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. 2022 Dec;26(12):2579-2584.
doi: 10.1007/s11605-022-05463-1. Epub 2022 Oct 12.

Total Neoadjuvant Therapy Is a Predictor for Complete Pathological Response in Patients Undergoing Surgery for Rectal Cancer

Nir Horesh  1   2 , Michael R Freund  1   3 , Zoe Garoufalia  1 , Rachel Gefen  1 , Arun Nagarajan  4 , Eva Suarez  5 , Sameh Hany Emile  1   6 , Steven D Wexner  7
Affiliations

Total Neoadjuvant Therapy Is a Predictor for Complete Pathological Response in Patients Undergoing Surgery for Rectal Cancer

Nir Horesh et al. J Gastrointest Surg. 2022 Dec.

Abstract

Introduction: Total neoadjuvant therapy (TNT) is a new therapeutic strategy in patients with rectal cancer. We examined the role of TNT, in addition to other pre-operative factors, as a predictor for pathologic complete response (pCR).

Methods: A retrospective analysis of all rectal cancer patients who underwent surgery between 2016 and 2021 was conducted. Patients were classified into two groups-pCR group and residual tumor group. Patient data were reviewed and entered into univariate and multivariate analyses to determine predictors of pCR.

Results: A total of 172 patients were treated with neoadjuvant therapy and underwent surgery during the study period. Sixty patients (34.9%) were treated with TNT while 112 (65.1%) were treated with traditional neoadjuvant chemoradiation. The overall pCR rate was 25.6% (44 patients), with 31.6% (19 patients) in patients who received TNT compared to 22.3% (25 patients) in patients who received neoadjuvant chemoradiation (NCRT). Univariate analysis of clinical and radiological factors correlated with pCR demonstrated no significant differences between the two groups in cT stage (p = 0.46), cN stage (p = 0.52), positive circumferential resection margin (CRM) (p = 0.72), tumor location (p = 0.35), symptomatic presentation (p = 0.09), and anal sphincter involvement (p = 0.68). Multivariate logistic analysis demonstrated that only pre-operative TNT (OR:2.35; 95% CI 1.06-5.25; p = 0.03) was predictive of pCR, while extramural vascular invasion (EMVI) was a predictor for lower rates of pCR (OR: 0.28; 95% CI 0.09-0.9; p = 0.03).

Conclusion: Rectal cancer patients undergoing TNT prior to surgery have a higher chance of developing a complete pathologic response. Evaluation of this therapy should be continued and extended to larger numbers of patients to see if the differences we observed are real.

Keywords: Pathology; Rectal cancer; Surgery; Total neoadjuvant therapy.

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Conflict of interest statement

SDW is a consultant for ICON Language Services, Intuitive Surgical, Stryker, Medtronic, Takeda, ARC/Corvus, Baxter, LivsMed, GI Supply, and Leading BioSciences/PalisadeBio; and receives royalties from Medtronic, Intuitive Surgical, Karl Storz Endoscopy America Inc., and Unique Surgical Innovations LLC. All other authors have no conflicts of interest.

Figures

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Fig. 1
Study flow chart
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References

    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA: a Cancer Journal for Clinicians. 2020;70(1):70:7–30. - PubMed
    1. Cercek A, Roxburgh CSD, Strombom P, et al. Adoption of total neoadjuvant therapy for locally advanced rectal cancer. JAMA Oncology. 2018;4:e180071. doi: 10.1001/jamaoncol.2018.0071. - DOI - PMC - PubMed
    1. Riesco-Martinez MC, Fernandez-Martos C, et al. Impact of total neoadjuvant therapy vs. Standard chemoradiotherapy in locally advanced rectal cancer: A systematic review and meta-analysis of randomized trials. Cancers. 2020;12:3655. doi: 10.3390/cancers12123655. - DOI - PMC - PubMed
    1. Coppola F, Giannini V, Gabelloni M, et al. Radiomics and magnetic resonance imaging of rectal cancer: From engineering to clinical practice. Diagnostics. 2021;11:756. doi: 10.3390/diagnostics11050756. - DOI - PMC - PubMed
    1. Reginelli A, Clemente A, Sangiovanni A, et al. Endorectal ultrasound and magnetic resonance imaging for rectal cancer staging: A modern multimodality approach. J Clin Med. 2021;10:641. doi: 10.3390/jcm10040641. - DOI - PMC - PubMed