Prognostic Significance of Serum Biomarkers in Rectal Cancer Patients Treated with Neoadjuvant Radiotherapy Followed by Radical Surgery

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type:TOHO University Scholarly Publication

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Background: The identification of predictive prognostic factors in locally-advanced rectal cancer patients is crucial before surgery. In this study, we aimed to evaluate the prognostic significance of pretreatment with various serum biomarkers in locally-advanced rectal cancer patients treated with neoadjuvant radiotherapy followed by radical surgery. Methods: A total of 154 locally-advanced rectal cancer patients who received preoperative radiotherapy or chemoradiation followed by total mesorectal excision at the Toranomon Hospital, Tokyo from April 2010 to December 2015 were retrospectively analyzed to evaluate prognostic variables. Various blood tests, neutrophil-to-lymphocyte ratio (NLR), modified Glasgow Prognostic Score (mGPS), and serum albumin, C-reactive protein (CRP), carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and serum p53 antibodies (s-p53-Abs) levels were evaluated before surgery for their prognostic impact. Relapse-free survival (RFS) was evaluated by the Kaplan-Meier method and differences were assessed using the log-rank test. The Cox proportional hazard model was used to assess independent predictors for RFS. Results: While age, tumor distance from anal verge, CA19-9, and ypT stage were associated with RFS, inflammation and nutritional status such as NLR and mGPS were not. Based on multivariate analyses, patients with a shorter tumor distance from anal verge, higher CA19-9 levels and advanced ypT stage had poorer RFS. Adjuvant chemotherapy in patients with elevated CA19-9 levels demonstrated a trend toward improved RFS, although this was statistically insignificant. Conclusions: Although neither inflammation scores nor nutritional status such as NLR and mGPS were prognostic factors, serum CA19-9 level was found to be an independent prognostic predictor of RFS

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