Role of adjuvant chemotherapy in locally advanced rectal cancer with ypT0-3N0 after preoperative chemoradiation therapy and surgery

Chang Gon Kim, Joong Bae Ahn, Sang Joon Shin, Seung Hoon Beom, Su Jin Heo, Hyung Soon Park, Jee Hung Kim, Eun Ah Choe, Woong Sub Koom, Hyuk Hur, Byung Soh Min, Nam Kyu Kim, Hoguen Kim, Chan Kim, Inkyung Jung, Minkyu Jung

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Abstract

Background: We aimed to explore the clinical benefit of adjuvant chemotherapy (AC) with fluoropyrimidine in patients with ypT0-3N0 rectal cancer after preoperative chemoradiation therapy (CRT) followed by total mesorectal excision (TME). Methods: Patients with ypT0-3N0 rectal cancer after preoperative CRT and TME were included using prospectively collected tumor registry cohort between January 2001 and December 2013. Patients were categorized into two groups according to the receipt of AC. Disease-free survival (DFS) and overall survival (OS) were compared between the adjuvant and observation groups. To control for potential confounding factors, we also calculated propensity scores and performed propensity score-matched analysis for DFS and OS. Results: Of the 339 evaluated patients, 87 patients (25.7%) did not receive AC. There were no differences in DFS (hazard ratio [HR], 0.921; 95% confidence interval [CI], 0.562-1.507; P = 0.742) and OS (HR, 0.835; 95% CI, 0.423-1.648; P = 0.603) between the adjuvant and observation groups. After propensity score matching, DFS (HR, 1.129; 95% CI, 0.626-2.035; P = 0.688) and OS (HR, 1.200; 95% CI, 0.539-2.669; P = 0.655) did not differ between the adjuvant and observation groups. Advanced T stage and positive resection margin were independently associated with inferior DFS and OS on multivariate analysis. Conclusions: AC did not improve DFS and OS for patients with ypT0-3N0 rectal cancer after preoperative CRT followed by TME in this cohort study. The confirmative role of AC in locally advanced rectal cancer should be evaluated in prospective randomized trials with a larger sample size.

Original languageEnglish
Article number615
JournalBMC cancer
Volume17
Issue number1
DOIs
Publication statusPublished - 2017 Sep 2

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All Science Journal Classification (ASJC) codes

  • Genetics
  • Oncology
  • Cancer Research

Cite this

Kim, C. G., Ahn, J. B., Shin, S. J., Beom, S. H., Heo, S. J., Park, H. S., Kim, J. H., Choe, E. A., Koom, W. S., Hur, H., Min, B. S., Kim, N. K., Kim, H., Kim, C., Jung, I., & Jung, M. (2017). Role of adjuvant chemotherapy in locally advanced rectal cancer with ypT0-3N0 after preoperative chemoradiation therapy and surgery. BMC cancer, 17(1), [615]. https://doi.org/10.1186/s12885-017-3624-7