Ann Coloproctol.  2019 Dec;35(6):335-341. 10.3393/ac.2019.03.10.

Impact of Adjuvant Chemotherapy Completion on Oncologic Outcomes in ypTNMstage 2 Rectal Cancer Patients

Affiliations
  • 1Department of Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. stoh@catholic.ac.kr
  • 2Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. bsmin@yuhs.ac
  • 3OpenNBI Convergence Technology Laboratory, Avison Biomedical Research Centre, Yonsei University College of Medicine, Seoul, Korea.
  • 4Department of Radiology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea.

Abstract

PURPOSE
Adjuvant chemotherapy (aCT) in rectal cancer patients who have undergone curative resection after neoadjuvant chemoradiation (nCRT) is controversial. We aimed to investigate the benefits of using aCT and the clinical impact of completing aCT in ypstage 2 rectal cancer patients.
METHODS
We retrospectively reviewed clinicopathological data from patients who had undergone radical resection after nCRT between January 2006 and December 2012. In total, 152 patients with ypT3/4N0M0 rectal cancer were included. Of these patients, 139 initiated aCT, while 13 did not receive aCT (no-aCT). Among those who received aCT, 132 patients completed their planned cycles (aCT-completion) whereas 7 did not (aCT-incompletion). All patients received longcourse chemoradiation; a 5-fluorouracil-based regimen was used for nCRT in most patients. The prognostic factors affecting disease-free survival (DFS) and overall survival (OS) were analyzed.
RESULTS
The median follow-up duration was 41 months. Demographic data did not differ significantly among the 3 groups. In multivariate analysis, open surgery, a tumor size >2 cm, retrieval of <12 lymph nodes, circumferential resection margin (CRM) positivity and aCT incompletion were independent prognostic factors for poor DFS. Old age (≥60 years), open surgery, CRM positivity, aCT incompletion, and lack of aCT initiation compared to aCT completion were independent prognostic factors for poor OS.
CONCLUSION
In ypstage 2 rectal cancer patients, aCT after nCRT and total mesorectal excision affected both DFS and OS; however, only patients who completed planned aCT exhibited survival benefits. Therefore, improving patients' compliance with the completion of aCT is desirable.

Keyword

Rectal neoplasm; Neoadjuvant therapy; Chemoradiotherapy; Adjuvant chemotherap

MeSH Terms

Chemoradiotherapy
Chemotherapy, Adjuvant*
Compliance
Disease-Free Survival
Follow-Up Studies
Humans
Lymph Nodes
Multivariate Analysis
Neoadjuvant Therapy
Rectal Neoplasms*
Retrospective Studies
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