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Elevated CEA Levels and Low Distance of the Tumor from the Anal Verge are Predictors of Incomplete Response to Chemoradiation in Patients with Rectal Cancer

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

ABSTRACT

Background

The objective of this study was to evaluate pretreatment clinical parameters as predictive factors for complete pathological response after long-term chemoradiotherapy (RCT) for rectal cancer. Tumor downstaging after RCT for rectal cancer can be obtained in half of cases, whereas a complete pathological response (CPR) is reported to range between 15 and 30 %. It is not possible to foresee before therapies who will respond.

Methods

Patients with stage II–III rectal cancer that had undergone RCT and rectal resection between January 1995 and October 2010 were considered. Patients were divided in those who achieved a CPR, “CR” group, and those who did not achieve a CPR, “NCR” group. Univariate and multivariate analyses between groups were performed considering the clinical parameters: gender, age, ASA score, preoperative hematic CEA, tumor grading; distance of the tumor from the anal verge, maximum tumor diameter, TNM stage, and neoadjuvant treatment details.

Results

Among 260 patients, 43 (16.5 %) achieved a CPR. The two groups resulted homogeneous for age, sex, pretreatment status, and tumor stage. A CEA <5 ng/dl and distance from anal verge >5 cm were correlated with CPR at multivariate analysis. Patients with both these conditions presented a significantly higher CPR rate (30.6 %) as well as improved 5-year survival. CPR was also correlated with improved survival.

Conclusions

Very low tumors with a high serum CEA are very unlikely to reach a CPR. The predictive value of these easily available clinical factors should not be underestimated, and better therapeutic strategies for these tumors are needed.

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Authors and Affiliations

  1. Department of Surgery, Colorectal Surgery Center, University of Cagliari, Cagliari, Italy

    Angelo Restivo MD, Luigi Zorcolo MD, Ivana Maria Francesca Cocco MD, Romina Manunza MD, Carla Margiani MD, Luigi Marongiu MD & Giuseppe Casula MD

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Restivo, A., Zorcolo, L., Cocco, I.M.F. et al. Elevated CEA Levels and Low Distance of the Tumor from the Anal Verge are Predictors of Incomplete Response to Chemoradiation in Patients with Rectal Cancer. Ann Surg Oncol 20, 864–871 (2013). https://doi.org/10.1245/s10434-012-2669-8

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