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Adjuvant chemotherapy after neoadjuvant chemoradiation and proctectomy improves survival irrespective of pathologic response in rectal adenocarcinoma: a population-based cohort study

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Abstract

Background

This study sought to determine whether adjuvant chemotherapy (AC) compared to no AC (noAC) after neoadjuvant chemoradiation (CRT) and resection for rectal adenocarcinoma prolongs survival. Current guidelines from expert groups are conflicting, and data to support administering AC to patients who received neoadjuvant CRT are lacking.

Methods

A total of 19,867 patients met inclusion/exclusion criteria. Mean age was 58.6 ± 12.0 years, and 12,396 (62.4%) were males. Complete response (CR) was documented in 3801 (19.1%) patients and 8167 (41.1%) received AC. The cohort was stratified into pathological complete (pCR, N = 3801) and incomplete (pIR, N = 16,066) subgroups, and pIR further subcategorized into ypN0 (N = 10,191) and ypN + (N = 5875) subgroups. After propensity score matching, AC was associated with improved OS in the pCR subgroups (mean 139.1 ± 1.9 vs. 134.0 ± 2.2 months; p < 0.001), in pIR ypN0 subgroup (141.6 ± 1.5 vs. 129.9 ± 1.2 months, p < 0.001), and in pIR ypN + subgroup (155.9 ± 5.4 vs. 126.5 ± 7.6 months; p < 0.001).

Results

AC was associated with improved OS in patients who received neoadjuvant CRT followed by proctectomy for clinical stages II and III rectal adenocarcinoma. This effect persisted irrespective of pathological response status.

Conclusions

AC following neoadjuvant CRT and surgery is associated with improved OS in patients with rectal adenocarcinoma. These findings warrant adoption of AC after neoadjuvant CRT and surgery for clinical stage II and III rectal adenocarcinoma.

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Data availability

The authors confirm that the data supporting the findings of this study are available within the article and the National Cancer Database.

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Authors and Affiliations

  1. Department of Surgical Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA

    Samer A. Naffouje

  2. Department of General Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA

    Yuen-Joyce Liu & George I. Salti

  3. Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Trust, Birmingham, UK

    Sivesh K. Kamarajah

  4. Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK

    Sivesh K. Kamarajah

  5. Department of Surgical Oncology, Edward-Elmhurst Health, 120 Spalding Drive, Ste 205, Naperville, IL, 60540, USA

    George I. Salti & Fadi Dahdaleh

Authors
  1. Samer A. Naffouje
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  2. Yuen-Joyce Liu
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  3. Sivesh K. Kamarajah
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  4. George I. Salti
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  5. Fadi Dahdaleh
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Contributions

Study conception and design: FD, SN. Acquisition of data: SN. Analysis and interpretation of data: FD, SN, IS. Drafting of manuscript: IS, TP, FD. Critical revision: FD, SN.

Corresponding author

Correspondence to Fadi Dahdaleh.

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Naffouje, S.A., Liu, YJ., Kamarajah, S.K. et al. Adjuvant chemotherapy after neoadjuvant chemoradiation and proctectomy improves survival irrespective of pathologic response in rectal adenocarcinoma: a population-based cohort study. Int J Colorectal Dis 37, 2137–2148 (2022). https://doi.org/10.1007/s00384-022-04245-0

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