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Considering the histological classification, a higher prevalence of positive Ki67 proliferation index was found in cases achieving the pathological response [5/7 (71%) pCR vs. 11/35 (31%) non-pCR]; a positive pERK1-2 expression was instead observed in patients who did not achieve the pathological response [0/8 pCR vs. 5/45 (11%) non-pCR] (Table 3).
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Although several randomised trials in patients with triple-negative breast cancer have shown that the addition of carboplatin, with or without poly(ADP-ribose) polymerase (PARP) inhibitors, to neoadjuvant chemotherapy increases the likelihood of achieving a pathological complete response, the use of these therapies in this setting has remained controversial.
Nonetheless, the probability of achieving a pathological residual <3 cm as predicted from the nomogram was 39%, but the observed rate was 73.3%.
More recently, the Southwest Oncology Group designed a trimodal, Phase II, single-arm trial with the objective of achieving a pathological complete remission (pCR) rate of 40% after neoadjuvant treatment with oxaliplatin/5-FU/radiation and adjuvant chemotherapy in esophageal adenocarcinoma.
Multivariate analysis confirmed a significant interaction between nodal status and the probability of achieving a pathological response (P=0.023) and between TS expression and treatment, indicating that a high TS level is predictive of a higher pathological response in the RCT subset (P=0.007).
It was anticipated, therefore, that where additional therapy given before surgery increased the proportion of patients achieving such pathological complete responses (pCR), this would lead to gains in long-term outcome.
Moreover, the degree of response to PST is considered an indicator of patient outcome, and the patients achieving pathological complete response (pCR) after PST have excellent disease-free and overall survival (Chollet et al, 2002).
Publications are sparse for resectable rectal cancer, and rely mainly on a single institution (McGill University in Montreal) which has reported significant tumour regression in over 300 patients, over 29% of the patients achieving a complete pathological response at surgery [80 82].
We also investigated if c-Myb expression levels correlated with achieving a pathological complete response (pCR), which is a measure of tumor response to neoadjuvant chemotherapy.
Patients achieving complete pathological response to NAC showed a non-significant trend towards better OS (P = 0.08).
These early results show encouraging symptomatic and objective responses of gastro-oesophageal carcinoma to ECF, but provide no instances of ECF achieving complete pathological response.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com