Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Feb 15, 2022; 14(2): 525-532
Published online Feb 15, 2022. doi: 10.4251/wjgo.v14.i2.525
Predictive value of serum alpha-fetoprotein for tumor regression after preoperative chemotherapy for rectal cancer
Da-Kui Zhang, Jun Qiao, Shao-Xuan Chen, Zhi-Yong Hou, Jian-Zheng Jie
Da-Kui Zhang, Shao-Xuan Chen, Zhi-Yong Hou, Jian-Zheng Jie, Department of General Surgery, China-Japan Friendship Hospital, Beijing 100029, China
Jun Qiao, Department of General Surgery, Inner Mongolia International Mongolian Hospital, Hohhot 010020, Inner Mongolia Autonomous Region, China
Author contributions: Jie JZ and Zhang DK designed the research study; Qiao J, Chen SX and Hou ZY performed the research.
Supported by Youth Foundation of China–Japan Friendship Hospital, No. 2019-1-QN-42
Institutional review board statement: The study was reviewed and approved by the China-Japan Friendship Hospital Institutional Review Board, No. 2021-117-K75.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
STROBE statement: All authors have read the STROBE statement checklist of items. The manuscript was prepared and revised according to the STROBE statement checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Zheng Jie, MD, Doctor, Department of General Surgery, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Beijing 100029, China. dakuizhang2021@126.com
Received: August 12, 2021
Peer-review started: August 12, 2021
First decision: November 8, 2021
Revised: November 20, 2021
Accepted: January 19, 2022
Article in press: January 19, 2022
Published online: February 15, 2022
Abstract
BACKGROUND

Preoperative therapy is widely used in locally advanced rectal cancer. It can improve local control of rectal cancer. However, there are few indicators that can predict the effect of preoperative chemotherapy accurately.

AIM

To investigate whether the increase in serum α-fetoprotein (AFP) can predict better efficacy of preoperative chemotherapy.

METHODS

This was a retrospective study. We analyzed 125 patients admitted between 2017 and 2019 with locally advanced rectal cancer. All patients received six cycles of preoperative chemotherapy (mFOLFOX6 every 2 wk). Serum AFP of 26 patients rose slightly after three or four cycles of chemotherapy, and fell to normal again within 2 mo. The other 99 patients had a normal level of serum AFP during chemotherapy. Patients were divided into two groups (AFP risen and AFP normal). According to postoperative pathology, we compared tumor regression and complete response rate between the two groups. The primary outcome measure was the tumor regression grade (TRG) after chemotherapy. The difference in pathological complete response between the two groups was also investigated.

RESULTS

There were no tumor progression and distant metastasis in both groups during preoperative chemotherapy. Patients in the AFP risen group achieved better TRG 0/1 than those in the AFP normal group (61.5% vs 39.4%). The increase in AFP was a significant predictor for better tumor regression [χ2 = 4.144, odds ratio (OR) = 2.666, P = 0.04]. In the AFP risen group, the complete response rate was 30.8%, which was higher than in the AFP normal group (30.8% vs 12.1%, χ2 = 4.542, OR = 3.251, P = 0.03).

CONCLUSION

Patients with a slight increase in serum AFP can achieve better tumor regression during preoperative chemotherapy, and are more likely to achieve pathological complete response.

Keywords: Rectal cancer, Preoperative chemotherapy, Alpha-fetoprotein, Predictive value, Tumor

Core Tip: We analyzed 125 patients with locally advanced rectal cancer retrospectively. The patients received 6 cycles of preoperative chemotherapy (mFOLFOX6 every 2 wk). Serum α-fetoprotein (AFP) of 26 patients rose slightly and returned to normal in two months. These patients achieved better tumor regression grade (TRG0-1) than those with normal AFP (61.5% vs 39.4%). Patients with a slight increase of serum AFP showed better tumor regression during preoperative chemotherapy, and were more likely to achieve pathological complete response (30.8% vs 12.1%).