Abstract
BackgroundWe 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).MethodsPatients 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.ResultsOf 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.ConclusionsAC 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.
Highlights
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)
Patient characteristics Of the 365 patients with locally advanced rectal cancer (LARC) who underwent neoadjuvant CRT with 5-FU or capecitabine followed by TME, 5 patients who underwent a trans-anal excision and 21 patients who sequentially received AC with oxaliplatin were excluded (Fig. 1)
In this study, we evaluated the outcomes of LARC for patients with ypT0-3N0, who are considered to have a relatively good prognosis, after preoperative CRT followed by TME, based on receipt of AC
Summary
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). Patients with a high risk for recurrence (yp stage III) benefited from adding oxaliplatin to 5-FU as AC after preoperative 5-FU-based CRT and TME [15]. With these heterogeneous results about the role of AC, we aimed to investigate the value of AC with fluoropyrimidine mono-therapy after preoperative CRT and TME in ypT0-3N0 patients, who are considered to have a good prognosis
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