Guo Su-Ping, Chen Chen, Zeng Zhi-Fan, Wang Qiao-Xuan, Jiang Wu, Gao Yuan-Hong, Chang Hui
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.
Cancer Manag Res. 2021 Mar 18;13:2623-2631. doi: 10.2147/CMAR.S302677. eCollection 2021.
Serum lipids have been reported as prognosticators for malignancies, including rectal cancer (RC). Yet, their value in predicting the response of RC to neoadjuvant chemoradiotherapy (NACRT) remains unknown. This study aimed to assess the predictive abilities of serum lipids for a bad response, and to build a serum lipid-based prediction model.
In total, 751 patients diagnosed with stage cII-III RC and treated with NACRT plus surgery from January 2007 to August 2018 were retrospectively reviewed and randomly divided into two data sets, in a ratio of 1:1. Receiver operating characteristics (ROC) analysis was conducted in the development set to select possible predictors of bad NACRT response from pathoclinical factors, including serum lipids. Multivariate logistic regression was conducted to further determine independent predictors, which were then used to develop a prediction index (PI). Finally, the PI was verified in the validation set, through ROC analysis and chi-squared test.
Five independent predictors were identified: tumor length ≥4 cm, cT4 stage, carcinoembryonic antigen ≥5.0 ng/mL, irradiation with three-dimensional conformal radiotherapy technique, and apolipoprotein A-I ≤1.20 g/L. Each of them was assigned a number of points. In the validation set, the area under the curve of PI appeared as 0.642 (95% confidence interval 0.586-0.697). The sensitivity, specificity, positive and negative predictive values, and concordance were 72.3%, 52.3%, 63.8%, 61.9%, and 63.0%, respectively.
Serum apolipoprotein A-I was found to correlate negatively with the RC response to NACRT. It could serve as a biomarker for guiding individualized treatment and a potential target for improving sensitivity to chemoradiation.
血清脂质已被报道为包括直肠癌（RC）在内的恶性肿瘤的预后指标。然而，它们在预测RC对新辅助放化疗（NACRT）反应方面的价值仍不清楚。本研究旨在评估血清脂质对不良反应的预测能力，并建立基于血清脂质的预测模型。
回顾性分析2007年1月至2018年8月期间诊断为cII-III期RC并接受NACRT加手术治疗的751例患者，并按1:1的比例随机分为两个数据集。在开发集中进行受试者操作特征（ROC）分析，以从包括血清脂质在内的病理临床因素中选择NACRT不良反应的可能预测指标。进行多变量逻辑回归以进一步确定独立预测指标，然后用于建立预测指数（PI）。最后，通过ROC分析和卡方检验在验证集中验证PI。
确定了五个独立预测指标：肿瘤长度≥4 cm、cT4期、癌胚抗原≥5.0 ng/mL、采用三维适形放疗技术以及载脂蛋白A-I≤1.20 g/L。每个指标都被赋予一定分数。在验证集中，PI的曲线下面积为0.642（95%置信区间0.586-0.697）。敏感性、特异性、阳性和阴性预测值以及一致性分别为72.3%、52.3%、63.8%、61.9%和63.0%。
发现血清载脂蛋白A-I与RC对NACRT的反应呈负相关。它可以作为指导个体化治疗的生物标志物以及提高对放化疗敏感性的潜在靶点。
