Is Final TNM Staging A Predictor for Survival in Locally Advanced Rectal Cancer after Preoperative Chemoradiation Therapy?

Kuo, Li Jen; Liu, Mei Ching; Jian, James Jer-Min; Horng, Cheng-Fang; Cheng, Tsun I.; Chen, Chung-Ming; Fang, Wei; Chung, Yih Lin

doi:10.1245/s10434-007-9471-z

Cited by 164 publications

(100 citation statements)

References 31 publications

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“…An independent adverse prognostic effect was observed in patients with low TRG. Kuo et al (2007) noted an improved survival in patients with complete pathologic response and a decreased prognosis in patients with more advanced post-treatment TNM stage. Das et al (2007) observed an association between complete pathologic response and locoregional control.…”

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confidence: 94%

Combined analysis of VEGF and EGFR predicts complete tumour response in rectal cancer treated with preoperative radiotherapy

et al. 2008

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The ability to predict complete pathologic response or sensitivity to radiation before treatment would have a significant impact on the selection of patients for preoperative radiotherapy or chemo-radiation therapy schedules. The aim of this study was to determine the value of epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), p53, Bcl-2 and apoptosis proteaseactivating factor-1 (APAF-1) as predictors of complete pathologic tumour regression in patients undergoing preoperative radiotherapy for advanced rectal cancer. Pretreatment tumour biopsies from predominantly cT3 patients undergoing a preoperative high-dose-rate brachytherapy protocol were immunostained for EGFR, VEGF, p53, Bcl-2 and APAF-1. Immunoreactivity was evaluated by three pathologists. Cut-off scores for tumour marker positivity were obtained by receiver-operating characteristic (ROC) curve analysis. The association of marker expression with complete pathologic response was analysed in univariate and multivariable analysis. Multi-marker phenotypes of the independent protein markers were evaluated. In multivariable analysis, loss of VEGF (P-value ¼ 0.009; odds ratio (OR) (95% CI) ¼ 0.24 (0.08 -0.69)) and positive EGFR (P-value ¼ 0.01; OR (95% CI) ¼ 3.82 (1.37 -10.6)) both demonstrated independent predictive value for complete pathologic response. The odds of complete response were 12.8 for the multi-marker combination of VEGF-negative and EGFR-positive tumours. Of the 34 EGFR-negative-and VEGFpositive cases, 32 (94.1%) had no complete pathologic response. The combined analysis of VEGF and EGFR is predictive of complete pathologic response in patients undergoing preoperative radiotherapy. In addition, the findings of this study have identified a subgroup of simultaneous EGFR-negative and VEGF-positive patients who are highly resistant to radiotherapy and should perhaps be considered candidates for innovative neoadjuvant combined modalities.

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confidence: 94%

Combined analysis of VEGF and EGFR predicts complete tumour response in rectal cancer treated with preoperative radiotherapy

et al. 2008

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“…A number of studies have shown that both ypT and ypN stage are independent predictors of outcome, and several retrospective studies report a link between outcome and histopathology assessment of final stage or tumor regression after NACRT [12,13]. Accurate preoperative assessment of response to therapy may permit the clinical teams to modify definitive treatment [14].…”

Section: Introductionmentioning

confidence: 99%

Timing of surgery following neoadjuvant chemoradiotherapy in locally advanced rectal cancer – A comparison of magnetic resonance imaging at two time points and histopathological responses

West

Dimitrov

Moyses

et al. 2016

European Journal of Surgical Oncology (EJSO)

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Purpose: There is wide inter-institutional variation in the interval between neoadjuvant chemoradiotherapy (NACRT) and surgery for locally advanced rectal cancer. We aimed to assess the association of magnetic resonance imaging (MRI) at 9 and 14 weeks post-NACRT;T-staging (ymrT) and post-NACRT tumour regression grading (ymrTRG) with histopathological outcomes; histopathological T-stage (ypT) and histopathological tumour regression grading (ypTRG) in order to inform decision-making about timing of surgery. Patients and Methods:We prospectively studied 35 consecutive patients (26 males) with MRI-defined resection margin threatened rectal cancer who had completed standardized NACRT. Patients underwent a MRI at Weeks 9 and 14 post-NACRT, and surgery at Week 15. Two readers independently assessed MRIs for ymrT, ymrTRG and volume change. ymrT and ymrTRG were analysed against histopathological ypT and ypTRG as predictors by logistic regression modelling and receiver operating characteristic (ROC) curve analyses.

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“…A large number of retrospective analyses suggest that the pathological stage of disease after neoadjuvant treatment and/or the tumor regression rate have a significant prognostic impact on disease-free and overall survival [4,5,6,7,8,9,10,11,12,13]. In particular, the subgroup of patients who achieve a complete pathological response (pCR) has a very limited risk of local or distant recurrence [7,8,11,13].…”

Section: Introductionmentioning

confidence: 99%

Predictive Factors of Complete Response to Neoadjuvant Chemoradiotherapy in Patients with Rectal Cancer

et al. 2010

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Purpose: Pathological complete response (pCR) after neoadjuvant chemoradiotherapy is a favorable prognosticator in rectal cancer patients. We investigated whether the biological features of the primary tumor affect pCR. Materials and Methods:Forty-six patients treated with capecitabine-oxaliplatin and pelvic conformal radiotherapy were considered. Forty-three patients underwent surgery, and the pathologic response was scored according to the tumor regression grade (TRG) scale. Epidermal growth factor receptor (EGFR), vascular endothelial growth factor, poly(adenosine diphosphate-ribose) polymerase-1, X-ray cross-complimenting, thymidylate synthase (TS) and Ki67 expression were evaluated by immunohistochemistry on rectal biopsies obtained before chemoradiotherapy, and scored as the percentage of positive cells. Cutoffs were selected based on ROC analysis. The correlation between the biological factors and the TRG coded as TRG1 (pCR) versus TRG ≧2 (no pCR) was assessed by the χ² test and logistic regression analysis. Results: Low EGFR (p = 0.007), high TS (p = 0.002), and high Ki67 (p = 0.05) were strongly associated with pCR. Upon univariate analysis, TRG significantly affected disease-free survival (p = 0.03). Conclusions: pCR was significantly associated with high TS, high Ki67 and low EGFR expression. Patients with pCR have a significantly lower incidence of relapse.

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Is Final TNM Staging A Predictor for Survival in Locally Advanced Rectal Cancer after Preoperative Chemoradiation Therapy?

Cited by 164 publications

References 31 publications

Combined analysis of VEGF and EGFR predicts complete tumour response in rectal cancer treated with preoperative radiotherapy

Combined analysis of VEGF and EGFR predicts complete tumour response in rectal cancer treated with preoperative radiotherapy

Timing of surgery following neoadjuvant chemoradiotherapy in locally advanced rectal cancer – A comparison of magnetic resonance imaging at two time points and histopathological responses

Predictive Factors of Complete Response to Neoadjuvant Chemoradiotherapy in Patients with Rectal Cancer

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