A multicentre cohort study assessing the utility of routine blood tests as adjuncts to identify complete responders in rectal cancer following neoadjuvant chemoradiotherapy
Purpose Management of rectal cancer with a complete clinical response (cCR) to neoadjuvant chemoradiotherapy (NACRT) is controversial. Some advocate “watch and wait” programmes and organ-preserving surgery. Central to these strategies is the ability to accurately preoperatively distinguish cCR from...
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| Veröffentlicht in: | International journal of colorectal disease 2022-04, Vol.37 (4), p.957-965 |
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| creator | Armstrong, John Balasubramanian, Ishwarya Brannigan, Ann Cahill, Ronan Cooke, Fiachra Creavin, Ben Fleming, Christina |
| description | Purpose
Management of rectal cancer with a complete clinical response (cCR) to neoadjuvant chemoradiotherapy (NACRT) is controversial. Some advocate “watch and wait” programmes and organ-preserving surgery. Central to these strategies is the ability to accurately preoperatively distinguish cCR from residual disease (RD). We sought to identify if post-NACRT (preoperative) inflammatory markers act as an adjunct to MRI and endoscopy findings for distinguishing cCR from RD in rectal cancer.
Methods
Patients from three specialist rectal cancer centres were screened for inclusion (2010–2015). For inclusion, patients were required to have completed NACRT, had a post-NACRT MRI (to assess mrTRG) and proceeded to total mesorectal excision (TME). Endoluminal response was assessed on endoscopy at 6–8 weeks post-NACRT. Pathological response to therapy was calculated using a three-point tumour regression grade system (TRG1-3). Neutrophil–lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), serum albumin (SAL), CEA and CA19-9 levels post-NACRT (preoperatively) were recorded. Variables were compared between those who had RD on post-operative pathology and those with ypCR. Statistical analysis was performed using SPSS (version 21).
Results
Six hundred forty-six patients were screened, of which 422 were suitable for inclusion. A cCR rate of 25.5% (
n
= 123) was observed. Sixty patients who achieved cCR were excluded from final analysis as they underwent organ-preserving surgery (local excision) leaving 63 ypCR patients compared to 359 with RD. On multivariate analysis, combining cCR on MRI and endoscopy with NLR |
| doi_str_mv | 10.1007/s00384-022-04103-z |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8976819</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A704310842</galeid><sourcerecordid>A704310842</sourcerecordid><originalsourceid>FETCH-LOGICAL-c541t-55af554bb59ef947d0f5bb851b42c7d3ffac297a86adcf935dabd41611d2d8d93</originalsourceid><addsrcrecordid>eNp9ksluFDEQhlsIRELgBTggS1y4dPDaywUpitikSFzgbLnt8oxHbnuw3Ykmz8RD4smELAghH-xyffWXqvQ3zWuCTwnG_fuMMRt4iyltMSeYtddPmmPCGW0J7ejTB--j5kXOG4xJ3_X8eXPEBKOC9uS4-XWG5sUXpyGUBEjHdUwF5bKYHVI5Q84urFBZA1qK867sULQoxRoEQJOP0aACueQKI2U2S9D1XSJypgo6u6uK89ZDAZQgb2MwkDJyoUa6KI-0ChoSstH7eLXvFCDuZS5VKEivYY5JGRdr_6S2u5fNM6t8hle390nz49PH7-df2otvn7-en120WnBSWiGUFYJPkxjBjrw32IppGgSZONW9YdYqTcdeDZ0y2o5MGDUZTjpCDDWDGdlJ8-Ggu12mGczNbpSX2-RmlXYyKicfZ4Jby1W8lMPYdwPZC7y7FUjx51L3I2eXNXiv6nxLlrTjHONRjKyib_9CN3FJoY63pzrRD6zj99RKeZAu2Fj76r2oPOsxZwQPnFbq9B9UPQZmp2MA6-r_owJ6KNAp5pzA3s1IsNx7TB48JqvH5I3H5HUtevNwO3clf0xVAXYAck2FFaT7kf4j-xtCYuKt</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2646578364</pqid></control><display><type>article</type><title>A multicentre cohort study assessing the utility of routine blood tests as adjuncts to identify complete responders in rectal cancer following neoadjuvant chemoradiotherapy</title><source>MEDLINE</source><source>SpringerLink</source><creator>Armstrong, John ; Balasubramanian, Ishwarya ; Brannigan, Ann ; Cahill, Ronan ; Cooke, Fiachra ; Creavin, Ben ; Fleming, Christina</creator><creatorcontrib>Armstrong, John ; Balasubramanian, Ishwarya ; Brannigan, Ann ; Cahill, Ronan ; Cooke, Fiachra ; Creavin, Ben ; Fleming, Christina ; Eastern Rectal Cancer Response Collaborative, Ireland</creatorcontrib><description>Purpose
Management of rectal cancer with a complete clinical response (cCR) to neoadjuvant chemoradiotherapy (NACRT) is controversial. Some advocate “watch and wait” programmes and organ-preserving surgery. Central to these strategies is the ability to accurately preoperatively distinguish cCR from residual disease (RD). We sought to identify if post-NACRT (preoperative) inflammatory markers act as an adjunct to MRI and endoscopy findings for distinguishing cCR from RD in rectal cancer.
Methods
Patients from three specialist rectal cancer centres were screened for inclusion (2010–2015). For inclusion, patients were required to have completed NACRT, had a post-NACRT MRI (to assess mrTRG) and proceeded to total mesorectal excision (TME). Endoluminal response was assessed on endoscopy at 6–8 weeks post-NACRT. Pathological response to therapy was calculated using a three-point tumour regression grade system (TRG1-3). Neutrophil–lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), serum albumin (SAL), CEA and CA19-9 levels post-NACRT (preoperatively) were recorded. Variables were compared between those who had RD on post-operative pathology and those with ypCR. Statistical analysis was performed using SPSS (version 21).
Results
Six hundred forty-six patients were screened, of which 422 were suitable for inclusion. A cCR rate of 25.5% (
n
= 123) was observed. Sixty patients who achieved cCR were excluded from final analysis as they underwent organ-preserving surgery (local excision) leaving 63 ypCR patients compared to 359 with RD. On multivariate analysis, combining cCR on MRI and endoscopy with NLR < 5 demonstrated the greatest odds of ypCR on final histological assessment [OR 6.503 (1.594–11.652])
p
< 0.001]. This method had the best diagnostic accuracy (AUC = 0.962 95% CI 0.936–0.987), compared to MRI (AUC = 0.711 95% CI 0.650–0.773) or endoscopy (AUC = 0.857 95% CI 0.811–0.902) alone or used together (AUC = 0.926 95% CI 0.892–0.961).
Conclusion
Combining post-NACRT inflammatory markers with restaging MRI and endoscopy findings adds another avenue to aid distinguishing RD from cCR in rectal cancer.</description><identifier>ISSN: 1432-1262</identifier><identifier>ISSN: 0179-1958</identifier><identifier>EISSN: 1432-1262</identifier><identifier>DOI: 10.1007/s00384-022-04103-z</identifier><identifier>PMID: 35325271</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Albumin ; Blood ; Blood tests ; Cancer ; Chemoradiotherapy ; Chemotherapy ; Cohort analysis ; Cohort Studies ; Colorectal cancer ; Endoscopy ; Gastroenterology ; Hematologic Tests ; Hepatology ; Humans ; Inflammation ; Internal Medicine ; Leukocytes (neutrophilic) ; Lymphocytes ; Magnetic resonance imaging ; Medical examination ; Medicine ; Medicine & Public Health ; Multivariate analysis ; Neoadjuvant Therapy ; Original ; Original Article ; Patients ; Proctology ; Radiation therapy ; Rectal Neoplasms - drug therapy ; Rectal Neoplasms - therapy ; Rectum ; Statistical analysis ; Surgery ; Tumors</subject><ispartof>International journal of colorectal disease, 2022-04, Vol.37 (4), p.957-965</ispartof><rights>The Author(s) 2022</rights><rights>2022. The Author(s).</rights><rights>COPYRIGHT 2022 Springer</rights><rights>The Author(s) 2022. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c541t-55af554bb59ef947d0f5bb851b42c7d3ffac297a86adcf935dabd41611d2d8d93</citedby><cites>FETCH-LOGICAL-c541t-55af554bb59ef947d0f5bb851b42c7d3ffac297a86adcf935dabd41611d2d8d93</cites><orcidid>0000-0003-2326-2655</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00384-022-04103-z$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00384-022-04103-z$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35325271$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Armstrong, John</creatorcontrib><creatorcontrib>Balasubramanian, Ishwarya</creatorcontrib><creatorcontrib>Brannigan, Ann</creatorcontrib><creatorcontrib>Cahill, Ronan</creatorcontrib><creatorcontrib>Cooke, Fiachra</creatorcontrib><creatorcontrib>Creavin, Ben</creatorcontrib><creatorcontrib>Fleming, Christina</creatorcontrib><creatorcontrib>Eastern Rectal Cancer Response Collaborative, Ireland</creatorcontrib><title>A multicentre cohort study assessing the utility of routine blood tests as adjuncts to identify complete responders in rectal cancer following neoadjuvant chemoradiotherapy</title><title>International journal of colorectal disease</title><addtitle>Int J Colorectal Dis</addtitle><addtitle>Int J Colorectal Dis</addtitle><description>Purpose
Management of rectal cancer with a complete clinical response (cCR) to neoadjuvant chemoradiotherapy (NACRT) is controversial. Some advocate “watch and wait” programmes and organ-preserving surgery. Central to these strategies is the ability to accurately preoperatively distinguish cCR from residual disease (RD). We sought to identify if post-NACRT (preoperative) inflammatory markers act as an adjunct to MRI and endoscopy findings for distinguishing cCR from RD in rectal cancer.
Methods
Patients from three specialist rectal cancer centres were screened for inclusion (2010–2015). For inclusion, patients were required to have completed NACRT, had a post-NACRT MRI (to assess mrTRG) and proceeded to total mesorectal excision (TME). Endoluminal response was assessed on endoscopy at 6–8 weeks post-NACRT. Pathological response to therapy was calculated using a three-point tumour regression grade system (TRG1-3). Neutrophil–lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), serum albumin (SAL), CEA and CA19-9 levels post-NACRT (preoperatively) were recorded. Variables were compared between those who had RD on post-operative pathology and those with ypCR. Statistical analysis was performed using SPSS (version 21).
Results
Six hundred forty-six patients were screened, of which 422 were suitable for inclusion. A cCR rate of 25.5% (
n
= 123) was observed. Sixty patients who achieved cCR were excluded from final analysis as they underwent organ-preserving surgery (local excision) leaving 63 ypCR patients compared to 359 with RD. On multivariate analysis, combining cCR on MRI and endoscopy with NLR < 5 demonstrated the greatest odds of ypCR on final histological assessment [OR 6.503 (1.594–11.652])
p
< 0.001]. This method had the best diagnostic accuracy (AUC = 0.962 95% CI 0.936–0.987), compared to MRI (AUC = 0.711 95% CI 0.650–0.773) or endoscopy (AUC = 0.857 95% CI 0.811–0.902) alone or used together (AUC = 0.926 95% CI 0.892–0.961).
Conclusion
Combining post-NACRT inflammatory markers with restaging MRI and endoscopy findings adds another avenue to aid distinguishing RD from cCR in rectal cancer.</description><subject>Albumin</subject><subject>Blood</subject><subject>Blood tests</subject><subject>Cancer</subject><subject>Chemoradiotherapy</subject><subject>Chemotherapy</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Colorectal cancer</subject><subject>Endoscopy</subject><subject>Gastroenterology</subject><subject>Hematologic Tests</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Inflammation</subject><subject>Internal Medicine</subject><subject>Leukocytes (neutrophilic)</subject><subject>Lymphocytes</subject><subject>Magnetic resonance imaging</subject><subject>Medical examination</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Multivariate analysis</subject><subject>Neoadjuvant Therapy</subject><subject>Original</subject><subject>Original Article</subject><subject>Patients</subject><subject>Proctology</subject><subject>Radiation therapy</subject><subject>Rectal Neoplasms - drug therapy</subject><subject>Rectal Neoplasms - therapy</subject><subject>Rectum</subject><subject>Statistical analysis</subject><subject>Surgery</subject><subject>Tumors</subject><issn>1432-1262</issn><issn>0179-1958</issn><issn>1432-1262</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><recordid>eNp9ksluFDEQhlsIRELgBTggS1y4dPDaywUpitikSFzgbLnt8oxHbnuw3Ykmz8RD4smELAghH-xyffWXqvQ3zWuCTwnG_fuMMRt4iyltMSeYtddPmmPCGW0J7ejTB--j5kXOG4xJ3_X8eXPEBKOC9uS4-XWG5sUXpyGUBEjHdUwF5bKYHVI5Q84urFBZA1qK867sULQoxRoEQJOP0aACueQKI2U2S9D1XSJypgo6u6uK89ZDAZQgb2MwkDJyoUa6KI-0ChoSstH7eLXvFCDuZS5VKEivYY5JGRdr_6S2u5fNM6t8hle390nz49PH7-df2otvn7-en120WnBSWiGUFYJPkxjBjrw32IppGgSZONW9YdYqTcdeDZ0y2o5MGDUZTjpCDDWDGdlJ8-Ggu12mGczNbpSX2-RmlXYyKicfZ4Jby1W8lMPYdwPZC7y7FUjx51L3I2eXNXiv6nxLlrTjHONRjKyib_9CN3FJoY63pzrRD6zj99RKeZAu2Fj76r2oPOsxZwQPnFbq9B9UPQZmp2MA6-r_owJ6KNAp5pzA3s1IsNx7TB48JqvH5I3H5HUtevNwO3clf0xVAXYAck2FFaT7kf4j-xtCYuKt</recordid><startdate>20220401</startdate><enddate>20220401</enddate><creator>Armstrong, John</creator><creator>Balasubramanian, Ishwarya</creator><creator>Brannigan, Ann</creator><creator>Cahill, Ronan</creator><creator>Cooke, Fiachra</creator><creator>Creavin, Ben</creator><creator>Fleming, Christina</creator><general>Springer Berlin Heidelberg</general><general>Springer</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-2326-2655</orcidid></search><sort><creationdate>20220401</creationdate><title>A multicentre cohort study assessing the utility of routine blood tests as adjuncts to identify complete responders in rectal cancer following neoadjuvant chemoradiotherapy</title><author>Armstrong, John ; Balasubramanian, Ishwarya ; Brannigan, Ann ; Cahill, Ronan ; Cooke, Fiachra ; Creavin, Ben ; Fleming, Christina</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c541t-55af554bb59ef947d0f5bb851b42c7d3ffac297a86adcf935dabd41611d2d8d93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Albumin</topic><topic>Blood</topic><topic>Blood tests</topic><topic>Cancer</topic><topic>Chemoradiotherapy</topic><topic>Chemotherapy</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Colorectal cancer</topic><topic>Endoscopy</topic><topic>Gastroenterology</topic><topic>Hematologic Tests</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Inflammation</topic><topic>Internal Medicine</topic><topic>Leukocytes (neutrophilic)</topic><topic>Lymphocytes</topic><topic>Magnetic resonance imaging</topic><topic>Medical examination</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Multivariate analysis</topic><topic>Neoadjuvant Therapy</topic><topic>Original</topic><topic>Original Article</topic><topic>Patients</topic><topic>Proctology</topic><topic>Radiation therapy</topic><topic>Rectal Neoplasms - drug therapy</topic><topic>Rectal Neoplasms - therapy</topic><topic>Rectum</topic><topic>Statistical analysis</topic><topic>Surgery</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Armstrong, John</creatorcontrib><creatorcontrib>Balasubramanian, Ishwarya</creatorcontrib><creatorcontrib>Brannigan, Ann</creatorcontrib><creatorcontrib>Cahill, Ronan</creatorcontrib><creatorcontrib>Cooke, Fiachra</creatorcontrib><creatorcontrib>Creavin, Ben</creatorcontrib><creatorcontrib>Fleming, Christina</creatorcontrib><creatorcontrib>Eastern Rectal Cancer Response Collaborative, Ireland</creatorcontrib><collection>Springer_OA刊</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International journal of colorectal disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Armstrong, John</au><au>Balasubramanian, Ishwarya</au><au>Brannigan, Ann</au><au>Cahill, Ronan</au><au>Cooke, Fiachra</au><au>Creavin, Ben</au><au>Fleming, Christina</au><aucorp>Eastern Rectal Cancer Response Collaborative, Ireland</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A multicentre cohort study assessing the utility of routine blood tests as adjuncts to identify complete responders in rectal cancer following neoadjuvant chemoradiotherapy</atitle><jtitle>International journal of colorectal disease</jtitle><stitle>Int J Colorectal Dis</stitle><addtitle>Int J Colorectal Dis</addtitle><date>2022-04-01</date><risdate>2022</risdate><volume>37</volume><issue>4</issue><spage>957</spage><epage>965</epage><pages>957-965</pages><issn>1432-1262</issn><issn>0179-1958</issn><eissn>1432-1262</eissn><abstract>Purpose
Management of rectal cancer with a complete clinical response (cCR) to neoadjuvant chemoradiotherapy (NACRT) is controversial. Some advocate “watch and wait” programmes and organ-preserving surgery. Central to these strategies is the ability to accurately preoperatively distinguish cCR from residual disease (RD). We sought to identify if post-NACRT (preoperative) inflammatory markers act as an adjunct to MRI and endoscopy findings for distinguishing cCR from RD in rectal cancer.
Methods
Patients from three specialist rectal cancer centres were screened for inclusion (2010–2015). For inclusion, patients were required to have completed NACRT, had a post-NACRT MRI (to assess mrTRG) and proceeded to total mesorectal excision (TME). Endoluminal response was assessed on endoscopy at 6–8 weeks post-NACRT. Pathological response to therapy was calculated using a three-point tumour regression grade system (TRG1-3). Neutrophil–lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), serum albumin (SAL), CEA and CA19-9 levels post-NACRT (preoperatively) were recorded. Variables were compared between those who had RD on post-operative pathology and those with ypCR. Statistical analysis was performed using SPSS (version 21).
Results
Six hundred forty-six patients were screened, of which 422 were suitable for inclusion. A cCR rate of 25.5% (
n
= 123) was observed. Sixty patients who achieved cCR were excluded from final analysis as they underwent organ-preserving surgery (local excision) leaving 63 ypCR patients compared to 359 with RD. On multivariate analysis, combining cCR on MRI and endoscopy with NLR < 5 demonstrated the greatest odds of ypCR on final histological assessment [OR 6.503 (1.594–11.652])
p
< 0.001]. This method had the best diagnostic accuracy (AUC = 0.962 95% CI 0.936–0.987), compared to MRI (AUC = 0.711 95% CI 0.650–0.773) or endoscopy (AUC = 0.857 95% CI 0.811–0.902) alone or used together (AUC = 0.926 95% CI 0.892–0.961).
Conclusion
Combining post-NACRT inflammatory markers with restaging MRI and endoscopy findings adds another avenue to aid distinguishing RD from cCR in rectal cancer.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>35325271</pmid><doi>10.1007/s00384-022-04103-z</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-2326-2655</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1432-1262 |
| ispartof | International journal of colorectal disease, 2022-04, Vol.37 (4), p.957-965 |
| issn | 1432-1262 0179-1958 1432-1262 |
| language | eng |
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| subjects | Albumin Blood Blood tests Cancer Chemoradiotherapy Chemotherapy Cohort analysis Cohort Studies Colorectal cancer Endoscopy Gastroenterology Hematologic Tests Hepatology Humans Inflammation Internal Medicine Leukocytes (neutrophilic) Lymphocytes Magnetic resonance imaging Medical examination Medicine Medicine & Public Health Multivariate analysis Neoadjuvant Therapy Original Original Article Patients Proctology Radiation therapy Rectal Neoplasms - drug therapy Rectal Neoplasms - therapy Rectum Statistical analysis Surgery Tumors |
| title | A multicentre cohort study assessing the utility of routine blood tests as adjuncts to identify complete responders in rectal cancer following neoadjuvant chemoradiotherapy |
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