title: Elevated CEA levels and low distance of the tumor from the anal verge are predictors of incomplete response to chemoradiation in patients with rectal cancer.
abstract: BACKGROUND
  The objective of this study was to evaluate pretreatment clinical parameters as predictive factors for complete pathological response after long-term chemoradiotherapy (RCT) for rectal cancer. Tumor downstaging after RCT for rectal cancer can be obtained in half of cases, whereas a complete pathological response (CPR) is reported to range between 15 and 30%. It is not possible to foresee before therapies who will respond.
  
  
  METHODS
  Patients with stage II-III rectal cancer that had undergone RCT and rectal resection between January 1995 and October 2010 were considered. Patients were divided in those who achieved a CPR, "CR" group, and those who did not achieve a CPR, "NCR" group. Univariate and multivariate analyses between groups were performed considering the clinical parameters: gender, age, ASA score, preoperative hematic CEA, tumor grading; distance of the tumor from the anal verge, maximum tumor diameter, TNM stage, and neoadjuvant treatment details.
  
  
  RESULTS
  Among 260 patients, 43 (16.5%) achieved a CPR. The two groups resulted homogeneous for age, sex, pretreatment status, and tumor stage. A CEA <5 ng/dl and distance from anal verge >5 cm were correlated with CPR at multivariate analysis. Patients with both these conditions presented a significantly higher CPR rate (30.6%) as well as improved 5-year survival. CPR was also correlated with improved survival.
  
  
  CONCLUSIONS
  Very low tumors with a high serum CEA are very unlikely to reach a CPR. The predictive value of these easily available clinical factors should not be underestimated, and better therapeutic strategies for these tumors are needed.
authors.affiliation: Department of Surgery, Colorectal Surgery Center, University of Cagliari, Cagliari, Italy. angelorestivo@tiscali.it
authors.forename: Angelo
authors.initials: A
authors.lastname: Restivo
authors.forename: Luigi
authors.initials: L
authors.lastname: Zorcolo
authors.forename: Ivana Maria Francesca
authors.initials: IM
authors.lastname: Cocco
authors.forename: Romina
authors.initials: R
authors.lastname: Manunza
authors.forename: Carla
authors.initials: C
authors.lastname: Margiani
authors.forename: Luigi
authors.initials: L
authors.lastname: Marongiu
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Casula
mesh_terms: D000368:Aged; D001003:Anal Canal / Q000473:pathology*; D014408:Biomarkers, Tumor / Q000097:blood*; D002272:Carcinoembryonic Antigen / Q000097:blood*; D059248:Chemoradiotherapy / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D012074:Remission Induction; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen