The survival impact of delayed surgery and adjuvant chemotherapy on stage II/III rectal cancer with pathological complete response after neoadjuvant chemoradiation

Feng Che Kuan, Chia Hsuan Lai, Hsiu Ying Ku, Chun Feng Wu, Meng Chiao Hsieh, Tsang Wu Liu, Chien Yuh Yeh, Kuan Der Lee

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Neoadjuvant concurrent chemoradiation (CCRT) is standard treatment for clinical stage II/III rectal cancers. However, whether patients with pathological complete response (pT0N0, pCR) should receive adjuvant chemotherapy and whether delayed surgery will influence the pCR rate remains controversial. A nationwide population study was conducted using the Taiwan Cancer Registry Database from January 2007 to December 2013. Kaplan-Meier survival analysis was performed. Cox proportional hazards models were used to estimate multivariate adjusted hazard ratios (HR) and 95% confidence intervals (95% CI). Of the 1,914 patients who received neoadjuvant CCRT, 259 (13.6%) achieved pCR and had better survival (adjusted HR: 0.37, 95% CI: 0.24-0.58; p < 0.001). The cumulative rate of pCR rose up to 83.4% in the 9th week and slowly reached a plateau after the 11th week. Among the patients with pCR, those who received adjuvant chemotherapy had no survival benefits compared to those without adjuvant chemotherapy (adjusted HR: 0.72, 95 CI: 0.27–1.93; p = 0.52). By subgroup analysis, those younger than 70-year old and received adjuvant chemotherapy had better survival benefit than those without adjuvant chemotherapy (adjusted HR: 0.19, 95% CI: 0.04–0.97; p = 0.046). Delayed surgery by 9–12 weeks after the end of neoadjuvant CCRT can maximize the pCR rate, which is correlated with better survival. Adjuvant chemotherapy may be considered in patients with pCR and aged <70-year old, but further prospectively randomized controlled trials are warranted to validate these findings.

Original languageEnglish
Pages (from-to)1662-1669
Number of pages8
JournalInternational Journal of Cancer
Volume140
Issue number7
DOIs
Publication statusPublished - Apr 1 2017
Externally publishedYes

Fingerprint

Adjuvant Chemotherapy
Rectal Neoplasms
Survival
Confidence Intervals
Kaplan-Meier Estimate
Survival Analysis
Taiwan
Proportional Hazards Models
Registries
Randomized Controlled Trials
Databases
Population
Neoplasms

Keywords

  • adjuvant chemotherapy
  • neoadjuvant chemo-radiation
  • pathological complete response
  • rectal cancer
  • survival

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

The survival impact of delayed surgery and adjuvant chemotherapy on stage II/III rectal cancer with pathological complete response after neoadjuvant chemoradiation. / Kuan, Feng Che; Lai, Chia Hsuan; Ku, Hsiu Ying; Wu, Chun Feng; Hsieh, Meng Chiao; Liu, Tsang Wu; Yeh, Chien Yuh; Lee, Kuan Der.

In: International Journal of Cancer, Vol. 140, No. 7, 01.04.2017, p. 1662-1669.

Research output: Contribution to journalArticle

Kuan, Feng Che ; Lai, Chia Hsuan ; Ku, Hsiu Ying ; Wu, Chun Feng ; Hsieh, Meng Chiao ; Liu, Tsang Wu ; Yeh, Chien Yuh ; Lee, Kuan Der. / The survival impact of delayed surgery and adjuvant chemotherapy on stage II/III rectal cancer with pathological complete response after neoadjuvant chemoradiation. In: International Journal of Cancer. 2017 ; Vol. 140, No. 7. pp. 1662-1669.
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abstract = "Neoadjuvant concurrent chemoradiation (CCRT) is standard treatment for clinical stage II/III rectal cancers. However, whether patients with pathological complete response (pT0N0, pCR) should receive adjuvant chemotherapy and whether delayed surgery will influence the pCR rate remains controversial. A nationwide population study was conducted using the Taiwan Cancer Registry Database from January 2007 to December 2013. Kaplan-Meier survival analysis was performed. Cox proportional hazards models were used to estimate multivariate adjusted hazard ratios (HR) and 95{\%} confidence intervals (95{\%} CI). Of the 1,914 patients who received neoadjuvant CCRT, 259 (13.6{\%}) achieved pCR and had better survival (adjusted HR: 0.37, 95{\%} CI: 0.24-0.58; p < 0.001). The cumulative rate of pCR rose up to 83.4{\%} in the 9th week and slowly reached a plateau after the 11th week. Among the patients with pCR, those who received adjuvant chemotherapy had no survival benefits compared to those without adjuvant chemotherapy (adjusted HR: 0.72, 95 CI: 0.27–1.93; p = 0.52). By subgroup analysis, those younger than 70-year old and received adjuvant chemotherapy had better survival benefit than those without adjuvant chemotherapy (adjusted HR: 0.19, 95{\%} CI: 0.04–0.97; p = 0.046). Delayed surgery by 9–12 weeks after the end of neoadjuvant CCRT can maximize the pCR rate, which is correlated with better survival. Adjuvant chemotherapy may be considered in patients with pCR and aged <70-year old, but further prospectively randomized controlled trials are warranted to validate these findings.",
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AU - Lai, Chia Hsuan

AU - Ku, Hsiu Ying

AU - Wu, Chun Feng

AU - Hsieh, Meng Chiao

AU - Liu, Tsang Wu

AU - Yeh, Chien Yuh

AU - Lee, Kuan Der

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AB - Neoadjuvant concurrent chemoradiation (CCRT) is standard treatment for clinical stage II/III rectal cancers. However, whether patients with pathological complete response (pT0N0, pCR) should receive adjuvant chemotherapy and whether delayed surgery will influence the pCR rate remains controversial. A nationwide population study was conducted using the Taiwan Cancer Registry Database from January 2007 to December 2013. Kaplan-Meier survival analysis was performed. Cox proportional hazards models were used to estimate multivariate adjusted hazard ratios (HR) and 95% confidence intervals (95% CI). Of the 1,914 patients who received neoadjuvant CCRT, 259 (13.6%) achieved pCR and had better survival (adjusted HR: 0.37, 95% CI: 0.24-0.58; p < 0.001). The cumulative rate of pCR rose up to 83.4% in the 9th week and slowly reached a plateau after the 11th week. Among the patients with pCR, those who received adjuvant chemotherapy had no survival benefits compared to those without adjuvant chemotherapy (adjusted HR: 0.72, 95 CI: 0.27–1.93; p = 0.52). By subgroup analysis, those younger than 70-year old and received adjuvant chemotherapy had better survival benefit than those without adjuvant chemotherapy (adjusted HR: 0.19, 95% CI: 0.04–0.97; p = 0.046). Delayed surgery by 9–12 weeks after the end of neoadjuvant CCRT can maximize the pCR rate, which is correlated with better survival. Adjuvant chemotherapy may be considered in patients with pCR and aged <70-year old, but further prospectively randomized controlled trials are warranted to validate these findings.

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