Predictive factors associated with complete pathological response after neoadjuvant treatment for rectal cancer

Introduction Total neoadjuvant therapy (TNT) is a new therapeutic strategy in patients with rectal cancer. We examined the role of TNT, in addition to other pre-operative factors, as a predictor for pathologic complete response (pCR). Methods A retrospective analysis of all rectal cancer patients who underwent surgery between 2016 and 2021 was conducted. Patients were classified into two groups—pCR group and residual tumor group. Patient data were reviewed and entered into univariate and multivariate analyses to determine predictors of pCR. Results A total of 172 patients were treated with neoadjuvant therapy and underwent surgery during the study period. Sixty patients (34.9%) were treated with TNT while 112 (65.1%) were treated with traditional neoadjuvant chemoradiation. The overall pCR rate was 25.6% (44 patients), with 31.6% (19 patients) in patients who received TNT compared to 22.3% (25 patients) in patients who received neoadjuvant chemoradiation (NCRT). Univariate analysis of clinical and radiological factors correlated with pCR demonstrated no significant differences between the two groups in cT stage ( p = 0.46), cN stage ( p = 0.52), positive circumferential resection margin (CRM) ( p = 0.72), tumor location ( p = 0.35), symptomatic presentation ( p = 0.09), and anal sphincter involvement ( p = 0.68). Multivariate logistic analysis demonstrated that only pre-operative TNT (OR:2.35; 95% CI 1.06–5.25; p = 0.03) was predictive of pCR, while extramural vascular invasion (EMVI) was a predictor for lower rates of pCR (OR: 0.28; 95% CI 0.09–0.9; p = 0.03). Conclusion Rectal cancer patients undergoing TNT prior to surgery have a higher chance of developing a complete pathologic response. Evaluation of this therapy should be continued and extended to larger numbers of patients to see if the differences we observed are real.

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“…Assessment of these factors could hopefully help clinicians to identify potential candidates for a watch and wait management. 22 – 24 …”

Section: Discussionmentioning

confidence: 99%

Total Neoadjuvant Therapy Is a Predictor for Complete Pathological Response in Patients Undergoing Surgery for Rectal Cancer

Horesh

Freund

Garoufalia

et al. 2022

Journal of Gastrointestinal Surgery

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“…Patients may achieve pathological complete response (pCR), which is defined as the complete absence of tumor cells in the resected specimen, while some patients may only have partial response or no response. The reported pCR rate of LACR to nCRT is relatively low, ranging from 10% to 30% ( 1 – 4 ). Patients who achieve a pCR may adopt a conservative “watch and wait” strategy without surgery ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

Pre-Treatment Computed Tomography Radiomics for Predicting the Response to Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer: A Retrospective Study

Mao

Pei

et al. 2022

Front. Oncol.

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Background and PurposeComputerized tomography (CT) scans are commonly performed to assist in diagnosis and treatment of locally advanced rectal cancer (LARC). This study assessed the usefulness of pretreatment CT-based radiomics for predicting pathological complete response (pCR) of LARC to neoadjuvant chemoradiotherapy (nCRT).Materials and MethodsPatients with LARC who underwent nCRT followed by total mesorectal excision surgery from July 2010 to December 2018 were enrolled in this retrospective study. A total of 340 radiomic features were extracted from pretreatment contrast-enhanced CT images. The most relevant features to pCR were selected using the least absolute shrinkage and selection operator (LASSO) method and a radiomic signature was generated. Predictive models were built with radiomic features and clinico-pathological variables. Model performance was assessed with decision curve analysis and was validated in an independent cohort.ResultsThe pCR was achieved in 44 of the 216 consecutive patients (20.4%) in this study. The model with the best performance used both radiomics and clinical variables including radiomic signatures, distance to anal verge, lymphocyte-to-monocyte ratio, and carcinoembryonic antigen. This combined model discriminated between patients with and without pCR with an area under the curve of 0.926 and 0.872 in the training and the validation cohorts, respectively. The combined model also showed better performance than models built with radiomic or clinical variables alone.ConclusionOur combined predictive model was robust in differentiating patients with and without response to nCRT.

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“…A successful watch-and-wait approach relies on a high correlation between cCR and pCR. In the pre-TNT era, the identification of the predictors of pCR after neoadjuvant therapy had been well studied and predictors included tumor size, circumferential extent, the pre-therapeutic T and N clinical stage, tumor fixation, and the distance of the tumor from the anal margin [25][26][27][28][29]. The last meta-analysis to assess the summative evidence on this important treatment decision point predates the acceptance and dissemination of TNT strategies.…”

Section: Introductionmentioning

confidence: 99%

The Predictors of Complete Pathologic Response in Rectal Cancer during the Total Neoadjuvant Therapy Era: A Systematic Review

Flom,

Schultz,

Pantel

et al. 2023

Cancers

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The modern rectal cancer treatment paradigm offers additional opportunities for organ preservation, most notably via total neoadjuvant therapy (TNT) and consideration for a watch-and-wait (WW) surveillance-only approach. A major barrier to widespread implementation of a WW approach to rectal cancer is the potential discordance between a clinical complete response (cCR) and a pathologic complete response (pCR). In the pre-TNT era, the identification of predictors of pCR after neoadjuvant therapy had been previously studied. However, the last meta-analysis to assess the summative evidence on this important treatment decision point predates the acceptance and dissemination of TNT strategies. The purpose of this systematic review was to assess preoperative predictors of pCR after TNT to guide the ideal selection criteria for WW in the current era. An exhaustive literature review was performed and the electronic databases Embase, Ovid, MEDLINE, PubMed, and Cochrane were comprehensively searched up to 27 June 2023. Search terms and their combinations included “rectal neoplasms”, “total neoadjuvant therapy”, and “pathologic complete response”. Only studies in English were included. Randomized clinical trials or prospective/retrospective cohort studies of patients with clinical stage 2 or 3 rectal adenocarcinoma who underwent at least 8 weeks of neoadjuvant chemotherapy in addition to chemoradiotherapy with pCR as a measured study outcome were included. In this systematic review, nine studies were reviewed for characteristics positively or negatively associated with pCR or tumor response after TNT. The results were qualitatively grouped into four categories: (1) biochemical factors; (2) clinical factors; (3) patient demographics; and (4) treatment sequence for TNT. The heterogeneity of studies precluded meta-analysis. The level of evidence was low to very low. There is minimal data to support any clinicopathologic factors that either have a negative or positive relationship to pCR and tumor response after TNT. Additional data from long-term trials using TNT is critical to better inform those considering WW approaches following a cCR.

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Predictive factors associated with complete pathological response after neoadjuvant treatment for rectal cancer

Cited by 5 publications

References 40 publications

Total Neoadjuvant Therapy Is a Predictor for Complete Pathological Response in Patients Undergoing Surgery for Rectal Cancer

Total Neoadjuvant Therapy Is a Predictor for Complete Pathological Response in Patients Undergoing Surgery for Rectal Cancer

Pre-Treatment Computed Tomography Radiomics for Predicting the Response to Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer: A Retrospective Study

The Predictors of Complete Pathologic Response in Rectal Cancer during the Total Neoadjuvant Therapy Era: A Systematic Review

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