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

15 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

Keywords

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

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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