title: ALDH1 is an independent prognostic factor for patients with stages II-III rectal cancer after receiving radiochemotherapy.
abstract: BACKGROUND
  About one in five patients with locally advanced rectal cancer (RC) suffers recurrence or distant metastasis after neoadjuvant therapy. We investigated how cancer stem cell markers change after neoadjuvant therapy and how these markers relate to recurrence.
  
  
  METHODS
  Pretreatment biopsies and postoperative specimens were taken from 64 patients with locally advanced rectal adenocarcinoma who received preoperative radiochemotherapy (RCT) between sampling. Samples were tested immunohistochemically for CD44, LGR5, ALDH1 and CD166; scores were dichotomised as high or low. The median follow-up period was 36 months.
  
  
  RESULTS
  High expression of CD44, LGR5, ALDH and CD166 was found in 38%, 5%, 48% and 10%, respectively, before RCT and 86%, 33%, 71% and 52%, respectively, after RCT. CD44 (P=0.001), LGR5 (P=0.049) and CD166 (P=0.003) were significantly upregulated after RCT. Whereas no recurrence was seen during the follow-up in the low ALDH group, 40% of the high ALDH group suffered recurrence. In multivariate COX analysis, postoperative ALDH1 independently predicted poor prognosis in patients with RC who received RCT (P=0.0095).
  
  
  CONCLUSIONS
  Preoperative RCT upregulates expression of stem cell markers in patients with RC. High post-treatment ALDH1 expression predicts poor prognosis for these patients after neoadjuvant therapy.
authors: Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors: Y
authors: Y
authors: Deng
authors: Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors: J
authors: J
authors: Zhou
authors: Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors: L
authors: L
authors: Fang
authors: Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors: Y
authors: Y
authors: Cai
authors: Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors: J
authors: J
authors: Ke
authors: Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors: X
authors: X
authors: Xie
authors: Department of Pathology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors: Y
authors: Y
authors: Huang
authors: Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors: M
authors: M
authors: Huang
authors: Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors: J
authors: J
authors: Wang
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000235:genetics / Q000473:pathology / Q000532:radiotherapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000080924:Aldehyde Dehydrogenase 1 Family; D015703:Antigens, CD / Q000096:biosynthesis / Q000235:genetics; D014408:Biomarkers, Tumor / Q000235:genetics / Q000378:metabolism; D015816:Cell Adhesion Molecules, Neuronal / Q000096:biosynthesis / Q000235:genetics; D059248:Chemoradiotherapy / Q000379:methods; D005260:Female; D005326:Fetal Proteins / Q000096:biosynthesis / Q000235:genetics; D006801:Humans; D018960:Hyaluronan Receptors / Q000096:biosynthesis / Q000235:genetics; D007527:Isoenzymes / Q000096:biosynthesis* / Q000235:genetics / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000235:genetics / Q000473:pathology / Q000532:radiotherapy; D009367:Neoplasm Staging; D014411:Neoplastic Stem Cells / Q000187:drug effects / Q000473:pathology / Q000528:radiation effects; D011379:Prognosis; D043562:Receptors, G-Protein-Coupled / Q000096:biosynthesis / Q000235:genetics; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000201:enzymology* / Q000473:pathology* / Q000532:radiotherapy; D050697:Retinal Dehydrogenase / Q000096:biosynthesis* / Q000235:genetics / Q000378:metabolism; D055815:Young Adult; D020410:Activated-Leukocyte Cell Adhesion Molecule
chemical_list: D000080924:Aldehyde Dehydrogenase 1 Family; D015703:Antigens, CD; D014408:Biomarkers, Tumor; D015816:Cell Adhesion Molecules, Neuronal; D005326:Fetal Proteins; D018960:Hyaluronan Receptors; D007527:Isoenzymes; D043562:Receptors, G-Protein-Coupled; D050697:Retinal Dehydrogenase; C105613:ALCAM protein, human; D020410:Activated-Leukocyte Cell Adhesion Molecule; C497483:CD44 protein, human; C116884:LGR5 protein, human; C510223:ALDH1A1 protein, human