Sheng XQ, Wang HZ, Li S, Zhang YZ, Geng JH, Zhu XG, Quan JZ, Li YH, Cai Y, Wang WH. Consolidation chemotherapy with capecitabine after neoadjuvant chemoradiotherapy in high-risk patients with locally advanced rectal cancer: Propensity score study. World J Gastrointest Oncol 2022; 14(9): 1711-1726 [PMID: 36187388 DOI: 10.4251/wjgo.v14.i9.1711]
Corresponding Author of This Article
Wei-Hu Wang, MD, Chief Physician, Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Fucheng Road, Beijing 100142, China. wangweihu88@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
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Sheng XQ, Wang HZ, Li S, Zhang YZ, Geng JH, Zhu XG, Quan JZ, Li YH, Cai Y, Wang WH. Consolidation chemotherapy with capecitabine after neoadjuvant chemoradiotherapy in high-risk patients with locally advanced rectal cancer: Propensity score study. World J Gastrointest Oncol 2022; 14(9): 1711-1726 [PMID: 36187388 DOI: 10.4251/wjgo.v14.i9.1711]
World J Gastrointest Oncol. Sep 15, 2022; 14(9): 1711-1726 Published online Sep 15, 2022. doi: 10.4251/wjgo.v14.i9.1711
Consolidation chemotherapy with capecitabine after neoadjuvant chemoradiotherapy in high-risk patients with locally advanced rectal cancer: Propensity score study
Xue-Qing Sheng, Hong-Zhi Wang, Shuai Li, Yang-Zi Zhang, Jian-Hao Geng, Xiang-Gao Zhu, Yong-Heng Li, Yong Cai, Wei-Hu Wang, Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, China
Xue-Qing Sheng, Department of Radiation Oncology, Peking University People's Hospital, Beijing 100044, China
Ji-Zhong Quan, Department of Radiation Oncology, Jilin Guowen Hospital, Gongzhuling 136199, Jilin Province, China
Author contributions: Wang WH and Cai Y are responsible for the manuscript conceptualization; Sheng XQ, Wang HZ, Zhang YZ and Geng JH are responsible for the methodology; Sheng XQ and Wang HZ are responsible for the formal analysis; Sheng XQ, Li S and Wang HZ are responsible for the investigation; Wang WH, YL, Cai Y and Zhu XG collect the resources; Sheng XQ, Li S, Zhang YZ and Geng JH do the data curation; Sheng XQ write the original draft; Wang WH and Cai Y are responsible for the reviewing and editing; Li YH and Quan JZ are responsible for the supervision; Li S, Wang HZ, Geng JH, and Zhu XG do the project administration.
Supported byBeijing Municipal Science and Technology Commission, No. Z181100001718192; Capital’s Funds for Health Improvement and Research, No. 2020-2-1027 and No. 2020-1-4021; National Natural Science Foundation, No. 82073333.
Institutional review board statement: The study was approved by the Ethics Committee of Peking University Cancer Hospital review board, No. 2021YJZ62.
Informed consent statement: Informed consent from patients was waived by the Ethics Committee of Peking University Cancer Hospital review board.
Conflict-of-interest statement: All authors report no relevant conflict of interest for this article.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding authors on reasonable request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Corresponding author: Wei-Hu Wang, MD, Chief Physician, Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Fucheng Road, Beijing 100142, China. wangweihu88@163.com
Received: April 29, 2022 Peer-review started: April 29, 2022 First decision: July 6, 2022 Revised: July 14, 2022 Accepted: August 9, 2022 Article in press: August 9, 2022 Published online: September 15, 2022 Processing time: 133 Days and 5.9 Hours
ARTICLE HIGHLIGHTS
Research background
Patients with locally advanced rectal cancer (LARC) who achieved complete response (CR) after neoadjuvant therapy had a better prognosis, but the optimal neoadjuvant therapy regimen remained unclear.
Research motivation
Several studies have suggested that consolidation chemotherapy (CC) after neoadjuvant chemoradiotherapy (NCRT) seemed to improve CR rate, however it also prolonged interval between NCRT and surgery, making surgery more difficult. Besides, in the concurrent chemotherapy, the additional oxaliplatin not only increased toxicity but also failed to improve the efficacy. Further, high-risk patients with LARC were less likely to achieve CR, and had worse prognosis than patients in low-risk. Considering the efficacy and low toxicity of capecitabine in the treatment of rectal cancer and the convenience of oral therapy, we designed this retrospective study.
Research objectives
To evaluate the effects of one to two cycles of CC with capecitabine in high-risk patients with LARC without extending NCRT and surgery interval.
Research methods
From January 2015 to July 2019, high-risk patients with LARC were divided into the CC and non-CC group according to whether they received CC after NCRT. Propensity score matching (PSM) and inverse probability of treatment weight (IPTW) were used to balance the differences between the two groups.
Research results
After PSM and IPTW, the CR rate in the CC group was higher than that in the non-CC group. The median follow-up was over three years, and there were no differences in 3-year non-regrowth disease-free survival nor overall survival in the two groups. There was also no increase in acute toxicity in the CC group.
Research conclusions
Our study first confirmed without extending the interval between the end of NCRT and surgery, one to two cycles of CC with capecitabine after NCRT was safe and increased the CR rate in high-risk patients with LARC. However, it failed to improve long-term outcomes.
Research perspectives
Further studies with more participants and a longer follow-up period need to be investigated to confirm these findings.
