Response to neoadjuvant treatment among rectal cancer patients in a population-based cohort
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ORIGINAL ARTICLE
Response to neoadjuvant treatment among rectal cancer patients in a population-based cohort Elizabeth Alwers 1 & Lina Jansen 1 & Jakob Kather 2 & Efrat Amitay 1 & Hendrik Bläker 3 & Matthias Kloor 4 & Katrin E. Tagscherer 5,6 & Wilfried Roth 5,6 & Esther Herpel 5,7 & Jenny Chang-Claude 8,9 & Hermann Brenner 1,10,11 & Michael Hoffmeister 1 Accepted: 8 September 2020 # The Author(s) 2020
Abstract Background In rectal cancer, prediction of tumor response and pathological complete response (pCR) to neoadjuvant treatment could contribute to refine selection of patients who might benefit from a delayed- or no-surgery approach. The aim of this study was to explore the association of clinical and molecular characteristics of rectal cancer with response to neoadjuvant treatment and to compare patient survival according to level of response. Methods Resected rectal cancer patients were selected from a population-based cohort study. Molecular tumor markers were determined from the surgical specimen. Tumor response and pCR were defined as downstaging in T or N stage and absence of tumor cells upon pathological examination, respectively. The associations of patient and tumor characteristics with tumor response and pCR were explored, and patient survival was determined by degree of response to neoadjuvant treatment. Results Among 1536 patients with rectal cancer, 602 (39%) received neoadjuvant treatment. Fifty-five (9%) patients presented pCR, and 239 (49%) and 250 (53%) patients showed downstaging of the T and N stages, respectively. No statistically significant associations were observed between patient or tumor characteristics and tumor response or pCR. Patients who presented any type of response to neoadjuvant treatment had significantly better cancer-specific and overall survival compared with non-responders. Conclusion In this study, patient characteristics were not associated with response to neoadjuvant treatment, and molecular characteristics determined after surgical resection of the tumor were not predictive of pCR or tumor downstaging. Future studies should include molecular biomarkers from biopsy samples before neoadjuvant treatment. Keywords Rectal cancer . Neoadjuvant treatment . Response to treatment . Pathological complete response
Introduction Neoadjuvant treatment is recommended for patients with locally advanced rectal cancer, usually including chemo-/radiotherapy (nCRT) followed by surgical resection [1]. The surgical approach, including abdominoperineal resection and total mesorectal excision, yields good local control and prognosis; Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00384-020-03744-2) contains supplementary material, which is available to authorized users. * Elizabeth Alwers [email protected] Extended author information available on the last page of the article
however, it is also associated with significant peri-operative morbidity, including bowel, sexual and urinary dysfunctions [2], and a permanent colostomy in som
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