In Ja Park1, Dae Yong Kim2, Hee Cheol Kim3, Nam Kyu Kim4, Hyeong-Rok Kim5, Sung-Bum Kang6, Gyu-Seog Choi7, Kang Young Lee8, Seon-Hahn Kim9, Seung Taek Oh10, Seok-Byung Lim1, Jin Cheon Kim1, Jae Hwan Oh2, Sun Young Kim2, Woo Yong Lee3, Jung Bok Lee11, Chang Sik Yu12. 1. Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea. 2. Center for Colorectal Cancer, National Cancer Center, Goyang-si, Korea. 3. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 4. Section of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. 5. Department of Surgery, Chonnam National University Hwansun Hospital, Gwangju, Korea. 6. Department of Surgery, Seoul National University Bungdang Hospital, Bundang, Korea. 7. Division of Colorectal Cancer Center, Kyungpook National University Medical Center, Daegu, Korea. 8. Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. 9. Department of Surgery, Korea University Anam Hospital, Seoul, Korea. 10. Department of Surgery, Seoul St. Mary Hospital, Catholic University, Seoul, Korea. 11. Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea. 12. Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea. Electronic address: csyu@amc.seoul.kr.
Abstract
OBJECTIVE: To explore the role of adjuvant chemotherapy for patients with ypT0-2N0 rectal cancer treated by preoperative chemoradiation therapy (PCRT) and radical resection. PATIENTS AND METHODS: A national consortium of 10 institutions was formed, and patients with ypT0-2N0 mid- and low-rectal cancer after PCRT and radical resection from 2004 to 2009 were included. Patients were categorized into 2 groups according to receipt of additional adjuvant chemotherapy: Adj CTx (+) versus Adj CTx (-). Propensity scores were calculated and used to perform matched and adjusted analyses comparing relapse-free survival (RFS) between treatment groups while controlling for potential confounding. RESULTS: A total of 1016 patients, who met the selection criteria, were evaluated. Of these, 106 (10.4%) did not receive adjuvant chemotherapy. There was no overall improvement in 5-year RFS as a result of adjuvant chemotherapy [91.6% for Adj CTx (+) vs 87.5% for Adj CTx (-), P=.18]. There were no differences in 5-year local recurrence and distant metastasis rate between the 2 groups. In patients who show moderate, minimal, or no regression in tumor regression grade, however, possible association of adjuvant chemotherapy with RFS would be considered (hazard ratio 0.35; 95% confidence interval 0.14-0.88; P=.03). Cox regression analysis after propensity score matching failed to show that addition of adjuvant chemotherapy was associated with improved RFS (hazard ratio 0.81; 95% confidence interval 0.39-1.70; P=.58). CONCLUSIONS: Adjuvant chemotherapy seemed to not influence the RFS of patients with ypT0-2N0 rectal cancer after PCRT followed by radical resection. Thus, the addition of adjuvant chemotherapy needs to be weighed against its oncologic benefits.
OBJECTIVE: To explore the role of adjuvant chemotherapy for patients with ypT0-2N0 rectal cancer treated by preoperative chemoradiation therapy (PCRT) and radical resection. PATIENTS AND METHODS: A national consortium of 10 institutions was formed, and patients with ypT0-2N0 mid- and low-rectal cancer after PCRT and radical resection from 2004 to 2009 were included. Patients were categorized into 2 groups according to receipt of additional adjuvant chemotherapy: Adj CTx (+) versus Adj CTx (-). Propensity scores were calculated and used to perform matched and adjusted analyses comparing relapse-free survival (RFS) between treatment groups while controlling for potential confounding. RESULTS: A total of 1016 patients, who met the selection criteria, were evaluated. Of these, 106 (10.4%) did not receive adjuvant chemotherapy. There was no overall improvement in 5-year RFS as a result of adjuvant chemotherapy [91.6% for Adj CTx (+) vs 87.5% for Adj CTx (-), P=.18]. There were no differences in 5-year local recurrence and distant metastasis rate between the 2 groups. In patients who show moderate, minimal, or no regression in tumor regression grade, however, possible association of adjuvant chemotherapy with RFS would be considered (hazard ratio 0.35; 95% confidence interval 0.14-0.88; P=.03). Cox regression analysis after propensity score matching failed to show that addition of adjuvant chemotherapy was associated with improved RFS (hazard ratio 0.81; 95% confidence interval 0.39-1.70; P=.58). CONCLUSIONS: Adjuvant chemotherapy seemed to not influence the RFS of patients with ypT0-2N0 rectal cancer after PCRT followed by radical resection. Thus, the addition of adjuvant chemotherapy needs to be weighed against its oncologic benefits.
Authors: Ali Bohlok; Alain Hendlisz; Fikri Bouazza; Maria Gomez Galdon; Jean Van de Stadt; Luigi Moretti; Issam El Nakadi; Gabriel Liberale Journal: Int J Colorectal Dis Date: 2018-07-08 Impact factor: 2.571
Authors: Hang Zhang; Ya Huang; Ge Sun; Kuo Zheng; Zheng Lou; Xian-Hua Gao; Li-Qiang Hao; Lian-Jie Liu; Rong-Gui Meng; Wei Zhang Journal: Ann Transl Med Date: 2020-06