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Adding Induction Chemotherapy Before Chemoradiotherapy with Total Mesorectal Excision and Selective Lateral Lymph Node Dissection for Patients with Poor-Risk, Locally Advanced, Mid-to-Low Rectal Cancer May Improve Oncologic Outcomes: A Propensity Score-Matched Analysis

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study aimed to investigate whether the addition of induction chemotherapy before chemoradiotherapy (CRT) and total mesorectal excision (TME) with selective lateral lymph node dissection improves disease-free survival for patients with poor-risk, mid-to-low rectal cancer.

Methods

The authors’ institutional prospective database was queried for consecutive patients with clinical stage II or III, primary, poor-risk, mid-to-low rectal cancer who received neoadjuvant treatment followed by TME from 2004 to 2019. The outcomes for the patients who received induction chemotherapy before neoadjuvant CRT (induction-CRT group) were compared (via log-rank tests) with those for a propensity score-matched cohort of patients who received neoadjuvant CRT without induction chemotherapy (CRT group).

Results

From 715 eligible patients, the study selected two matched cohorts with 130 patients each. The median follow-up duration was 5.4 years for the CRT group and 4.1 years for the induction-CRT group. The induction-CRT group had significantly higher rates of 3-year disease-free survival (83.5 % vs 71.4 %; p = 0.015), distant metastasis-free survival (84.3 % vs 75.2 %; p = 0.049), and local recurrence-free survival (98.4 % vs 94.4 %; p = 0.048) than the CRT group. The pathologically complete response rate also was higher in the induction-CRT group than in the CRT group (26.2 % vs 10.0 %; p < 0.001). Postoperative major complications (Clavien–Dindo classification ≥III) did not differ significantly between the two groups (12.3 % vs 10.8 %; p = 0.698).

Conclusions

The addition of induction chemotherapy to neoadjuvant CRT appeared to improve oncologic outcomes significantly, including disease-free survival, for the patients with poor-risk, mid-to-low rectal cancer who underwent TME using selective lateral lymph node dissection.

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Acknowledgment

We thank Editage (www.editage.com) for English language editing.

Funding

No funding was received for this research.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan

    Tomohiro Yamaguchi MD, PhD, Takashi Akiyoshi MD, PhD, Yosuke Fukunaga MD, PhD, Takashi Sakamoto MD, MPH, Toshiki Mukai MD, PhD, Yukiharu Hiyoshi MD, PhD, Toshiya Nagasaki MD, PhD & Tsuyoshi Konishi MD, PhD

  2. Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan

    Takashi Sakamoto MD, MPH

  3. Department of Radiation Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan

    Senzo Taguchi MD, PhD

  4. Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan

    Akiko Chino MD, PhD

  5. Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan

    Eiji Shinozaki MD, PhD & Kensei Yamaguchi MD, PhD

  6. Department of Colon and Rectal Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Tsuyoshi Konishi MD, PhD

Authors
  1. Tomohiro Yamaguchi MD, PhD
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  2. Takashi Akiyoshi MD, PhD
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  3. Yosuke Fukunaga MD, PhD
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  11. Kensei Yamaguchi MD, PhD
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Contributions

All authors contributed to the study conception and design.Tomohiro Yamaguchi and Takashi Akiyoshi collected and analyzed the data. The first draft of the manuscript was written by Tomohiro Yamaguchi and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Tomohiro Yamaguchi MD, PhD.

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Yamaguchi, T., Akiyoshi, T., Fukunaga, Y. et al. Adding Induction Chemotherapy Before Chemoradiotherapy with Total Mesorectal Excision and Selective Lateral Lymph Node Dissection for Patients with Poor-Risk, Locally Advanced, Mid-to-Low Rectal Cancer May Improve Oncologic Outcomes: A Propensity Score-Matched Analysis. Ann Surg Oncol 30, 4716–4724 (2023). https://doi.org/10.1245/s10434-023-13458-8

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