Value of ctDNA in predicting pathological complete remission of neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer

ZHAO Yuhong; CAO Wei; ZHANG Lei

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Medical Journal of the Chinese People Armed Police Forces ›› 2024, Vol. 35 ›› Issue (7) : 607-612.

Value of ctDNA in predicting pathological complete remission of neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer

ZHAO Yuhong, CAO Wei, ZHANG Lei

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Abstract

Objective To investigate the value of circulating tumor (ct) DNA in predicting pathological complete remission (pCR) of neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer (LARC). Methods A total of 104 LARC patients recruited from March 2020 to September 2021 were selected as the study objects, and the baseline data and plasma samples during nCRT were collected for gene sequencing. The association between ctDNA status and treatment response was analyzed. The value of ctDNA alone, MRI alone, and the combination of ctDNA and MRI in predictive pCR was evaluated. The independent clinical factors influencing pCR were analyzed by logistic univariate and multifactorial analysis. Results Of the 104 patients, 35 (33.65%) achieved pCR after surgery, and 91 (87.50%) had positive ctDNA at baseline. The proportion of negative ctDNA and ctDNA clearance before surgery in patients with pCR were significantly higher than those in patients with N-pCR (P＜0.05).The proportion of ctDNA negativity and ctDNA clearance in pTRG3 patients were significantly reduced (P＜0.05). Logistic univariate and multivariate analysis showed that ctDNA clearance and cCR were independent clinical factors affecting pCR (P＜0.05). The area under the pCR curve of ctDNA clearance combined with MRI diagnosis was 0.937 (0.885-0.989), which was higher than that of ctDNA clearance or MRI alone. Conclusions The standard of clinical complete response based on MRI combined with ctDNA has the value of predicting pCR in LARC patients.

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circulating tumor DNA / locally advanced rectal cancer / complete pathological remission / clinical complete remission / MRI

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ZHAO Yuhong, CAO Wei, ZHANG Lei. Value of ctDNA in predicting pathological complete remission of neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer[J]. Medical Journal of the Chinese People Armed Police Forces. 2024, 35(7): 607-612

References

[1] Vendrely V, Rivin D E, Modesto A, et al. Rectal cancer radiotherapy[J]. Cancer Radiother, 2022, 26(12): 272-278.
[2] 孙文凯, 黄河. 影像组学技术及其在结直肠癌精准诊疗中的应用进展[J]. 武警医学, 2021, 32(8): 725-729.
[3] Fleshman J, Branda M E, Sargent D J, et al. Disease-free survival and local recurrence for laparoscopic resection compared with open resection of stage II to III rectal cancer: follow-up results of the ACOSOG Z6051 randomized controlled trial[J]. Ann Surg, 2019, 269(4): 589-595.
[4] Cambray M, Gonzalez V J, Berenguer M A, et al. Short-course radiotherapy in locally advanced rectal cancer[J]. Clin Transl Gastroenterol, 2020, 11(6): e00162-e00168.
[5] Body A, Prenen H, Lam M,et al. Neoadjuvant therapy for locally advanced rectal cancer: recent advances and ongoing challenges[J]. Clin Colorectal Cancer, 2021, 20(1): 29-41.
[6] Feeney G, Sehgal R, Sheehan M, et al. Neoadjuvant radiotherapy for rectal cancer management[J]. World J Gastroenterol, 2019, 25(33): 4850-4870.
[7] Wang Q, Zhang R, Xiao W, et al. The watch and wait strategy versus surgical resection for rectal cancer patients with a clinical complete response after neoadjuvant chemoradiotherapy[J]. Radiat Oncol, 2021, 16(1):16-23.
[8] Smith J J, Strombom P, Chow O S, et al. Assessment of a watch-and-wait strategy for rectal cancer in patients with a complete response after neoadjuvant therapy[J]. JAMA Oncol, 2019, 5(4): e185896-e185896.
[9] Wang Y, Shen L, Wan J, et al. Neoad juvant chemoradiotherapy combined with immunotherapy for locally advanced rectal cancer: a new era for anal preservation[J]. Front Immunol, 2022, 13: 1067036-1067045.
[10] Morais M, Pinto D M, Machado J C, et al. ctDNA on liquid biopsy for predicting response and prognosis in locally advanced rectal cancer: a systematic review[J]. Eur J Surg Oncol, 2022, 48(1): 218-227.
[11] Wang Y, Yang L, Bao H, et al. Utility of ctDNA in predicting response to neoadjuvant chemoradiotherapy and prognosis assessment in locally advanced rectal cancer: a prospective cohort study[J]. PLoS Med, 2021, 18(8): e1003741-e1003760.
[12] Li M, Xiao Q, Venkatachalam N, et al. Predicting response to neoadjuvant chemoradiotherapy in rectal cancer: from biomarkers to tumor models[J]. Ther Adv Med Oncol, 2022, 14: 77972- 77994.
[13] 陈朱虹, 徐本华. 直肠癌新辅助放化疗后达病理完全缓解的关联因素分析[J]. 中华肿瘤防治杂志, 2022, 29(4): 296-301.
[14] 王一飞, 安永铸, 王韬, 等. 外周血 ERCC1 表达及基因多态性与局部晚期直肠癌新辅助放化疗疗效的关系[J]. 中华保健医学杂志, 2022, 24(5): 393-395.
[15] Zhou J, Wang C, Lin G, et al. Serial circulating tumor DNA in predicting and monitoring the effect of neoadjuvant chemoradiotherapy in patients with rectal cancer: a prospective multicenter study[J]. Clin Cancer Res, 2021, 27(1): 301-310.
[16] Khakoo S, Carter P D, Brown G, et al. MRI tumor regression grade and circulating tumor DNA as complementary tools to assess response and guide therapy adaptation in rectal cancer[J]. Clin Cancer Res, 2020, 26(1): 183-192.
[17] 张一擎, 孙开国, 陆佳莹, 等. 全程新辅助治疗对比新辅助放化疗治疗局部晚期直肠癌的疗效及安全性的Meta分析[J]. 中华胃肠外科杂志, 2022, 25(6): 531-538.
[18] Wang Y, Shen L, Wan J, et al. Short-course radiotherapy combined with CAPOX and toripalimab for the total neoadjuvant therapy of locally advanced rectal cancer: a randomized, prospective, multicentre, double arm, phase II trial (TORCH)[J]. BMC Cancer, 2022, 22(1): 274-281.
[19] Shin J, Seo N, Baek S E, et al. MRI radiomics model predicts pathologic complete response of rectal cancer following chemoradiotherapy[J]. Radiology, 2022, 303(2): 351-358.
[20] Wang H, Jia H, Gao Y, et al. Serum metabolic traits reveal therapeutic toxicities and responses of neoadjuvant chemoradiotherapy in patients with rectal cancer[J]. Nat Commun, 2022, 13(1): 7802-7815.
[21] 许宁, 黄凤昌, 李文亮, 等. 磁共振肿瘤退缩分级和表观弥散系数对局部进展期直肠癌新辅助治疗后病理完全缓解的预测价值[J]. 中华胃肠外科杂志, 2021, 24(4): 359-365.
[22] European Society of Coloproctology collaborating group.Evaluating the incidence of pathological complete response in current international rectal cancer practice: the barriers to widespread safe deferral of surgery[J]. Colorectal Dis, 2018, 20(Suppl 6): 58-68.
[23] Eyck B M, Jansen M P, Noordman B J, et al. Detection of circulating tumour DNA after neoadjuvant chemoradiotherapy in patients with locally advanced oesophageal cancer[J]. J Pathol, 2023, 259(1): 35-45.
[24] Chang L, Zhang X, He L, et al. Prognostic value of ctDNA detection in patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiotherapy: a systematic review and meta-analysis[J]. Oncologist, 2023, 28(12): e1198-e1208.