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In locally advanced rectal cancer (LARC), the role and extent of adjuvant chemotherapy is still under debate. Meanwhile, some prior studies have shown the possibility of predicting survival outcome with hypoxic markers, especially with glucose transporter-1(GLUT-1) in LARC. This study aimed to investigate the prognostic role of GLUT-1 in LARC using both pre-chemoradiotherapy (CRT) and post-CRT outcomes and to identify groups may benefit from adjuvant chemotherapy.

Pre-CRT and post-CRT (surgical) specimen was collected from 208 patients with clinical T3–4 and/or node-positive rectal adenocarcinoma. All patients received neo-adjuvant CRT followed by total mesorectal excision (TME). Both the pre-CRT and post-CRT specimen were immunohistologically stained for GLUT-1 and compared to distant metastasis free survival (DMFS) and overall survival (OS).

Median follow up was 74 months. Post-CRT GLUT-1 positivity was significantly associated with inferior DMFS (p=0.027, HR 2.26) and OS (p=0.030, HR 2.30). When patients were classified into 4 groups according to yp Stage II/III and post-CRT GLUT-1 positivity (yp Stage II & GLUT-1(-), yp Stage II & GLUT-1 (+), yp Stage III & GLUT-1 (-), yp Stage III & GLUT-1 (+)), the second and third group showed 5 year DMFS of 63.9% and 65.4% with first group and fourth group showing markedly better and worse outcome of 92.3% and 46.5% (p=0.013). Similar tendency was observed with OS with 5 year OS being 91.7%, 79%, 72.7%, 43.4% respectively for group 1-4 (p=0.008).

Post-CRT GLUT-1 has significant association DMFS and OS in LARC, and may serve as a prognostic marker for selecting more fit patients for adjuvant chemotherapy.