Evaluating the benefit of adjuvant chemotherapy in patients with ypT0–1 rectal cancer treated with preoperative chemoradiotherapy

doi:10.4240/wjgs.v13.i9.1000

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World Journal of Gastrointestinal Surgery

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World J Gastrointest Surg. Sep 27, 2021; 13(9): 1000-1011
Published online Sep 27, 2021. doi: 10.4240/wjgs.v13.i9.1000

Evaluating the benefit of adjuvant chemotherapy in patients with ypT0–1 rectal cancer treated with preoperative chemoradiotherapy

Ye Won Jeon, In Ja Park, Jeong Eun Kim, Jin-Hong Park, Seok-Byung Lim, Chan Wook Kim, Yong Sik Yoon, Jong Lyul Lee, Chang Sik Yu, Jin Cheon Kim

Ye Won Jeon, Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul 05505, South Korea

In Ja Park, Seok-Byung Lim, Chan Wook Kim, Yong Sik Yoon, Jong Lyul Lee, Chang Sik Yu, Jin Cheon Kim, Department of Colon and Rectal Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul 05505, South Korea

Jeong Eun Kim, Department of Oncology, Asan Medical Center and University of Ulsan College of Medicine, Seoul 05505, South Korea

Jin-Hong Park, Department of Radiation Oncology, Asan Medical Center and University of Ulsan College of Medicine, Seoul 05505, South Korea

Author contributions: Jeon YW and Park IJ conceptualized and designed the study and wrote the manuscript; Jeon YW provided data analysis and literature review; Kim JE and Park JH provided clinical data and critical revision; Lim SB, Lee JL, Yoon YS, Kim CW, Yu CS, and Kim JC critical revision and editing, and all authors approved of the final version.

Institutional review board statement: This study was approved by the Institutional Review Board of the Asan Medical Center, No. 2017-1114.

Informed consent statement: The requirement for obtaining an informed consent was waived.

Conflict-of-interest statement: The authors declare no conflicts of interest.

Data sharing statement: Data are available upon reasonable request. We may be able to share de-identified participant data with researchers following the publication of this manuscript. Requests for data should be directed to the corresponding author. Data sharing will need to be approved by third-party data providers.

Corresponding author: In Ja Park, MD, PhD, Doctor, Professor, Surgeon, Department of Colon and Rectal Surgery, Asan Medical Center and University of Ulsan College of Medicine, No. 88 Olympic-ro, Songpa-gu, Seoul 05505, South Korea. ipark@amc.seoul.kr

Received: February 21, 2021
Peer-review started: February 21, 2021
First decision: May 13, 2021
Revised: May 22, 2021
Accepted: August 2, 2021
Article in press: August 2, 2021
Published online: September 27, 2021
Processing time: 209 Days and 9 Hours

Abstract

BACKGROUND

Adjuvant chemotherapy (ACTx) is recommended in rectal cancer patients after preoperative chemoradiotherapy (PCRT), but its efficacy in patients in the early post-surgical stage who have a favorable prognosis is controversial.

AIM

To evaluate the long-term survival benefit of ACTx in patients with ypT0–1 rectal cancer after PCRT and surgical resection.

METHODS

We identified rectal cancer patients who underwent PCRT followed by surgical resection at the Asan Medical Center from 2005 to 2014. Patients with ypT0–1 disease and those who received ACTx were included. The 5-year overall survival (OS) and 5-year recurrence-free survival (RFS) were analyzed according to the status of the ACTx.

RESULTS

Of 520 included patients, 413 received ACTx (ACTx group) and 107 did not (no ACTx group). No significant difference was observed in 5-year RFS (ACTx group, 87.9% vs no ACTx group, 91.4%, P = 0.457) and 5-year OS (ACTx group, 90.5% vs no ACTx group, 86.2%, P = 0.304) between the groups. cT stage was associated with RFS and OS in multivariate analysis [hazard ratio (HR): 2.57, 95% confidence interval (CI): 1.07–6.16, P = 0.04 and HR: 2.27, 95%CI: 1.09–4.74, P = 0.03, respectively]. Furthermore, ypN stage was associated with RFS and OS (HR: 4.74, 95%CI: 2.39–9.42, P < 0.00 and HR: 4.33, 95%CI: 2.20–8.53, P < 0.00, respectively), but only in the radical resection group.

CONCLUSION

Oncological outcomes of patients with ypT0–1 rectal cancer who received ACTx after PCRT showed no improvement, regardless of the radicality of resection. Further trials are needed to evaluate the efficacy of ACTx in these group of patients.

Keywords: Rectal neoplasm; Adjuvant chemotherapy; ypT0-1; Radical resection; Local excision

Core Tip: Adjuvant chemotherapy (ACTx) is administered based on the clinical stage of rectal cancer after preoperative chemoradiotherapy (PCRT), regardless of post-treatment pathologic stage. Prognosis differs according to post-treatment pathologic stage or regression grade. Adjuvant treatment may be administered based on prognostic influence. Patients with ypT0-1 rectal cancer with favorable oncologic outcomes were included. Since local excision (LE) frequency has increased, ACTx effects in these patients need to be studied. We included patients who underwent LE. ACTx in patients with ypT0-1 rectal cancer after PCRT and LE did not exert benefits in terms of overall survival and recurrence-free survival.