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Signet ring cell component in pretreatment biopsy predicts pathological response to preoperative chemoradiotherapy in rectal cancer

  • Original Article
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Abstract

Purpose

Neoadjuvant therapy is routinely used in the management of locally advanced rectal cancer. This study aimed to evaluate the predictive value of pathological parameters in tumor response after treatment.

Methods

We reviewed the hematoxylin–eosin slides from pretreatment biopsies of 150 rectal cancer patients who received preoperative chemoradiotherapy (PCRT) at Sun Yat-sen University Cancer Center between May 2013 and June 2016. Pathological and clinical parameters were both studied. The tumor response after chemoradiotherapy was evaluated using the tumor regression grade (TRG). Logistic regression was used to evaluate the relevance between these parameters and tumor response.

Results

Complete tumor response (TRG0 and pCR) to PCRT was identified in 40 (26.7%) patients. The pCR rate was 93.33% (14 of 15) in cases with signet ring cell component versus 19.26% (26 of 135) in those without signet ring cell component (p < 0.001). Four cases with signet ring cell component were evaluated as clinical complete response (cCR), all of whom also achieved pCR; in contrast, only 9 of 15 (60%) cCR cases without signet ring cell achieved pCR.

Conclusion

Our data suggest that the signet ring cell component in pretreatment biopsies may be a potential predictor of tumor response to PCRT in rectal cancer. This suggests patients with clinical complete response are more suitable for a wait-and-watch approach.

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Data Availability

The authenticity of this article has been validated by uploading the key raw data onto the Research Data Deposit public platform (www.researchdata.org.cn), with the approval RDD number as RDDA2020001420.

Abbreviations

PCRT:

Preoperative chemoradiotherapy

TRG:

Tumor regression grade

pCR:

Pathological complete response

SRCC:

Signet ring cell cancer

PDCs:

Poorly differentiated clusters

CEA:

Carcinoembryonic antigen

CA-199:

Carbohydrate antigen-199

CT:

Computerized tomography

MRI:

Magnetic resonance imaging

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Acknowledgements

We thank all the patients who participated in this study and for their willingness to contribute valuable data for this manuscript.

Funding

This work was supported by grants from the Natural Science Foundation of China (81802942).

Author information

Authors and Affiliations

Authors

Contributions

Conception and design: JPY; administrative support: HZZ; provision of study materials or patients: SXL, YHH, PRD; collection and assembly of data: XC, ZXW, SBZ; data analysis and interpretation: XC, ZXW; manuscript writing: all authors; final approval of manuscript: all authors.

Corresponding authors

Correspondence to Huizhong Zhang or Jingping Yun.

Ethics declarations

Conflict of interest

There are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.

Ethical approval

The study was approved by the ethics committee of the Sun Yat-sen University Cancer Center.

Informed consent

All patients were systemically asked consent to the use of anonymous data for analysis and publication.

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Electronic supplementary material

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Supplemental Fig. 1

(A) shows the intral-tumor tumor budding. (B) shows the poorly differentiated clusters. Supplementary material 1 (TIFF 1524 kb)

Supplemental Fig. 2

The disease-free survival curve of signet ring cell (SRC) and non-SRC group. Supplementary material 2 (TIFF 40 kb)

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Chao, X., Wang, Z., Lu, S. et al. Signet ring cell component in pretreatment biopsy predicts pathological response to preoperative chemoradiotherapy in rectal cancer. Int J Clin Oncol 25, 1653–1662 (2020). https://doi.org/10.1007/s10147-020-01697-8

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  • DOI: https://doi.org/10.1007/s10147-020-01697-8

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