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Predictive Value of Flexible Proctosigmoidoscopy and Laboratory Findings for Complete Clinical Responses After Neoadjuvant Chemoradiotherapy in Patients With Locally Advanced Primary Rectal Cancer: A Retrospective Cohort Study Publisher Pubmed



Hadizadeh A1 ; Kazemikhaledi H1, 2 ; Fazeli MS1, 2 ; Ahmaditafti SM1, 2 ; Keshvari A1, 2 ; Akbariasbagh R2, 3 ; Keramati MR1, 2 ; Kazemeini A1, 2 ; Fazeli AR1, 2 ; Behboudi B1, 2 ; Parsaei M4
Authors
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Authors Affiliations
  1. 1. Colorectal Research Center, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Division of Colorectal Surgery, Department of Surgery, Tehran University of Medical Sciences, Tehan, 1419733141, Iran
  3. 3. Research Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Research Institute, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Maternal, Fetal & amp
  5. 5. Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran

Source: International Journal of Colorectal Disease Published:2024


Abstract

Purpose: Colorectal cancer is the second leading cause of cancer death worldwide. Standard treatments for locally advanced rectal cancer include neoadjuvant chemoradiotherapy and total mesorectal excision (TME), which are associated with significant morbidity. After neoadjuvant therapy, one-third of patients achieve a pathological complete response (pCR) and are eligible for a watch-and-wait approach without TME. The purpose of this study was to determine the potential predictors of pCR before surgery. Methods: The demographic, clinical, and endoscopic data of 119 patients with primary locally advanced rectal cancer without distant metastasis who underwent restaging endoscopy and TME 6–8 weeks after the end of neoadjuvant therapy were collected. The absence of tumor cells in the histological examination of the TME specimen after neoadjuvant therapy was considered pCR. Binary logistic regression and receiver operating characteristic curves were utilized for analysis. Results: According to the multivariate logistic regression analysis, flattening of marginal tumor swelling (p value < 0.001, odds ratio = 100.605) emerged as an independent predictor of pCR in rectal cancer patients. Additionally, receiver operating characteristic curve analysis revealed that lower preoperative carcinoembryonic antigen and erythrocyte sedimentation rate levels predict pCR, with cutoffs of 2.15 ng/ml and 19.0 mm/h, respectively. Conclusion: Carcinoembryonic antigen and erythrocyte sedimentation rate, along with the presence of flattening of marginal tumor swelling, can predict pCR after neoadjuvant chemoradiotherapy in patients with primary rectal cancer. These factors offer a potential method for selecting candidates for conservative treatment based on endoscopic and laboratory findings. © The Author(s) 2024.
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