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Competing-Risk Nomogram for Predicting Cancer-Specific Survival in Multiple Primary Colorectal Cancer Patients after Surgery
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Predicting Factors of Complete Pathological Response in Locally Advanced Rectal Cancer.

AmirHossein Latif1,2, Mohammad Shirkhoda2, Mohammad Reza Rouhollahi2

  • 1Department of General Surgery, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Middle East Journal of Digestive Diseases
|August 7, 2023
PubMed
Summary

Predicting complete pathological response (cPR) in rectal cancer patients after neoadjuvant chemoradiotherapy (neo-CRT) is key. Lower tumor stage, no lymph node involvement, lower CEA, and longer wait times after neo-CRT improve cPR chances.

Keywords:
Complete pathologic responseIranNeoadjuvant chemoradiotherapyRectal cancerWait and watch policy

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Area of Science:

  • Oncology
  • Gastroenterology
  • Surgical Oncology

Background:

  • Locally advanced rectal cancer (LARC) treatment typically involves neoadjuvant chemoradiotherapy (neo-CRT), surgery, and adjuvant chemotherapy.
  • Complete pathological response (cPR) after neo-CRT is a significant prognostic factor, but predictors remain debated.
  • Understanding cPR predictors can optimize treatment strategies and patient selection.

Purpose of the Study:

  • To identify predictive factors for achieving complete pathological response (cPR) in patients with locally advanced rectal cancer treated with neo-CRT.
  • To analyze the association between clinical and treatment-related variables and cPR.
  • To inform future treatment decisions and potentially refine the 'wait and watch' approach.

Main Methods:

  • Retrospective cohort study of 258 patients with locally advanced rectal cancer.
  • Patients were grouped based on the achievement of cPR post-neo-CRT.
  • Logistic regression analysis, including multivariate analysis, was used to identify significant predictors of cPR.

Main Results:

  • The overall cPR rate was 21.3%.
  • Factors associated with lower cPR included tumors >10 cm from the anal verge, N1/N2 lymph node involvement, and higher carcinoembryonic antigen (CEA) levels.
  • A longer interval (>12 weeks) between neo-CRT and surgery was significantly associated with a higher likelihood of achieving cPR.

Conclusions:

  • Patients with lower clinical stage (II or lower), no lymph node involvement, lower CEA levels, and tumors in the lower rectum are more likely to achieve cPR.
  • A longer delay between neo-CRT and surgery appears to increase the odds of cPR.
  • Further research is needed to precisely define the 'wait and watch' policy based on these predictive factors.