Downstaged ypT0-2N0 rectal cancer after neoadjuvant chemoradiation therapy may not need adjuvant chemotherapy: a retrosp
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ORIGINAL ARTICLE
Downstaged ypT0-2N0 rectal cancer after neoadjuvant chemoradiation therapy may not need adjuvant chemotherapy: a retrospective cohort study Yu-Tso Liao 1,2 & Yu-Lin Lin 3 & John Huang 4 & Ji-Shiang Hung 4 & Been-Ren Lin 4 Accepted: 21 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Current guidelines suggest that adjuvant chemotherapy (AC) be administered to all locally advanced (clinically T3–4 or N-positivity) rectal cancer patients undergoing neoadjuvant chemoradiotherapy (nCRT) and radical surgical resection regardless of the final pathological staging (yp staging). This study aimed to evaluate the necessity of AC for ypT0-2N0 rectal cancer. Methods Patients with ypT0-2N0 rectal cancer, who received nCRT and radical surgical resection, were recruited retrospectively at a university hospital. The main outcome was to evaluate the 5-year overall survival (OS) and disease-free survival (DFS) between ypT0-2N0 rectal cancer patients with AC and those without AC. We also identified potential independent prognostic factors associated with poor outcomes. Results One hundred and ten ypT0-2N0 rectal cancer patients (ypT0: n = 6; ypT1: n = 44; ypT2: n = 60) were followed up for a median of 60 months. No significant difference was observed in DFS and 5-year OS between patients with AC and those without AC. The risk of recurrence was associated with the postoperative pathological staging (0% with ypT0, 2.4% with ypT1, and 10% with ypT2). In the multivariate analysis, retrieval of < 12 lymph nodes was an independent favorable prognostic factor, which correlated with a higher OS (HR: 2.263; 95% CI: 1.093–4.687, P = 0.028). Intra-tumor lymphovascular and perineural invasion were poor prognostic markers for shorter DFS (HR: 5.940; 95% CI: 1.150–30.696, P = 0.033). Conclusion Postoperative AC is not required for patients with ypT0-2N0 rectal cancer downstaged by nCRT, especially in those without poor prognostic factors. Keywords Locally advanced rectal cancer . ypT0-2N0 . Neoadjuvant chemoradiotherapy . Adjuvant chemotherapy
Introduction
* Been-Ren Lin [email protected] 1
Division of Colorectal Surgery, Department of Surgery, Biomedical Park Hospital, National Taiwan University Hospital, Hsinchu, Taiwan, Republic of China
2
Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taiwan Taipei, Republic of China
3
Division of Hematology and Oncology, Department of Internal Medicine, Cardinal Tien Hospital, New Taipei, Taiwan, Republic of China
4
Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan, Republic of China
Neoadjuvant chemoradiation therapy (nCRT) followed by radical surgical resection is the current mainstay treatment for locally advanced (clinical stage of T3–4 or N-positivity) rectal cancer [1, 2]. Compared with postoperative radiotherapy, nCRT decreases the local recurrence rate [3] and reduces toxicity [4]. Furthermore, nCRT may en
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