Vimentin and tumor–stroma ratio for neoadjuvant chemoradiotherapy response prediction in locally advanced rectal cancer

Vimentin expression in tumor tissues and the tumor–stroma ratio (TSR) have been demonstrated as strong prognostic factors for cancer patients, but whether they are predictive markers of neoadjuvant chemoradiotherapy (nCRT) outcome in locally advanced rectal cancer (LARC) patients is poorly understood. This study aimed to explore the predictive significance of vimentin and TSR combined for nCRT response in LARC patients. Imaging mass cytometry (IMC) was performed to determine the association of vimentin and TSR with nCRT response in six LARC patients [three achieved pathological complete response (pCR), three did not]. Immunohistochemistry (IHC) for vimentin and TSR on biopsy tissues before nCRT and logistic regression analysis were performed to further evaluate their predictive value for treatment responses in a larger patient cohort. A trend of decreased vimentin expression and increased TSR in the pCR group was revealed by IMC. In the validation group, vimentin [odds ratio (OR) 0.260, 95% confidence interval (CI) 0.102–0.602, p = 0.002] and TSR (OR 4.971, 95% CI 1.933–15.431, p = 0.002) were associated with pCR by univariate analysis. Patients in the vimentin‐low/TSR‐low or vimentin‐high/TSR‐high (OR 5.211, 95% CI 1.248–35.582, p = 0.042) and vimentin‐low/TSR‐high groups (OR 11.846, 95% CI 3.197–77.079, p = 0.001) had significantly higher odds of pCR. By multivariate analysis, only the combination of vimentin and TSR was an independent predictor for nCRT response (OR 9.324, 95% CI 2.290–63.623, p = 0.006). Our study suggested that the combined assessment of vimentin and TSR can provide additive significance and may be a promising indicator of nCRT response in LARC patients.