A Retrospective Analysis of Locally Advanced Rectal Cancer Treated by Neoadjuvant Chemoradiotherapy Combined With Surgery

Abstract

PurposeNeoadjuvant chemoradiotherapy (nCRT) has been recommended as a standard treatment for locally advanced rectal cancer. In our study, we retrospectively analyzed the oncological outcomes of patients with stage II-III rectal cancer who were treated in our department.Patients and MethodsDuring March 2014 to June 2020, total 139 patients were retrospectively reviewed, of whom 121 were analyzable. All of our enrolled patients with stage II to III rectal cancer were treated with nCRT with a capecitabine-based regimen, total mesorectal excision surgery, and an adjuvant capecitabine-based chemotherapy regimen. We examined the pathologic complete response (pCR) rate after neoadjuvant chemoradiotherapy, 3-year overall survival (OS), and disease-free survival (DFS) and investigated adverse factors related to the survival of this group of patients. We used the Kaplane-Meier method and Cox modeling to estimate and compare survival in our populations.ResultsWith a median follow-up of 36 months, overall survival at 3 years was 83.2%, and disease-free survival at 3 years was 74.4% in this arm. After multivariate adjustment, ypTNM stage(TNM stage after neoadjuvant therapy) was significantly associated with disease-free survival (DFS). A positive circumferential resection margin (CRM) status on MRI and ypTNM stage were significantly related to a worse overall survival (OS). Among the 121 patients, 24 achieved a pCR (19.8%); two patients did not complete radiation therapy. Eighteen patients died due to a cancer-related cause.ConclusionThe oncological outcomes of nCRT at our institution are comparable with those of other clinical studies on rectal cancer in which patients were treated with neoadjuvant therapy. Among the 121 patients, 24 had a pCR (19.8%). ypTNM stage was significantly associated with DFS; CRM status and ypTNM stage were were significantly related to overall survival (OS) after multivariate analysis.

Can neoadjuvant chemoradiotherapy combined with immunotherapy benefit patients with microsatellite stable locally advanced rectal cancer? a pooled and integration analysis

“…Two studies (15, 22), with a total of 32 patients, reported MPR rates of 0.2 and 0.5, respectively, and the result of the integrated analysis of MPR rates in this study was 0.33 (95% CI: 0.04-0.62, I 2 = 68.0%; Figure 4).…”

“…Four studies (18,20,22,23), with a total of 122 patients, reported CCR rates of 0.31, 0.43, 0.13, and 0.34 respectively, and the integrated analysis of CCR rates in this study resulted in 0.30 (95% CI: 0.18-0.42, I 2 = 56.3%; Figure 6).…”

“…The study showed that the combination of PD-1 antibody with full neoadjuvant chemoradiotherapy yielded positive safety and histopathologic regression outcomes. Combining histologic and genetic testing can further assist in identifying individuals who may benefit most from this approach (22).…”