Department of Surgery, Ajou University School of Medicine, Suwon 16499, Gyeonggi-do, South Korea.
World J Gastroenterol. 2020 Nov 28;26(44):7022-7035. doi: 10.3748/wjg.v26.i44.7022.
Preoperative chemoradiotherapy (CRT) is a standard treatment modality for locally advanced rectal cancer. However, CRT alone cannot improve overall survival. Approximately 20% of patients with CRT-resistant tumors show disease progression. Therefore, predictive factors for treatment response are needed to identify patients who will benefit from CRT. We theorized that the prognosis may vary if patients are classified according to pre- to post-CRT changes in carcinoembryonic antigen (CEA) levels.
To identify patients with locally advanced rectal cancer for preoperative chemoradiotherapy based on carcinoembryonic antigen levels.
We retrospectively included locally advanced rectal cancer patients who underwent preoperative CRT and curative resection between 2011 and 2017. Patients were assigned to groups A, B, and C based on pre- and post-CRT serum CEA levels: Both > 5; pre > 5 and post ≤ 5; and both ≤ 5 ng/mL, respectively. We compared the response to CRT based on changes in serum CEA levels. Receiver operating characteristic curve analysis was performed to determine optimal cutoff for neutrophil-lymphocyte ratio and platelet-lymphocyte ratio. Multivariate logistic regression analysis was used to evaluate the prognostic factors for pathologic complete response (pCR)/good response.
The cohort comprised 145 patients; of them, 27, 43, and 65 belonged to groups A, B, and C, respectively, according to changes in serum CEA levels before and after CRT. Pre- ( < 0.001) and post-CRT ( < 0.001) CEA levels and the ratio of down-staging ( = 0.013) were higher in Groups B and C than in Group A. The ratio of pathologic tumor regression grade 0/1 significantly differed among the groups ( 0.003). Group C had the highest number of patients showing pCR ( < 0.001). Most patients with pCR showed pre- and post-CRT CEA levels < 5 ng/mL ( < 0.001, = 0.008). Pre- and post-CRT CEA levels were important risk factors for pCR (OR = 18.71; 95%CI: 4.62-129.51, < 0.001) and good response (OR = 5.07; 95%CI: 1.92-14.83, = 0.002), respectively. Pre-CRT neutrophil-lymphocyte ratio and post-CRT T ≥ 3 stage were also prognostic factors for pCR or good response.
Pre- and post-CRT CEA levels, as well as change in CEA levels, were prognostic markers for treatment response to CRT and may facilitate treatment individualization for rectal cancer.
术前放化疗（CRT）是局部晚期直肠癌的标准治疗方法。然而，单独的 CRT 并不能提高总生存率。大约 20%的 CRT 耐药肿瘤患者出现疾病进展。因此，需要预测治疗反应的因素来识别将从 CRT 中受益的患者。我们推测，如果根据术前至 CRT 后癌胚抗原（CEA）水平的变化对患者进行分类，预后可能会有所不同。
根据癌胚抗原水平确定接受术前 CRT 的局部晚期直肠癌患者。
我们回顾性纳入了 2011 年至 2017 年间接受术前 CRT 和根治性切除术的局部晚期直肠癌患者。根据术前和术后血清 CEA 水平，患者被分为 A、B 和 C 组：均>5ng/ml；前>5ng/ml 且后≤5ng/ml；以及均≤5ng/ml。我们比较了基于血清 CEA 水平变化的 CRT 反应。进行受试者工作特征曲线分析以确定中性粒细胞-淋巴细胞比值和血小板-淋巴细胞比值的最佳截断值。使用多变量逻辑回归分析评估病理完全缓解（pCR）/良好反应的预后因素。
该队列包括 145 名患者；其中，27、43 和 65 名患者分别根据 CRT 前后血清 CEA 水平的变化属于 A、B 和 C 组。术前（<0.001）和术后（<0.001）CEA 水平以及降期比例（=0.013）在 B 组和 C 组中更高。各组的病理肿瘤消退分级 0/1 比例差异有统计学意义（<0.001）。C 组中 pCR 患者比例最高（<0.001）。大多数 pCR 患者术前和术后 CEA 水平<5ng/ml（<0.001，=0.008）。术前和术后 CEA 水平是 pCR（OR=18.71；95%CI：4.62-129.51，<0.001）和良好反应（OR=5.07；95%CI：1.92-14.83，=0.002）的重要危险因素。术前中性粒细胞-淋巴细胞比值和术后 T≥3 期也是 pCR 或良好反应的预后因素。
术前和术后 CEA 水平以及 CEA 水平的变化是 CRT 治疗反应的预后标志物，可能有助于直肠癌的个体化治疗。
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