectum 48:1851–1857. doi:10.1007/s10350-005-0133-6
Greene FL, American Joint Committee on Cancer (AJCC), American Cancer Society (2002) AJCC cancer staging handbook : from the AJCC cancer staging manual, 6th edn. Springer, New York
Holten-Andersen MN, Stephens RW, Nielsen HJ, Murphy G, Christensen IJ, Stetler-Stevenson W, Brunner N (2000) High preoperative plasma tissue inhibitor of metalloproteinase-1 levels are associated with short survival of patients with colorectal cancer. Clin Cancer Res 6:4292–4299
Holten-Andersen M, Christensen IJ, Nilbert M, Bendahl PO, Nielsen HJ, Brunner N, Fernebro E (2004) Association between preoperative plasma levels of tissue inhibitor of metalloproteinases 1 and rectal cancer patient survival. A validation study. Eur J Cancer 40:64–72
Ishida H, Murata N, Hayashi Y, Tada M, Hashimoto D (2003) Serum levels of tissue inhibitor of metalloproteinases-1 (TIMP-1) in colorectal cancer patients. Surg Today 33:885–892. doi:10.1007/s00595-003-2628-x
Janjan NA, Khoo VS, Abbruzzese J, Pazdur R, Dubrow R, Cleary KR, Allen PK, Lynch PM, Glober G, Wolff R, Rich TA, Skibber J (1999) Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer: the M. D. Anderson Cancer Center experience. Int J Radiat Oncol Biol Phys 44:1027–1038
Janjan NA, Crane C, Feig BW, Cleary K, Dubrow R, Curley S, Vauthey JN, Lynch P, Ellis LM, Wolff R, Lenzi R, Abbruzzese J, Pazdur R, Hoff PM, Allen P, Brown T, Skibber J (2001) Improved overall survival among responders to preoperative chemoradiation for locally advanced rectal cancer. Am J Clin Oncol 24:107–112
Jung K (2008) Matrix metalloproteinase-8 and tissue inhibitor of metalloproteinase-1 in serum do not reflect the analytes circulating in blood. Arterioscler Thromb Vasc Biol 28:e15–e16; author reply e17. doi:10.1161/ATVBAHA.107.158790
Kalady MF, de Campos-Lobato LF, Stocchi L, Geisler DP, Dietz D, Lavery IC, Fazio VW (2009) Predictive factors of pathologic complete response after neoadjuvant chemoradiation for rectal cancer. Ann Surg 250:582–589. doi:10.1097/SLA.0b013e3181b91e63
Losi L, Luppi G, Gavioli M, Iachetta F, Bertolini F, D’Amico R, Jovic G, Bertoni F, Falchi AM, Conte PF (2006) Prognostic value of Dworak grade of regression (GR) in patients with rectal carcinoma treated with preoperative radiochemotherapy. Int J Colorectal Dis 21:645–651. doi:10.1007/s00384-005-0061-x
Maas M, Nelemans PJ, Valentini V, Das P, Rodel C, Kuo LJ, Calvo FA, Garcia-Aguilar J, Glynne-Jones R, Haustermans K, Mohiuddin M, Pucciarelli S, Small W Jr, Suarez J, Theodoropoulos G, Biondo S, Beets-Tan RG, Beets GL (2010) Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol 11:835–844. doi:10.1016/S1470-2045(10)70172-8
Martin ST, Heneghan HM, Winter DC (2012) Systematic review and meta-analysis of outcomes following pathological complete response to neoadjuvant chemoradiotherapy for rectal cancer. Br J Surg 99:918–928. doi:10.1002/bjs.8702
McShane LM, Altman DG, Sauerbrei W, Taube SE, Gion M, Clark GM (2005) Reporting recommendations for tumor marker prognostic studies (REMARK). Nat Clin Pract Oncol 2:416–422
Navarro M, Dotor E, Rivera F, Sanchez-Rovira P, Vega-Villegas ME, Cervantes A, Garcia JL, Gallen M, Aranda E (2006) A Phase II study of preoperative radiotherapy and concomitant weekly irinotecan in combination with protracted venous infusion 5-fluorouracil, for resectable locally advanced rectal cancer. Int J Radiat Oncol Biol Phys 66:201–205. doi:10.1016/j.ijrobp.2006.04.007
Nielsen HJ, Brunner N, Jorgensen LN, Olsen J, Rahr HB, Thygesen K, Hoyer U, Laurberg S, Stieber P, Blankenstein MA, Davis G, Dowell BL, Christensen IJ, Danish Endoscopy Study Group on Colorectal Cancer D, Danish Colorectal Cancer Cooperative G (2011) Plasma TIMP-1 and CEA in detection of primary colorectal cancer: a prospective, population based study of 4509 high-risk individuals. Scand J Gastroenterol 46:60–69. doi:10.3109/00365521.2010.513060
Oblak I, Anderluh F, Velenik V, Mozina B, Ocvirk J, Ciric E, Podvrsnik NH (2011) Differences in plasma TIMP-1 levels between healthy people and patients with rectal cancer stage II or III. Radiol Oncol 45:209–212. doi:10.2478/v10019-011-0027-2
Oblak I, Velenik V, Anderluh F, Mozina B, Ocvirk J (2013) The correlation between the levels of tissue inhibitor of metalloproteinases 1 in plasma and tumour response and survival after preoperative radiochemotherapy in patients with rectal cancer. Radiol Oncol 47:138–144. doi:10.2478/raon-2013-0028
Rodel C, Martus P, Papadoupolos T, Fuzesi L, Klimpfinger M, Fietkau R, Liersch T, Hohenberger W, Raab R, Sauer R, Wittekind C (2005) Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol 23:8688–8696. doi:10.1200/JCO.2005.02.1329
Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens JH, Liersch T, Schmidberger H, Raab R (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740. doi:10.1056/NEJMoa040694
Sorensen NM, Bystrom P, Christensen IJ, Berglund A, Nielsen HJ, Brunner N, Glimelius B (2007) TIMP-1 is significantly associated with objective response and survival in metastatic colorectal cancer patients receiving combination of irinotecan, 5-fluorouracil, and folinic acid. Clin Cancer Res 13:4117–4122. doi:10.1158/1078-0432.CCR-07-0186
Stephens RW, Nielsen HJ, Christensen IJ, Thorlacius-Ussing O, Sorensen S, Dano K, Brunner N (1999) Plasma urokinase receptor levels in patients with colorectal cancer: relationship to prognosis. J Natl Cancer Inst 91:869–874
R&D Systems (2009) Human TIMP-1 Quantikine ELISA Kit-SixPak (6 Plates) Cat No. STM100. R&D Systems, Minneapolis
Theodoropoulos G, Wise WE, Padmanabhan A, Kerner BA, Taylor CW, Aguilar PS, Khanduja KS (2002) T-level downstaging and complete pathologic response after preoperative chemoradiation for advanced rectal cancer result in decreased recurrence and improved disease-free survival. Dis Colon Rectum 45:895–903
Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, Verweij J, Van Glabbeke M, van Oosterom AT, Christian MC, Gwyther SG (2000) New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 92:205–216
Unsal Kilic D, Uner A, Akyurek N, Erpolat P, Dursun A, Pak Y (2007) Matrix metalloproteinase-9 expression correlated with tumor response in patients with locally advanced rectal cancer undergoing preoperative chemoradiotherapy. Int J Radiat Oncol Biol Phys 67:196–203. doi:10.1016/j.ijrobp.2006.08.010
Valentini V, Coco C, Cellini N, Picciocchi A, Genovesi D, Mantini G, Barbaro B, Cogliandolo S, Mattana C, Ambesi-Impiombato F, Tedesco M, Cosimelli M (1998) Preoperative chemoradiation for extraperitoneal T3 rectal cancer: acute toxicity, tumor response, and sphincter preservation. Int J Radiat Oncol Biol Phys 40:1067–1075
Wolthuis AM, Penninckx F, Haustermans K, De Hertogh G, Fieuws S, Van Cutsem E, D’Hoore A (2012) Impact of interval between neoadjuvant chemoradiotherapy and TME for locally advanced rectal cancer on pathologic response and oncologic outcome. Ann Surg Oncol 19:2833–2841. doi:10.1245/s10434-012-2327-1
Wong RK, Tandan V, De Silva S, Figueredo A (2007) Pre-operative radiotherapy and curative surgery for the management of localized rectal carcinoma. Cochrane Database Syst Rev:CD002102. doi:10.1002/14651858.CD002102.pub2
Zlobec I, Steele R, Compton CC (2005) VEGF as a predictive marker of rectal tumor response to preoperative radiotherapy. Cancer 104:2517–2521. doi:10.1002/cncr.21484
Acknowledgments
This study was supported by a faculty research grant of Yonsei University College of Medicine for 2007 (6-2007-0192). The sponsor had no involvement in this manuscript.
Conflict of interest
We declare that we have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Yoon, H.I., Koom, W.S., Kim, Y.B. et al. Predicting the pathologic response of locally advanced rectal cancer to neoadjuvant concurrent chemoradiation using enzyme-linked immunosorbent assays (ELISAs) for biomarkers. J Cancer Res Clin Oncol 140, 399–409 (2014). https://doi.org/10.1007/s00432-013-1578-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00432-013-1578-y