Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Oct 15, 2022; 14(10): 2014-2024
Published online Oct 15, 2022. doi: 10.4251/wjgo.v14.i10.2014
Predictive value of a serum tumor biomarkers scoring system for clinical stage II/III rectal cancer with neoadjuvant chemoradiotherapy
Jie-Yi Zhao, Qing-Qing Tang, Yu-Ting Luo, Shu-Min Wang, Xiao-Rui Zhu, Xiao-Yu Wang
Jie-Yi Zhao, Xiao-Yu Wang, Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Qing-Qing Tang, Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Yu-Ting Luo, Shu-Min Wang, Xiao-Rui Zhu, West China Medical School, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Zhao JY and Wang XY designed the research and wrote the manuscript; Tang QQ and Luo YT analyzed the data; Wang SM and Zhu XR performed data extraction; all authors have read and approved the final version.
Institutional review board statement: This study was reviewed and approved by the West China hospital, Sichuan University Institutional Review Board, Approval No. 2020.18.
Informed consent statement: The requirement for patients’ informed consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: All author reports no conflict of interest.
Data sharing statement: Anyone who wants the data can connect to the corresponding author (yuxixi1052006@126.com).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Yu Wang, MD, Doctor, Department of Neurosurgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China. yuxixi1052006@126.com
Received: June 8, 2022
Peer-review started: June 8, 2022
First decision: June 23, 2022
Revised: July 6, 2022
Accepted: August 22, 2022
Article in press: August 22, 2022
Published online: October 15, 2022
Processing time: 128 Days and 6.9 Hours
Abstract
BACKGROUND

Multiple classes of molecular biomarkers have been studied as potential predictors for rectal cancer (RC) response. Carcinoembryonic antigen (CEA) is the most widely used blood-based marker of RC and has proven to be an effective predictive marker. Cancer antigen 19-9 (CA19-9) is another tumor biomarker used for RC diagnosis and postoperative monitoring, as well as monitoring of the therapeutic effect. Using a panel of tumor markers for RC outcome prediction is a practical approach.

AIM

To assess the predictive effect of pre-neoadjuvant chemoradiotherapy (NCRT) CEA and CA19-9 levels on the prognosis of stage II/III RC patients.

METHODS

CEA and CA19-9 levels were evaluated 1 wk before NCRT. According to the receiver operating characteristic curve analysis, the optimal cut-off point of CEA and CA19-9 levels for the prognosis were 3.55 and 19.01, respectively. The novel serum tumor biomarker (NSTB) scores were as follows: score 0: Pre-NCRT CEA < 3.55 and CA19-9 < 19.01; score 2: Pre-NCRT CEA > 3.55 and CA19-9 > 19.01; score 1: Other situations. Pathological information was recorded according to histopathological reports after the operation.

RESULTS

In the univariate analysis, pre-NCRT CEA < 3.55 [P = 0.025 for overall survival (OS), P = 0.019 for disease-free survival (DFS)], pre-NCRT CA19-9 < 19.01 (P = 0.014 for OS, P = 0.009 for DFS), a lower NSTB score (0-1 vs 2, P = 0.009 for OS, P = 0.005 for DFS) could predict a better prognosis. However, in the multivariate analysis, only a lower NSTB score (0-1 vs 2; for OS, HR = 0.485, 95%CI: 0.251-0.940, P = 0.032; for DFS, HR = 0.453, 95%CI: 0.234-0.877, P = 0.019) and higher pathological grade, node and metastasis stage (0-I vs II-III; for OS, HR = 0.363, 95%CI: 0.158-0.837, P = 0.017; for DFS, HR = 0.342, 95%CI: 0.149-0.786, P = 0.012) were independent predictive factors.

CONCLUSION

The combination of post-NCRT CEA and CA19-9 was a predictive factor for clinical stage II/III RC patients receiving NCRT, and the combined index had a stronger predictive effect.

Keywords: Rectal cancer; Neoadjuvant chemoradiotherapy; Scoring system; Carcinoembryonic antigen; Carbohydrate antigen 19-9; Predictive

Core Tip: Tumor microenvironment (TME) combined with neoadjuvant chemotherapy (NCRT) is the standard treatment for resectable stage II/III rectal cancer (RC). Multiple classes of molecular biomarkers have been studied as potential predictors for RC response but there is no sufficient evidence for any of them to be introduced into clinical practice. By retrospectively evaluating clinical stage II/III RC patients undergoing NCRT followed by standard TME, we found that the combination of NCRT carcinoembryonic antigen and carbohydrate antigen 19-9 levels could be a prognostic predictor for clinical stage II/III RC patients receiving NCRT, and the combined indexes had a stronger predictive effect than the index alone.