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Re-evaluation of controversial issues in the treatment of cT3N0-2 rectal cancer: a 10-year cohort analysis using propensity-score matching

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Although neoadjuvant treatment is thought to provide optimal local control for stage II and III rectal cancers, many patients have been reported cured by total mesorectal excision (TME), alone or with additional chemotherapy (CTX).

Methods

This study retrospectively evaluated outcomes in 2643 patients with cT3N0-2 rectal cancers undergoing curative TME during 2005–2015. Recurrence and survival outcomes were measured in three propensity-score matched groups, consisting of patients who underwent preoperative chemoradiotherapy (CRT) with postoperative CTX (NAPOC), postoperative CRT (POCRT), and exclusively postoperative CTX (EPOCT).

Results

Near-complete or complete TME was conducted in more than 95.9% of patients and 80% of scheduled dose of postoperative CTX was completed in 99%. Except for higher SR rate in the POCRT group than the NAPOC group (p = 0.008), 5-year cumulative local and systemic recurrence (LR and SR) rates were 4.9% and 15.2% for cT3N0, and 4.2% and 21% for cT3N1-2 patients (LR, p = 0.703; SR, 0.065), respectively, with no significant differences associated with treatment exposure (p = 0.11–1). The 5-year cumulative disease-free (75.6% vs 65.7%, p = 0.018) and overall survival (87.1% vs 79.4%, p = 0.018 each) rates were higher in the NAPOC group than the POCRT group with cT3N1-2. However, any significant survival differences were not identified between the NAPOC and EPOCT groups according to tumor sub-stages or locations (p = 0.395–0.971).

Conclusions

We found any treatment modalities including competent TME and postoperative adjuvant CTX efficiently reducing LR generating robust survival outcome in the propensity-matched cohorts, demanding further randomized controlled trials by clinical sub-stages II–III.

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Acknowledgements

The authors would like to thank Young Il Kim, MD, Jong Beom Kim, MD, Hyo Seon Yu, MD, Mi Young Park, MD, Jay Jung, MD, Hyun Joo Jeong, RN, and Jung Rang Kim, RN, for their support with data enrollment, collection, and update.

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Authors and Affiliations

  1. Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, 05505, Republic of Korea

    Jin Cheon Kim, Chang Sik Yu, Seok-Byung Lim, In Ja Park, Yong Sik Yoon & Chan Wook Kim

  2. Department of Radiation Oncology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, 05505, Republic of Korea

    Jong Hun Kim

  3. Department of Oncology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, 05505, Republic of Korea

    Tae Won Kim

  4. Institute of Innovative Cancer Research, Asan Institute for Life Sciences and Asan Medical Center, 88, Olympic-ro-43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    Jin Cheon Kim

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  1. Jin Cheon Kim
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Contributions

Jin Cheon Kim and Tae Won Kim contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Jin Cheon Kim, Chang Sik Yu, Seok-Byung Lim, In Ja Park, Yong Sik Yoon, Chan Wook Kim, Jong Hun Kim, and Tae Won Kim. The first draft of the manuscript was written by Felix Jin Cheon Kim and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Jin Cheon Kim.

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Kim, J.C., Yu, C.S., Lim, SB. et al. Re-evaluation of controversial issues in the treatment of cT3N0-2 rectal cancer: a 10-year cohort analysis using propensity-score matching. Int J Colorectal Dis 36, 2649–2659 (2021). https://doi.org/10.1007/s00384-021-04003-8

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