Vascular calcification and response to neoadjuvant therapy in locally advanced rectal cancer: an exploratory study

Knight, K. A., Drami, I., McMillan, D. C. , Horgan, P. G. , Park, J. H. , Jenkins, J. T. and Roxburgh, C. S.D. (2021) Vascular calcification and response to neoadjuvant therapy in locally advanced rectal cancer: an exploratory study. Journal of Cancer Research and Clinical Oncology, 147(11), pp. 3409-3420. (doi: 10.1007/s00432-021-03570-1) (PMID:33710416) (PMCID:PMC8484095)

Abstract

Purpose: Patients with locally advanced rectal cancer (LARC) may experience a clinical complete response (cCR) to neoadjuvant chemoradiotherapy (NACRT) and opt for non-operative management. Pathological factors that relate to NACRT response have been well described. Host factors associated with response, however, are poorly defined. Calcification of the aortoiliac (AC) vessels supplying the rectum may influence treatment response. Methods: Patients with LARC having NACRT prior to curative surgery at Glasgow Royal Infirmary (GRI) and St Mark’s hospital (SMH) between 2008 and 2016 were identified. AC was scored on pre-treatment CT imaging. NACRT response was assessed using pathologic complete response (pCR) rates, tumour regression grades (TRGs), the NeoAdjuvant Rectal score and T-/N-downstaging. Associations were assessed using Chi-squared, Mantel–Haenszel and Fisher’s exact tests. Results: Of 231 patients from GRI, 79 (34%) underwent NACRT for LARC. Most were male (58%), aged over 65 (51%) with mid- to upper rectal tumours (56%) and clinical T3/4 (95%), node-positive (77%) disease. pCR occurred in 10 patients (13%). Trends were noted between higher clinical T stage and poor response by Royal College of Pathologist’s TRG (p = 0.021) and tumour height > 5 cm and poor response by Mandard TRG (0.068). In the SMH cohort, 49 of 333 (15%) patients underwent NACRT; 8 (16%) developed a pCR. AC was not associated with NACRT response in either cohort. Conclusions: AC was not associated with NACRT response in this cohort. Larger contemporary cohorts are required to better assess host determinants of NACRT response and develop predictive models to improve patient selection.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Park, Mr James and Horgan, Professor Paul and McMillan, Professor Donald and Roxburgh, Professor Campbell and Jenkins, Mr John and Knight, Miss Katrina
• Authors: Knight, K. A., Drami, I., McMillan, D. C., Horgan, P. G., Park, J. H., Jenkins, J. T., and Roxburgh, C. S.D.
• College/School: College of Medical Veterinary and Life Sciences > School of Cancer Sciences; College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Journal of Cancer Research and Clinical Oncology
• Publisher: Springer
• ISSN: 0171-5216
• ISSN (Online): 1432-1335
• Published Online: 12 March 2021
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in Journal of Cancer Research and Clinical Oncology 2021
• Publisher Policy: Reproduced under a Creative Commons licence