The predictive value of apoptosis protease-activating factor 1 in rectal tumors treated with preoperative, high-dose-rate brachytherapy

BACKGROUND. The objective of this study was to assess the value of apoptosis protease-activating factor 1 (APAF-1) as a predictive marker of response in rectal tumors treated with preoperative, high-dose-rate endorectal brachytherapy. METHODS. Immunohistochemistry for APAF-1 was performed on 94 rectal tumor biopsy specimens from patients who were treated on a preoperative, high-dose-rate brachytherapy protocol. Tumors were considered positive when > 10% of tumor cells were immunoreactive. The association between APAF-1 expression and tumor response was made using the chi-square test. RESULTS. Forty-four tumors (43%) were positive for APAF-1. Thirty tumors had complete pathologic tumor regression after preoperative radiotherapy. Of these, 18 tumors were positive for APAF-1. A partial response occurred in 35 tumors. Eighteen tumors (51%) were positive for the protein. Only 8 of 29 nonresponsive tumors (28%) were immunoreactive for APAF-1. A significant association was found between complete tumor regression and positive APAF-1 status (P = 0.018). APAF-1 expression in partially responsive tumors was significantly greater than in nonresponsive tumors (P = 0.03). CONCLUSIONS. APAF-1 expression in pretreatment rectal tumor biopsy specimens may be useful as a predictive marker of response to preoperative radiotherapy in patients with rectal carcinoma.