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Microvessel density as predictor chemotherapy in locally advanced colorectal cancer

  • Maria Yustina ,
  • Tomy Lesmana ,
  • Alphania Rahniayu ,
  • Edwin Danardono ,
  • Denny Septarendra ,

Abstract

Introduction: Colorectal cancer is the leading cause of morbidity and mortality worldwide. The role of neo-adjuvant chemotherapy in the treatment of locally advanced colorectal cancer (LACRC) has been increased the overall survival. We must consider the benefit and disadvantage of neoadjuvant therapy for LACRC, otherwise window for surgery diminish in progressive disease.  The growth of the tumor requires neoangiogenesis, and more aggressive the cancer, more active the angiogenesis. Micro Vessel Density (MVD) is the result of angiogenesis. In our simple thought, the tumor with rich vascular has better chemotherapy response due to enhance chemotherapy drug’s delivery. But the preclinical and clinical studies report that vascularity of the tumor is unlike normal tissue, tumor vascular is leaky and tortous, hence the interstitial fluid pressure increase, resulted in ineficiency of chemotherapy and oxygen delivery. This study aims to determine whether MVD beneficial as predictor of chemotherapy response in LACRC.

Methods: Fifty-one patients underwent colonoscopy biopsy and diagnosed with LACRC. The patient underwent abdominal CT scan for staging. They were treated with neoadjuvant FOLFOX (leucovorin, fluorouracil, oxaliplatin) and then underwent abdominal CT scan for evaluation chemotherapy response. The response of chemotherapy assessment based on RECIST criteria which classified into progressive disease, stable disease, partial response and complete response. MVD was examined using endothelial marker CD31 from the paraffin block from biopsy colonoscopy specimen 

Results: A total of 51 patients enrolled in the study, 27 (52.9%) responded to chemotherapy. The chemotherapeutic response was partial response in patients with well-differentiated pathological grade, but not statistically significant (n =20 (39.3%), p-value = 0.556, p >0.05). The MVD CD31 ranges between 7 – 82, the mean is 31.04, low MVD is identified in 25 patients and high MVD is identified in 26 patients. In this study, no significant correlation was recorded between gender, staging TNM, histologic grading, location of lesion and accuracy of chemotherapy and response of chemotherapy, the p-value is 0.809, 0.156, 0.298, 0.556, 0.573, and 0.259 respectively.  There is no statistically significant correlation between MVD and response to chemotherapy (OR: 0.92; CI 95%: 0.30-2.79; p = 0.991)

Conclusion: Pre-treatment CD31 micro-vessel density could not be used to predict neoadjuvant chemotherapy response in LACRC.

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How to Cite

Yustina, M., Lesmana, T. ., Rahniayu, A. ., Danardono, E. ., & Septarendra, D. . (2021). Microvessel density as predictor chemotherapy in locally advanced colorectal cancer. Bali Medical Journal, 13(1), 542–547. https://doi.org/10.15562/bmj.v13i1.4985

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