Prognostic value of Smac expression in rectal cancer patients treated with neoadjuvant therapy |
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Authors: | Hongjiang Yan Jinming Yu Renben Wang Shumei Jiang Kunli Zhu Dianbin Mu Zhongfa Xu |
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Institution: | (1) Department of Radiation Oncology, Shandong Tumor Hospital, Jinan, 250117, China;(2) Department of Pathology, Shandong Tumor Hospital, Jinan, 250117, China;(3) Department of General Surgery, Shandong Tumor Hospital, Jinan, 250117, China; |
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Abstract: | The objective was to evaluate expression of second mitochondria-derived activator of caspase (Smac) expression before and
after treatment in patients treated with preoperative chemoradiotherapy (CRT) for locally advanced rectal cancer and to correlate
the clinicopathological characteristics and level of Smac expression with pathologic response and outcome. Expression of biomarker
was evaluated by immunohistochemistry in tumor samples from 98 patients with clinical Stage II and III rectal cancer treated
with preoperative pelvic radiotherapy plus concurrent chemotherapy. All patients received a standardized total mesorectal
excision procedure after a long interval of 4–6 weeks. For Smac, patients with a good response to neoadjuvant CRT tended to
have higher pre-therapy levels (P = 0.007). The level of Smac expression decreased after neoadjuvant therapy (P = 0.016). High expression of Smac before CRT, and high Dworak’s tumor regression grade (TRG) were significantly associated
with improved 5-year disease-free survival (P < 0.05). Pretreatment nodal status also was significantly associated with 5-year disease-free survival and 5-year local relapse-free
survival (P < 0.05). Multivariate analysis confirmed that the pretreatment expression of Smac and Lymph nodal status were independent
prognostic factors. Our study suggests that high expression of Smac before neoadjuvant CRT could predict good outcome in locally
advanced rectal cancer patients. |
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