Background: Preoperative chemoradiotherapy (CRT) followed by surgery is the standard care for locally advanced rectal cancer,
but tumour response to CRT and disease outcome are variable. The current study aimed to investigate the effectiveness of plasma
telomerase reverse transcriptase (TERT) levels in predicting tumour response and clinical outcome.
Methods: 176 rectal cancer patients were included. Plasma samples were collected at baseline (before CRT\ubcT0), 2 weeks after
CRT was initiated (T1), post-CRT and before surgery (T2), and 4\u20138 months after surgery (T3) time points. Plasma TERT mRNA levels
and total cell-free RNA were determined using real-time PCR.
Results: Plasma levels of TERT were significantly lower at T2 (Po0.0001) in responders than in non-responders. Post-CRT TERT
levels and the differences between pre- and post-CRT TERT levels independently predicted tumour response, and the prediction
model had an area under curve of 0.80 (95% confidence interval (CI) 0.73\u20130.87). Multiple analysis demonstrated that patients with
detectable TERT levels at T2 and T3 time points had a risk of disease progression 2.13 (95% CI 1.10\u20134.11)-fold and 4.55 (95% CI
1.48\u201313.95)-fold higher, respectively, than those with undetectable plasma TERT levels.
Conclusions: Plasma TERT levels are independent markers of tumour response and are prognostic of disease progression in rectal
cancer patients who undergo neoadjuvant therapy
