바로가기  >

Abstract
AIM:
To identify the candidate marker predicting treatment response and survival outcome in rectal cancer patients who received preoperative chemoradiotherapy (CRT).

PATIENTS AND METHODS:
Between 2000 and 2015, 159 patients with histologically-confirmed rectal adenocarcinoma underwent preoperative CRT followed by surgery. Among them, 70 patients were enrolled and the expression of survivin, cancer stem cell markers (CD44 and CD133) and epithelial-mesenchymal transition markers (E-cadherin and TWIST1) in pretreatment biopsy specimens were evaluated by immunohistochemistry. Associations between the expression of markers and clinical outcomes were evaluated.

RESULTS:
The median follow-up period of all patients was 71 (range=15-203) months. Five-year overall (OS), disease-free (DFS), locoregional recurrence-free (LRRFS) and distant metastasis-free (DMFS) survival were 80.5%, 60.2% 90.1% and 76.5%, respectively. A significant association between survivin overexpression and worse treatment outcome was shown on univariate analyses for OS, DFS and DMFS (p=0.022, 0.002, and 0.005, respectively). On multivariate analysis, survivin overexpression was an adverse prognosticator for DFS and DMFS (p=0.007 and 0.015, respectively), with a borderline significant trend towards a shorter OS (p=0.069). Four other single biomarkers were not associated with survival outcomes. However, overexpression of both survivin and CD44 was significantly associated with worse OS on multivariate analysis (p=0.003).

CONCLUSION:
Survivin combined with CD44 might be a candidate biomarker for the prediction of recurrence and survival in patients who received preoperative CRT for rectal cancer. Further research with a larger population is needed to validate these results.

Author information

Kim J1, Ahn S2, Kim K3, Cho MS4, Kim KH5, Lee RA5, Nam EM6.
1
Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Republic of Korea.
2
Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
3
Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Republic of Korea kyubokim.ro@gmail.com mcho1124@ewha.ac.kr.
4
Department of Pathology, Ewha Womans University College of Medicine, Seoul, Republic of Korea kyubokim.ro@gmail.com mcho1124@ewha.ac.kr.
5
Department of Surgery, Ewha Womans University College of Medicine, Seoul, Republic of Korea.
6
Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea.