Aires Fátima, Rodrigues Darlene, Lamas María Piñeiro, Herdeiro Maria Teresa, Figueiras Adolfo, Oliveira Maria José, Marques Margarida, Pinto Ana Teresa
Radiotherapy Department of Centro Hospitalar Universitário de São João (CHUSJ), 4200-319 Porto, Portugal.
ICBAS-Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4050-313 Porto, Portugal.
Cancers (Basel). 2022 Jan 19;14(3):491. doi: 10.3390/cancers14030491.
The standard of care for the treatment of locally advanced rectal cancer is neoadjuvant chemoradiotherapy (nCRT) followed by surgery, but complete response rates are reduced. To find predictive biomarkers of response to therapy, we conducted a retrospective study evaluating blood biomarkers before nCRT. Hemoglobin (Hg), C-reactive protein (CRP), platelets, carcinoembryonic antigen, carbohydrate antigen 19.9 levels, and neutrophil/lymphocyte ratio were obtained from 171 rectal cancer patients before nCRT. Patients were classified as responders (Ryan 0-1; ycT0N0), 59.6% ( = 102), or nonresponders (Ryan 2-3), 40.3% ( = 69), in accordance with the Ryan classification. A logistic regression using prognostic pretreatment factors identified CRP ≤ 3.5 (OR = 0.05; 95%CI: 0.01-0.21) as a strong independent predictor of response to treatment. Multivariate analysis showed that CRP was an independent predictor of disease-free survival (DFS) (HR = 5.48; 95%CI: 1.54-19.48) and overall survival (HR = 6.10; 95%CI 1.27-29.33) in patients treated with nCRT. Platelets were an independent predictor of DFS (HR = 3.068; 95%CI: 1.29-7.30) and OS (HR= 4.65; 95%CI: 1.66-13.05) and Hg was revealed to be an independent predictor of DFS (HR = 0.37; 95%CI: 0.15-0.90) in rectal cancer patients treated with nCRT. The lower expression of CRP is independently associated with an improved response to nCRT, DFS, and OS.
局部晚期直肠癌的标准治疗方案是新辅助放化疗（nCRT）后行手术，但完全缓解率有所降低。为了寻找治疗反应的预测生物标志物，我们进行了一项回顾性研究，评估nCRT前的血液生物标志物。在171例直肠癌患者nCRT前获取血红蛋白（Hg）、C反应蛋白（CRP）、血小板、癌胚抗原、糖类抗原19.9水平及中性粒细胞/淋巴细胞比值。根据Ryan分类，患者被分为反应者（Ryan 0 - 1；ycT0N0），占59.6%（n = 102），或无反应者（Ryan 2 - 3），占40.3%（n = 69）。使用预后预处理因素进行的逻辑回归分析确定CRP≤3.5（OR = 0.05；95%CI：0.01 - 0.21）是治疗反应的强有力独立预测因素。多变量分析显示，在接受nCRT治疗的患者中，CRP是无病生存期（DFS）（HR = 5.48；95%CI：1.54 - 19.48）和总生存期（OS）（HR = 6.10；95%CI 1.27 - 29.33）的独立预测因素。血小板是接受nCRT治疗的直肠癌患者DFS（HR = 3.068；95%CI：1.29 - 7.30）和OS（HR = 4.65；95%CI：1.66 - 13.05）的独立预测因素，且Hg被发现是接受nCRT治疗的直肠癌患者DFS（HR = 0.37；95%CI：0.15 - 0.90）的独立预测因素。CRP的低表达与对nCRT的反应改善、DFS和OS独立相关。
