Effectiveness of neoadjuvant concurrent chemoradiotherapy versus up-front proctectomy in clinical stage II–III rectal cancer

A population-based study

Tao Wei Ke, Yu Min Liao, Hua Che Chiang, Sheng Chi Chang, Pin Hui Wang, Yi Ya Chen, William Tzu Liang Chen, Chun Ru Chien

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Aims: Neoadjuvant concurrent chemoradiotherapy (NCCRT) is currently the preferred treatment for rectal cancer of clinical stage II–III based on its efficacy in clinical trials. The population-based effectiveness of NCCRT is rarely reported on in the literature. The purpose of our study is to investigate the nationwide population-based effectiveness of NCCRT as compared with up-front proctectomy. Methods: In this retrospective cohort study, we identified the study population by linking datasets including the cancer registry, death registry and other related files in Taiwan. We identified all patients with rectal adenocarcinoma of American Joint Committee on Cancer clinical stage II or III who were diagnosed in 2007 or 2008 and received either NCCRT or up-front proctectomy. We included patients' age, gender, residence, socioeconomic status and clinical stage as covariables. We used overall survival as the measure of effectiveness. The Cox proportional-hazards regression model was used for statistical analyses. We further conducted sensitivity analyses, one in only those who received optimal postoperative chemotherapy and one in two subgroups matched for propensity score. Results: We included 1933 patients (NCCRT: 424; up-front proctectomy: 1509) in the study population. NCCRT was associated with improved survival as compared with up-front proctectomy (adjusted hazard ratio of death 0.656; 95% confidence interval 0.495–0.871). Our results were robust in the sensitivity analyses. Conclusion: We demonstrated that the use of neoadjuvant concurrent systemic therapy and radiotherapy is associated with better effectiveness in rectal adenocarcinoma of clinical stage II–III as compared with up-front proctectomy. Further studies are needed to elucidate the subgroups most likely to benefit and to clarify NCCRT's cost-effectiveness.

Original languageEnglish
Pages (from-to)e234-e240
JournalAsia-Pacific Journal of Clinical Oncology
Volume12
Issue number2
DOIs
Publication statusPublished - Jun 1 2016
Externally publishedYes

Fingerprint

Chemoradiotherapy
Rectal Neoplasms
Population
Registries
Adenocarcinoma
Propensity Score
Survival
Taiwan
Proportional Hazards Models
Social Class
Cost-Benefit Analysis
Neoplasms
Cohort Studies
Radiotherapy
Retrospective Studies
Clinical Trials
Confidence Intervals
Drug Therapy
Therapeutics

Keywords

  • effectiveness
  • neoadjuvant concurrent chemoradiotherapy
  • population-based
  • rectal cancer
  • Taiwan

ASJC Scopus subject areas

  • Oncology

Cite this

Effectiveness of neoadjuvant concurrent chemoradiotherapy versus up-front proctectomy in clinical stage II–III rectal cancer : A population-based study. / Ke, Tao Wei; Liao, Yu Min; Chiang, Hua Che; Chang, Sheng Chi; Wang, Pin Hui; Chen, Yi Ya; Chen, William Tzu Liang; Chien, Chun Ru.

In: Asia-Pacific Journal of Clinical Oncology, Vol. 12, No. 2, 01.06.2016, p. e234-e240.

Research output: Contribution to journalArticle

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abstract = "Aims: Neoadjuvant concurrent chemoradiotherapy (NCCRT) is currently the preferred treatment for rectal cancer of clinical stage II–III based on its efficacy in clinical trials. The population-based effectiveness of NCCRT is rarely reported on in the literature. The purpose of our study is to investigate the nationwide population-based effectiveness of NCCRT as compared with up-front proctectomy. Methods: In this retrospective cohort study, we identified the study population by linking datasets including the cancer registry, death registry and other related files in Taiwan. We identified all patients with rectal adenocarcinoma of American Joint Committee on Cancer clinical stage II or III who were diagnosed in 2007 or 2008 and received either NCCRT or up-front proctectomy. We included patients' age, gender, residence, socioeconomic status and clinical stage as covariables. We used overall survival as the measure of effectiveness. The Cox proportional-hazards regression model was used for statistical analyses. We further conducted sensitivity analyses, one in only those who received optimal postoperative chemotherapy and one in two subgroups matched for propensity score. Results: We included 1933 patients (NCCRT: 424; up-front proctectomy: 1509) in the study population. NCCRT was associated with improved survival as compared with up-front proctectomy (adjusted hazard ratio of death 0.656; 95{\%} confidence interval 0.495–0.871). Our results were robust in the sensitivity analyses. Conclusion: We demonstrated that the use of neoadjuvant concurrent systemic therapy and radiotherapy is associated with better effectiveness in rectal adenocarcinoma of clinical stage II–III as compared with up-front proctectomy. Further studies are needed to elucidate the subgroups most likely to benefit and to clarify NCCRT's cost-effectiveness.",
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AU - Chiang, Hua Che

AU - Chang, Sheng Chi

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AU - Chen, Yi Ya

AU - Chen, William Tzu Liang

AU - Chien, Chun Ru

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N2 - Aims: Neoadjuvant concurrent chemoradiotherapy (NCCRT) is currently the preferred treatment for rectal cancer of clinical stage II–III based on its efficacy in clinical trials. The population-based effectiveness of NCCRT is rarely reported on in the literature. The purpose of our study is to investigate the nationwide population-based effectiveness of NCCRT as compared with up-front proctectomy. Methods: In this retrospective cohort study, we identified the study population by linking datasets including the cancer registry, death registry and other related files in Taiwan. We identified all patients with rectal adenocarcinoma of American Joint Committee on Cancer clinical stage II or III who were diagnosed in 2007 or 2008 and received either NCCRT or up-front proctectomy. We included patients' age, gender, residence, socioeconomic status and clinical stage as covariables. We used overall survival as the measure of effectiveness. The Cox proportional-hazards regression model was used for statistical analyses. We further conducted sensitivity analyses, one in only those who received optimal postoperative chemotherapy and one in two subgroups matched for propensity score. Results: We included 1933 patients (NCCRT: 424; up-front proctectomy: 1509) in the study population. NCCRT was associated with improved survival as compared with up-front proctectomy (adjusted hazard ratio of death 0.656; 95% confidence interval 0.495–0.871). Our results were robust in the sensitivity analyses. Conclusion: We demonstrated that the use of neoadjuvant concurrent systemic therapy and radiotherapy is associated with better effectiveness in rectal adenocarcinoma of clinical stage II–III as compared with up-front proctectomy. Further studies are needed to elucidate the subgroups most likely to benefit and to clarify NCCRT's cost-effectiveness.

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