The prognostic role of TCF4 expression in locally advanced rectal cancer patients treated with neoadjuvant chemoradiotherapy

Article type: Research Article

Authors: Dou, Xue^a | Wang, Renben^{a; *} | Meng, Xiangjiao^a | Yan, Hongjiang^a | Jiang, Shumei^a | Zhu, Kunli^a | Xu, Xiaoqing^a | Chen, Dong^a | Song, Xianrang^b | Mu, Dianbin^c

Affiliations: [a] Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, University of Jinan, Jinan, Shandong, China | [b] Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, University of Jinan, Jinan, Shandong, China | [c] Department of Pathology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, University of Jinan, Jinan, Shandong, China

Correspondence: [*] Corresponding author: Renben Wang, Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, University of Jinan, Jinan, Shandong, China. E-mail: wangrenben@sina.cn.

Abstract: Background:At present no useful factors to predict the sensitivity to neoadjuvant chemoradiotherapy (nCRT) have been established in patients with locally advanced rectal cancer (LARC). Objective:The objective of this study was to explore the prognostic role of T cell factor 4 (TCF4) expression in predicting tumor response to nCRT and tumor outcomes for patients with LARC. Methods:The study enrolled 96 patients who underwent nCRT followed by total mesorectal excision (TME). The TCF4 expression of all patients’ biopsies before nCRT was evaluated by Immunohistochemical staining method. Results:After completion of nCRT, 5 cases (5.2%) achieved clinical complete response (cCR) thus the remaining 91 patients underwent a standardized total mesorectal excision (TME) procedure. There were 44 patients (45.8%) achieved good tumor response (including TRG 3-4 and 5 cCR patients) while poor response (TRG 0-2) was achieved in 52 patients (54.2%). Our results demonstrated that patients with low expression of TCF4 were more sensitive to nCRT than those with high TCF4 expression (P=0.031). Low TCF4 expression before nCRT and good response were significantly associated with improved 5-year disease-free survival and 5-year overall survival (P<0.05). Multivariate analysis confirmed that the pretreatment TCF4 expression was an independent prognostic factor. Conclusions:Our data revealed that low TCF4 protein expression was a useful predictive factor of good tumor response to nCRT and good outcomes in patients with LARC.

Keywords: T cell factor 4 (TCF4), rectal cancer, neoadjuvant chemoradiotherapy, tumor regression grade

DOI: 10.3233/CBM-140452

Journal: Cancer Biomarkers, vol. 15, no. 2, pp. 181-188, 2015