Rectal cancer patients with downstaging after neoadjuvant chemoradiotherapy and radical resection do not benefit from adjuvant chemotherapy

Hang Zhang, Ya Huang, Ge Sun, Kuo Zheng, Zheng Lou, Xian-Hua Gao, Li-Qiang Hao, Lian-Jie Liu, Rong-Gui Meng, Wei Zhang*

*Corresponding author for this work

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    Abstract

    Background: Whether adjuvant chemotherapy is beneficial for rectal cancer patients who respond well to neoadjuvant chemoradiotherapy (NCRT) and undergo radical resection is controversial. This study aimed to assess the effect of adjuvant chemotherapy on the oncological outcomes of ypT0-2N0 rectal cancer patients after NCRT and radical resection, and identify the prognostic factors.

    Methods: The clinical and pathological data of rectal cancer patients with ypT0-2N0 who underwent NCRT and radical resection between January, 2010 and June, 2018 were collected and retrospectively analyzed. The oncological outcomes of the chemotherapy (chemo) group and the non-chemotherapy (non-chemo) group were compared. Multivariate analysis, using a Cox proportional hazard model, was performed to identify independent predictors of oncological outcome.

    Results: Of the 121 rectal cancer patients enrolled, 90 patients received postoperative adjuvant chemotherapy with no fewer than 3 cycles (the chemo group), and the other 31 patients with fewer than 3 cycles (the non-chemo group). There was no significant difference in the 5-year disease-free survival (DFS) or overall survival (OS) rates between the two groups (DFS: 79.1% vs. 82.9%, P=0.442; OS: 87.5% vs. 78.2%, P=0.667). cT4 is an independent risk factor for OS (HR =4.227, 95% CI: 1.128-15.838, P=0.02) and DFS (HR =4.878, 95% CI: 1.752-13.578). Preoperative consolidation chemotherapy with Capeox or FOLFOX after NCRT significantly improved the DFS rate (HR =0.212, 95% CI: 0.058-0.776, P=0.019).

    Conclusions: Rectal cancer patients with ypT0-2N0 who underwent NCRT and radical resection did not benefit significantly from postoperative adjuvant chemotherapy. For these patients, cT4 was an independent risk factor for OS and DFS. Preoperative consolidation chemotherapy with Capeox or FOLFOX after NCRT can significantly improve DFS.

    Original languageEnglish
    Article number743
    Number of pages10
    JournalTranslational Research
    Volume8
    Issue number12
    DOIs
    Publication statusPublished - Jun-2020

    Keywords

    • Rectal cancer
    • adjuvant chemotherapy
    • neoadjuvant chemoradiotherapy (NCRT)
    • downstaging
    • prognosis
    • PATHOLOGICAL COMPLETE RESPONSE
    • TOTAL MESORECTAL EXCISION
    • PHASE-III TRIAL
    • PREOPERATIVE CHEMORADIOTHERAPY
    • COLORECTAL-CANCER
    • FOLLOW-UP
    • FLUOROURACIL
    • THERAPY
    • COLON
    • STAGE

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