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The benefits of adjuvant chemotherapy are associated with the kind of neoadjuvant therapy in stage ypI rectal cancer: evidence based on population analysis

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The oncological role of adjuvant chemotherapy (ACT) remains debated in locally advanced rectal cancer (RC) after neoadjuvant therapy (NAT), especially ypI RC. In this study, we used population-based data to evaluate the benefits of ACT in stage ypI RC after NAT and surgery. Moreover, we tried to differentiate what kind of NAT (radiotherapy alone or chemoradiotherapy) was administered because this may affect the further efficacy of ACT.

Methods

All patients with stage ypI primary rectal malignancy were diagnosed in the SEER database between 2004 and 2017. The Kaplan–Meier method was applied to estimate the effects of ACT in survival analysis. Cox regression was performed to calculate the hazard ratio (HR) and the prognosis factors of survival. Propensity score matching (PSM) was used to balance the parameters between therapy groups.

Results

The overall cohort’s median follow-up time was 105 months. For 5-year OS and CSS, there were no significant differences between the ACT ( +) and ACT (-) groups (p = 0.105; p = 0.788). However, subgroup analyses according to the kind of NAT found that ACT improved overall survival (OS) and cancer-specific survival (CSS) in patients who received neoadjuvant radiotherapy (nRT) (p < 0.001, p = 0.015). Among patients who received neoadjuvant chemoradiotherapy (nCRT), no significant survival benefits were found between the ACT ( +) and ACT (-) groups (p = 0.526, p = 0.288).

Conclusion

Our population-based cohort study suggested that the efficacy of ACT was associated with the kind of NAT. The ACT provides survival benefits in stage ypI RC for patients who received nRT. However, among patients who received nCRT, ACT did not improve long-term survival.

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Data availability

The data is publicly available in the SEER database (seer.cancer.gov).

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Authors and Affiliations

  1. Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China

    Hualin Liao, Tao Li, Yahang Liang, Yaxiong Liu, Yuli Yuan, Mingming Li, Aidi Li, Yang Liu, Yao Yao & Taiyuan Li

  2. Gastrointestinal Surgical Institute, Nanchang University, Nanchang, 330006, Jiangxi, China

    Hualin Liao, Tao Li, Yahang Liang, Yaxiong Liu, Yuli Yuan, Mingming Li, Aidi Li, Yang Liu, Yao Yao & Taiyuan Li

Authors
  1. Hualin Liao
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  2. Tao Li
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  3. Yahang Liang
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  4. Yaxiong Liu
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  10. Taiyuan Li
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Contributions

Taiyuan Li conceived and designed the study. Hualin Liao was involved in the interpretation of data and drafting of the manuscript; Huanlin Liao, Tao Li, Yahang Liang, Yaxiong Liu, Yuli Yuan and Mingming Li, Yang Liu, Yao Yao, and Aidi Li were involved in the analysis, acquisition, and interpretation of data. Taiyuan Li was involved in the critical manuscript revision for important intellectual content.

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Correspondence to Taiyuan Li.

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Liao, H., Li, T., Liang, Y. et al. The benefits of adjuvant chemotherapy are associated with the kind of neoadjuvant therapy in stage ypI rectal cancer: evidence based on population analysis. Int J Colorectal Dis 38, 235 (2023). https://doi.org/10.1007/s00384-023-04530-6

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