Predictive factors of pathological complete response after neoadjuvant therapy for locally advanced rectal cancer

doi:10.16139/j.1007-9610.2025.01.09

Abstract

Abstract:

Objective To analyze the tumor characteristics associated with achieving pathological complete response(pCR) and tumor prognosis in the patients undergoing laparoscopic rectal cancer surgery after neoadjuvant chemoradiotherapy(nCRT). Methods A retrospective review was conducted on clinical and pathological data of locally advanced rectal cancer(LARC) patients who underwent nCRT at Renji Hospital from January 2017 to January 2024. Factors influencing the achievement of pCR were analyzed, and the patients prognosis of pCR group and non-pCR group was compared. Results Univariate analysis, multivariate Logistic regression analysis, and receiver operating characteristic (ROC) curve analysis showed that tumor length less than 5 cm(cutoff value 5.24 cm) and baseline carcinoembryonic antigen(CEA) less than 5 μg/L(cutoff value 5.33 μg/L) were independent predictors of achieving pCR after nCRT in LARC patients. Prognostic survival analysis showed that the 3-year overall survival(OS) rate for pCR group and non-pCR group were 92.86% and 82.46%, respectively (P=0.193), and the 3-year disease-free survival (DFS) rate were 85.71% and 70.18%, respectively (P=0.141), with no statistically significant differences between the two groups. Conclusions Tumor length and baseline CEA level are independent predictors for achieving pCR after nCRT in LARC patients. Additionally, there were no statistically significant differences in 3-year OS and DFS between pCR group and non-pCR group.

Key words: Locally advanced rectal cancer(LARC), Neoadjuvant chemoradiotherapy(nCRT), Pathological complete response(pCR), Watch and wait(W&W), Prognosis

CLC Number:

R735.37

LI Hao, LUO Yang, WANG Tingfeng, LIN Haiping, GONG Tingyue, ZHAO Yongheng, ZHONG Ming. Predictive factors of pathological complete response after neoadjuvant therapy for locally advanced rectal cancer[J]. Journal of Surgery Concepts & Practice, 2025, 30(01): 47-53.

Figures/Tables 4

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References 28

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Characteristics	Total(n=131)	pCR (n=24)	Non-pCR (n=107)	P value
Age (years)				0.154
<60	54 (41.22)	13 (54.17)	41 (38.32)
≥60	77 (58.78)	11 (45.83)	66 (61.68)
Gender				0.088
Male	104 (79.39)	16 (66.67)	88 (82.24)
Female	27 (20.61)	8 (33.33)	19 (17.76)
BMI(kg/m²)				0.303
<24	103 (78.63)	17 (70.83)	86 (80.37)
≥24	28 (21.37)	7 (29.17)	21 (19.63)
Baseline T stage				0.673
T3	55 (41.98)	11 (45.83)	44 (41.12)
T4	76 (58.02)	13 (54.17)	63 (58.88)
Baseline N stage				0.895
N0	23 (17.56)	5 (20.83)	18 (16.82)
N1	29 (22.14)	5 (20.83)	24 (22.43)
N3	79 (60.31)	14 (58.33)	65 (60.75)
Distance between tumor and anal border (cm)				0.111
<5	47 (35.88)	12 (50.00)	35 (32.71)
≥5	84 (64.12)	12 (50.00)	72 (67.29)
Tumor length (cm)				0.015
<5	58 (44.27)	16 (66.67)	42 (39.25)
≥5	73 (55.73)	8 (33.33)	65 (60.75)
Proportion of tumor in enteric cavity				0.049
≤1/2	48 (36.64)	13 (54.17)	35 (32.71)
>1/2	83 (63.36)	11 (45.83)	72 (67.29)
Baseline CEA level (μg/L)				0.024
<5	55 (41.98)	15 (62.50)	40 (37.38)
≥5	76 (58.02)	9 (37.50)	67 (62.62)
Baseline CA19-9 level (kU/L)				0.280
<27	73 (55.73)	11 (45.83)	62 (57.94)
≥27	58 (44.27)	13 (54.17)	45 (42.06)
Preoperative CEA level (μg/L)				0.077
<5	99 (75.57)	22 (91.67)	77 (71.76)
≥5	32 (24.43)	2 (8.33)	30 (28.04)
Preoperative CA19-9 level (kU/L)				0.205
<27	114 (87.02)	19 (79.17)	95 (88.79)
≥27	17 (12.98)	5 (20.83)	12 (11.21)
Operation				0.942
Low anterior resection	99 (75.57)	18 (75.00)	81 (75.70)
Abdominoperineal resection	32 (24.43)	6 (25.00)	26 (24.30)
Degree of differentiation				0.387
Poorly	19 (14.50)	4 (16.67)	15 (14.02)
Moderately	95 (72.52)	15 (62.50)	80 (74.77)
Well	17 (12.98)	5 (20.83)	12 (11.21)

	β	SE	Wald	P value	OR（95%CI）
Tumor length(cm)	0.529	0.265 9	3.955	0.047	0.347(0.122-0.985)
Proportion of tumor in enteric cavity	0.167	0.259 6	0.411	0.521	0.717(0.259-1.983)
Baseline CEA level (μg/L)	0.520	0.244 0	4.549	0.033	0.353(0.136-0.919)