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.
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.
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.
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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Tumor regression grade
Pathological complete response
Signet ring cell cancer
Poorly differentiated clusters
Magnetic resonance imaging
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We thank all the patients who participated in this study and for their willingness to contribute valuable data for this manuscript.
This work was supported by grants from the Natural Science Foundation of China (81802942).
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.
The study was approved by the ethics committee of the Sun Yat-sen University Cancer Center.
All patients were systemically asked consent to the use of anonymous data for analysis and publication.
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Electronic supplementary material
Below is the link to the electronic supplementary material.
(A) shows the intral-tumor tumor budding. (B) shows the poorly differentiated clusters. Supplementary material 1 (TIFF 1524 kb)
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 (2020). https://doi.org/10.1007/s10147-020-01697-8
- Signet ring cell cancer
- Preoperative chemoradiotherapy
- Tumor response