title: Telomere-specific reverse transcriptase (hTERT) and cell-free RNA in plasma as predictors of pathologic tumor response in rectal cancer patients receiving neoadjuvant chemoradiotherapy.
abstract: OBJECTIVE
  To investigate whether the plasma levels of cell-free RNA (cfRNA) and telomere-specific reverse transcriptase mRNA (hTERT) are associated with tumor response in rectal cancer patients who received preoperative chemoradiotherapy (pCRT).
  
  
  METHODS
  Patients who underwent pCRT for rectal cancer and for whom baseline and paired post-pCRT blood samples were available were studied. On the basis of tumor regression score, patients were classified as having response or having no response. Clinical variables and plasma levels of cfRNA and hTERT before and after the pCRT were evaluated. The association between each predictor and tumor response was assessed by univariate and multivariate analyses.
  
  
  RESULTS
  Of 98 eligible patients, 45 were determined to respond to therapy, and 53 did not respond to therapy. In univariate analysis, gender (P = 0.040), baseline levels of cfRNA (P = 0.026), post-pCRT levels of both hTERT and cfRNA (P < 0.0001 and P = 0.001, respectively), and the difference between the post- and pre-pCRT levels of both hTERT and cfRNA (P = 0.009 and P = 0.001, respectively) were found to be significant predictors of tumor response. In multivariate analysis, using variables that were available before pCRT, cfRNA levels and gender independently predicted the tumor response, while in multivariate analysis, which used all of the variables available before the surgical procedure, the post-pCRT levels of cfRNA and the difference between the post- and pre-pCRT levels of cfRNA independently predicted tumor response.
  
  
  CONCLUSIONS
  Plasma levels of cfRNA and hTERT are promising markers of tumor response to pCRT for rectal cancer.
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, Section of Surgery, University of Padova, Padua, Italy. puc@unipd.it
authors.forename: Salvatore
authors.initials: S
authors.lastname: Pucciarelli
authors.forename: Enrica
authors.initials: E
authors.lastname: Rampazzo
authors.forename: Marta
authors.initials: M
authors.lastname: Briarava
authors.forename: Isacco
authors.initials: I
authors.lastname: Maretto
authors.forename: Marco
authors.initials: M
authors.lastname: Agostini
authors.forename: Maura
authors.initials: M
authors.lastname: Digito
authors.forename: Sonia
authors.initials: S
authors.lastname: Keppel
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Friso
authors.forename: Sara
authors.initials: S
authors.lastname: Lonardi
authors.forename: Antonino
authors.initials: A
authors.lastname: De Paoli
authors.forename: Claudia
authors.initials: C
authors.lastname: Mescoli
authors.forename: Donato
authors.initials: D
authors.lastname: Nitti
authors.forename: Anita
authors.initials: A
authors.lastname: De Rossi
mesh_terms: D000230:Adenocarcinoma / Q000097:blood* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D014408:Biomarkers, Tumor / Q000097:blood*; D002272:Carcinoembryonic Antigen / Q000097:blood; D059186:Chemoradiotherapy, Adjuvant; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012313:RNA / Q000097:blood*; D012372:ROC Curve; D012004:Rectal Neoplasms / Q000097:blood* / Q000628:therapy; D012189:Retrospective Studies; D019098:Telomerase / Q000097:blood*; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen; D012313:RNA; D019098:Telomerase