Oncologic benefit of adjuvant chemotherapy for locally advanced rectal cancer after neoadjuvant chemoradiotherapy and curative surgery with selective lateral pelvic lymph node dissection: An international retrospective cohort study |
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| Institution: | 1. Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan;2. Colorectal Cancer Center, Kyungpook National University Medical Center, Department of Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea;3. Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan;4. Division of Colorectal Surgery, Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center, Daegu, South Korea;1. Department of Medical and Surgical Sciences (DIMEC), IRCCS Sant’Orsola-Malpighi, Obstetric and Gynecologic Unit, University of Bologna, Bologna, Italy;2. Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP. Centre, Université de Paris, Paris, France;3. INSERM UMR-S 1124, Université de Paris, Centre Universitaire des Saint-Père, Paris, France;4. INSERM UMR-S 1147, Université de Paris, Centre de Recherche des Cordeliers, Paris, France;1. Department of Surgical Sciences, Department of Colorectal Surgery, Uppsala University, 752 36, Uppsala, Sweden;2. Department of Surgical Sciences, Department of Colorectal Surgery, Uppsala University Hospital, S-751 85, Uppsala, Sweden;1. Department of Surgery, The Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA;2. Department of Geriatrics, The Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA;1. Department of Gynaecological Oncology, The Pan-Birmingham Gynaecological Cancer Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK;2. Department of Gynaecology, Worcestershire Acute Hospitals NHS Trust, Worcester, UK;3. Institute of Cancer and Genomic Sciences, University of Birmingham, UK;1. Peter MacCallum Cancer Centre, Division of Surgical Oncology, Australia;2. Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia;3. Peter MacCallum Cancer Centre, Division of Medical Oncology, Australia;4. Peter MacCallum Cancer Centre, Division of Cancer Imaging, Australia;5. Peter MacCallum Cancer Centre, Division of Anatomical Pathology, Australia;1. Department of Hepatobiliary and Pancreatic Surgery, Oxford University Hospitals NHS Foundation Trust, UK;2. Queen''s University Belfast, University Road, Belfast, Northern Ireland, UK |
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| Abstract: | IntroductionIntensive local treatment comprising total mesorectal excision (TME) with selective lateral pelvic lymph node dissection (LPND) after neoadjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC) has received attention among clinicians treating rectal cancer. It remains unclear whether adjuvant chemotherapy (ACT) after intensive local treatment is beneficial for these patients. We evaluated the oncologic benefit of ACT for patients with LARC who received intensive local treatment.Materials and methodsThis international multicentre retrospective cohort study included 737 patients treated in Japan and Korea between 2010 and 2017. The effectiveness of ACT on recurrence-free survival (RFS) was evaluated using univariable and multivariable Cox proportional hazards models, with subgroup analyses to identify subpopulations potentially benefiting from ACT.ResultsThe median follow-up was 49 months; the 5-year RFS and local recurrence rates for the entire cohort were 72.1% and 4.9%, respectively; 514 patients (69.7%) received adjuvant chemotherapy, without an oncologic benefit (hazard ratio, 1.14; 95% confidence interval CI]: 0.79–1.68) demonstrated in the multivariable Cox regression analysis. In subgroup analyses, the distributions of the 95% CI in patients aged ≥70 years and those with ypStage 0 tended to place a disproportionate emphasis that favoured the non-ACT treatment strategy.ConclusionDespite achieving good local control with intensive local treatment strategy, the effectiveness of ACT for the LARC patients with CRT followed by TME with selective LPND was not proved. Elderly patients and those with ypStage0 may not receive benefit from ACT after CRT and TME ± LPND. |
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| Keywords: | Rectal cancer Chemoradiotherapy Lateral pelvic lymph node dissection Adjuvant chemotherapy |
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