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Changes in serum uric acid, serum uric acid/serum creatinine ratio, and gamma-glutamyltransferase might predict the efficacy of neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer

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Abstract

Purpose

The purpose of this study was to investigate the predictive value of changes in serum uric acid (SUA), the ratio of serum uric acid to serum creatinine (SUA/SCr), and serum gamma-glutamyltransferase (GGT) from before to after therapy in patients with locally advanced rectal cancer (LARC).

Methods

Data from 114 LARC patients from January 2016 to December 2021 were included in this retrospective study. All patients received neoadjuvant chemoradiotherapy (nCRT) and total mesorectal excision (TME). The change in SUA was calculated as a ratio: (SUA level after nCRT–SUA level before nCRT)/SUA level before nCRT. The change ratios of SUA/SCr and GGT were calculated in the same way. The efficacy of nCRT was evaluated by magnetic resonance (MR) and postoperative pathological response. A nonlinear model was used to evaluate whether the change ratios of SUA, SUA/SCr, and GGT were associated with the efficacy of nCRT. The predictive power of the change ratios of SUA, SUA/SCr, and GGT was assessed by receiver operating characteristic (ROC) curves. Univariate and multivariate Cox regression analyses were employed to measure the associations between disease-free survival (DFS) and other predictive indicators. The Kaplan–Meier method was used to further compare DFS between groups.

Results

The nonlinear model indicated that the change ratios of SUA, SUA/SCr, and GGT were associated with the efficacy of nCRT. The change ratios of SUA, SUA/SCr, and GGT were used to predict the area under the ROC curve of efficacy for nCRT (0.95, 0.91–0.99), which was better than the prediction by the change ratio of SUA (0.94, 0.89–0.99), SUA/SCr (0.90, 0.84–0.96), or GGT alone (0.86, 0.79–0.93; p < 0.05). The optimal cut-off values of SUA, SUA/SCr, and GGT change were 0.02, 0.01, and 0.04, respectively. The Kaplan–Meier method indicated that patients with SUA, SUA/SCr, or GGT changes greater than the cut-off values had shorter DFS (p < 0.05).

Conclusion

Change ratios of SUA, SUA/SCr, or GGT greater than the cut-off values implied a risk of poor pathological response after nCRT and shorter DFS in LARC patients.

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Funding

This work was supported by the Basic Scientific Research Operating Expenses of Wenzhou Medical University in 2019 (KYYW201923).

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Authors and Affiliations

  1. Department of Radiotherapy, The First Affiliated Hospital of Wenzhou Medical University, 325000, Wenzhou, China

    Zhenyong Shao, Yuyan Xu, Xuebang Zhang, Changlin Zou & Raoying Xie

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  1. Zhenyong Shao
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  2. Yuyan Xu
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Contributions

RX, XZ, and CZ participated in study design, data analysis, and manuscript review. YX and ZS participated in data collection, data analysis, and manuscript writing. All authors reviewed the manuscript and revision and provided final approval for submission.

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Correspondence to Changlin Zou or Raoying Xie.

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Conflict of interest

Z. Shao, Y. Xu, X. Zhang, C. Zou, and R. Xie declare that they have no competing interests.

Ethical standards

The study was carried out in accordance with the ethical standards of the World Medical Association Declaration of Helsinki. The study involving human participants was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Wenzhou Medical University. The ethical number is KY2020-R190. A waiver of written consent was requested for this study and the Ethics Committee approved.

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The authors Zhenyong Shao and Yuyan Xu contributed equally to the manuscript.

Data Availability Statement

The authors will provide the raw data supporting the conclusions of this study without reservation.

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Shao, Z., Xu, Y., Zhang, X. et al. Changes in serum uric acid, serum uric acid/serum creatinine ratio, and gamma-glutamyltransferase might predict the efficacy of neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer. Strahlenther Onkol 200, 523–534 (2024). https://doi.org/10.1007/s00066-023-02096-4

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