Normalization of CEA Levels Post-Neoadjuvant Therapy is a Strong Predictor of Pathologic Complete Response in Rectal Cancer

Kleiman, Ariella; Alkhamis, Ahmed; Farsi, Ali; Kezouh, Abbas; Vuong, T.; Gordon, Philip H.; Vasilevsky, Carol‐Ann; Morin, Nancy; Faria, Julio; Ghitulescu, Gabriela; Boutros, Marylise

doi:10.1007/s11605-015-2814-3

Cited by 59 publications

(55 citation statements)

References 24 publications

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“…As for the relation between the serum CEA level after nCRT and the histologic response, some studies have reported a high rate of ypCR among patients with negative serum CEA levels [22,23,37], whereas another study found no relation between the serum CEA level after nCRT and response [24]. Consistent results have thus not been obtained.…”

Section: Discussionmentioning

confidence: 96%

“…Several studies have reported that the serum CEA level before nCRT is related to the histologic response [9,20,21], whereas another study found no relation between these factors [22]. The serum CEA level after nCRT has been reported to be related to the treatment response by some studies [22,23], whereas another study found no relation between these factors [24]. In patients with rectal cancer who receive CRT, the clinical significance of serum CEA as a predictor of the treatment response and outcomes has not been established.…”

mentioning

confidence: 99%

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Relations of Changes in Serum Carcinoembryonic Antigen Levels before and after Neoadjuvant Chemoradiotherapy and after Surgery to Histologic Response and Outcomes in Patients with Locally Advanced Rectal Cancer

Saito

Sadahiro²,

Ogimi³

et al. 2017

Oncology

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Objectives: The histologic response to neoadjuvant chemoradiotherapy (nCRT) has been intimately related to outcomes in locally advanced rectal cancer. Serum carcinoembryonic antigen (CEA) levels change after nCRT and after surgery as compared with before nCRT. Methods: The subjects were 149 patients with locally advanced rectal cancer who received nCRT between 2005 and 2013. The patients were divided into 4 groups according to the serum CEA levels: group 1, 55 patients with negative serum CEA levels before nCRT; group 2, 41 patients with positive serum CEA levels before nCRT that became negative after nCRT; group 3, 37 patients with positive serum CEA levels after nCRT that became negative after surgery; and group 4, 16 patients with positive serum CEA levels after nCRT as well as after surgery. Results: Pathological complete response, T downstaging, and tumor shrinkage were significantly higher in group 1 than in other groups. Disease-free survival was significantly poorer in group 4. The lack of a decrease in the serum CEA level in group 4 was most likely attributed to the persistence of micrometastases outside the resection field. Conclusions: Changes in serum CEA levels measured before nCRT, after nCRT, and after surgery can be used to reliably predict the histologic response to nCRT and outcomes.

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Section: Discussionmentioning

confidence: 96%

mentioning

confidence: 99%

Relations of Changes in Serum Carcinoembryonic Antigen Levels before and after Neoadjuvant Chemoradiotherapy and after Surgery to Histologic Response and Outcomes in Patients with Locally Advanced Rectal Cancer

Saito

Sadahiro²,

Ogimi³

et al. 2017

Oncology

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“…Numerous retrospective cohort studies have previously examined this question and have identified a variety of disease-related variables as potential predictors of pCR. These include low pre-therapy CEA, 17,21,26, 28,37,38 low CEA after nCRT, 29, 35 small pre- 31,38 and post-treatment tumor size, 22 pre-treatment tumor ‘movability’, 22 low N category, 31 low tumor grade, 36 shorter distance from the anal verge, 18,36 smaller circumferential tumor extent, 18,28 and low neutrophil to lymphocyte ratio. 38 Identification and awareness of these factors may help to predict which patients are more likely to achieve pCR with neoadjuvant treatment, and may be used to counsel patients more accurately regarding their prognosis and treatment options.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Pathologic Complete Response Following Neoadjuvant Chemoradiotherapy for Rectal Cancer

et al. 2015

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Background Some patients with rectal cancer who receive neoadjuvant chemoradiotherapy (nCRT) achieve a pathologic complete response (pCR) and may be eligible for less radical surgery or non-operative management. The aim of this study was to identify variables that predict pCR after nCRT for rectal cancer and to examine the impact of pCR on postoperative complications. Methods A retrospective review was performed of the NCDB from 2006 to 2011. Patients with rectal cancer who received nCRT followed by radical resection were included in this study. Multivariable analysis of the association between clinicopathologic characteristics and pCR was performed, and propensity-adjusted analysis was used to identify differences in postoperative morbidity between pCR and non-pCR patients. Results A total of 23,747 patients were included in the study. Factors associated with pCR included lower tumor grade, lower clinical T and N stage, higher radiation dose, and delaying surgery by more than 6–8 weeks after the end of radiation, while lack of health insurance was linked with a lower likelihood of pCR. Complete response was not associated with an increased risk of major postoperative complications. Conclusions Several clinical, pathologic, and treatment variables can help to predict which patients are most likely to have pCR after nCRT for rectal cancer. Awareness of these variables can be valuable in counseling patients regarding prognosis and treatment options.

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“…However, not only the pre-CRT CEA level but also the post-CRT CEA level, and/or the change in the CEA pattern after CRT, are often analyzed together. The latter two measures are more closely related to the pathological CRT response than is the pre-CRT CEA level [58][59][60]. This is not surprising because the latter values reflect the degree of CRT response.…”

Section: Predictive Markers Clinicopathological Factorsmentioning

confidence: 91%

Clinical utility of pretreatment prediction of chemoradiotherapy response in rectal cancer: a review

Yoo

Yeo

2017

EPMA Journal

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Approximately 20% of all patients with locally advanced rectal cancer experience pathologically complete responses following neoadjuvant chemoradiotherapy (CRT) and standard surgery. The utility of radical surgery for patients exhibiting good CRT responses has been challenged. Organsparing strategies for selected patients exhibiting complete clinical responses include local excision or no immediate surgery. The subjects of this tailored management are patients whose presenting disease corresponds to current indications of neoadjuvant CRT, and their post-CRT tumor response is assessed by clinical and radiological examinations. However, a model predictive of the CRT response, applied before any treatment commenced, would be valuable to facilitate such a personalized approach. This would increase organ preservation, particularly in patients for whom upfront CRT is not generally prescribed. Molecular biomarkers hold the greatest promise for development of a pretreatment predictive model of CRT response. A combination of clinicopathological, radiological, and molecular markers will be necessary to render the model robust. Molecular research will also contribute to the development of drugs that can overcome the radioresistance of rectal tumors. Current treatments for rectal cancer are based on the expected prognosis given the presenting disease extent. In the future, treatment schemes may be modified by including the predicted CRT response evaluated at presentation.

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Normalization of CEA Levels Post-Neoadjuvant Therapy is a Strong Predictor of Pathologic Complete Response in Rectal Cancer

Abstract: Low post-nCRT CEA is an independent predictor of pCR, and normalization of CEA post-nCRT is a strong predictor of pCR.

Cited by 59 publications

References 24 publications

Relations of Changes in Serum Carcinoembryonic Antigen Levels before and after Neoadjuvant Chemoradiotherapy and after Surgery to Histologic Response and Outcomes in Patients with Locally Advanced Rectal Cancer

Relations of Changes in Serum Carcinoembryonic Antigen Levels before and after Neoadjuvant Chemoradiotherapy and after Surgery to Histologic Response and Outcomes in Patients with Locally Advanced Rectal Cancer

Predictors of Pathologic Complete Response Following Neoadjuvant Chemoradiotherapy for Rectal Cancer

Clinical utility of pretreatment prediction of chemoradiotherapy response in rectal cancer: a review

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