Original scientific paper
https://doi.org/10.20471/acc.2024.63.04.10
Tumor Response to Neoadjuvant Long-Course Chemoradiotherapy Depends on the Rectal Cancer Patient Gender
Velda Smajlbegović
; Department of Oncology, Clinical Center, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
Snježana Ramić
orcid.org/0000-0002-5916-8815
; Oncologic Pathology, Ljudevit Jurak Department of Pathology and Cytology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
*
Iva Kirac
; Surgical Oncology, University Hospital for Tumors, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Meliha Solak Mekić
; Division of Oncology and Radiotherapy, University Hospital for Tumors, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Loris Ćurt
; Surgical Oncology, University Hospital for Tumors, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Danko Velimir Vrdoljak
; Surgical Oncology, University Hospital for Tumors, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
* Corresponding author.
Abstract
Our study aimed to analyze the correlation of cancer-related parameters with tumor
regression grade (TRG) and disease-free survival (DFS) by gender in 192 rectal cancer patients operated
on after neoadjuvant long-course chemoradiotherapy (LCCRT). Preoperative diagnostics revealed
no significant gender differences in any clinical parameters other than obesity (p=0.031). We found
that slightly overweight men had a lower incidence of distant metastases (p=0.042). The post-LCCRT
pathologic finding showed that women had more positive lymph nodes (ypN, p=0.002) while no other
pathologic parameter differed significantly between the genders. Overall, a poor response to therapy correlated
with a shorter time to disease progression (p=0.002). Women achieved ypN0 in 50% of cases, but
only 27% had a good TRG compared to 40.5% of men (p=0.073). Women had a worse DFS than men,
even when complete response to therapy was achieved (p=0.003), and greater depth of residual tumor
invasion (ypT, p=0.035) and higher ypN (p=0.002) correlated with shorter DFS. Positive resection margins
(p<0.001), higher ypN stage (p=0.003), and poor TRG (p=0.025) correlated with shorter DFS in
men. We conclude that women have a poorer response to LCCRT with the possibility that therapeutic
approach to the neoadjuvant treatment of rectal cancer may be gender-specific.
Keywords
Rectal cancer; Neoadjuvant chemoradiotherapy; Gender; Tumor regression grade; Disease-free survival
Hrčak ID:
333190
URI
Publication date:
31.12.2024.
Visits: 710 *