Preoperative radiotherapy does not improve and may even be detrimental to the long-term prognosis of patients diagnosed with stage III colon adenocarcinoma: a propensity score-matched SEER database analysis

Abstract

BackgroundCurrently, for patients with colon adenocarcinoma who are diagnosed with local lymph node metastasis, it is typically recommended to undergo neoadjuvant treatment before undergoing curative surgical intervention. Nowadays, the focus of preoperative adjuvant therapy for colon adenocarcinoma patients mainly revolves around chemotherapy, and the impact of preoperative radiotherapy on long-term prognosis remains uncertain.MethodsWe extracted data from the Surveillance, Epidemiology, and End Results database for patients with stage III colon adenocarcinoma between 2004 and 2019. Using propensity score matching (PSM), the patients were divided into a preoperative radiotherapy group and a non-preoperative radiotherapy group, and the differences in Kaplan-Meier (KM) survival curves between the two groups were compared. Cox regression analysis was employed to identify clinical factors that influence survival in stage III colon adenocarcinoma, and the prognostic differences between the two groups were compared within specific subgroups of these clinical factors.ResultsAfter PSM, a total of 242 patients were included in the study, divided into the preoperative radiotherapy group and the non-preoperative radiotherapy group. There were no statistically significant differences in important clinical characteristics between the two groups. KM analysis revealed no statistically significant difference in overall survival (OS) between the two groups. Furthermore, age, chemotherapy, T staging, N staging, race, tumor grade, gender, tumor location, and tumor diameter were identified as important factors influencing the prognosis of patients. Within each level of the aforementioned subgroups, there were no differences in OS between the two groups. In fact, in specific subgroups, the non-preoperative radiotherapy group exhibited better OS than the preoperative radiotherapy group.ConclusionPreoperative radiotherapy does not improve the long-term prognosis of patients with stage III colon adenocarcinoma. In certain patient populations with specific clinical characteristics, preoperative radiotherapy may even lead to a decrease in OS.