Is neoadjuvant chemoradiotherapy always necessary for mid/high local advanced rectal cancer: A comparative analysis after propensity score matching

Publication date: Available online 4 May 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Yiyi Zhang, Yanwu Sun, Zongbin Xu, Pan Chi, Xingrong Lu
AimThis study was aimed to compare perioperative and oncological outcomes of mid/high locally advanced midrectal cancer (LARC) treated with neoadjuvant chemoradiotherapy (NCRT) vs. surgery alone, and to identify risk factors for local recurrence in mid/high LARC.MethodA total of 471 mid/high LARC patients treated with surgery alone or NCRT (50.4 Gy in 28 fractions) with concurrent FOLFOX/XELOX followed by TME in 6–8 weeks from 2008 to 2014 were matched 1:1 by using propensity score analysis. Perioperative and survival outcome was compared between groups. Multivariate analyse was performed to identify risk factors for local recurrence.ResultsTwo hundred and two patients were matched for the analysis. Postoperative morbidity was similar between groups. With a mean follow-up of 57 months, the 5-year overall survival (NCRT vs. surgery alone: 80.4% vs. 81.4%; p = 0.978), 5-year local recurrence rate (3.1% vs. 5%; p = 0.467), and 5-year distant metastasis rates between two groups (29.5% vs. 23.7%; p = 0.140) was similar between two groups. Cox regression analysis showed that the circumferential resection margin (CRM) involvement (OR = 5.205, p = 0.005) was the only risk factor for local recurrence in mid/high LARC patients.ConclusionIn matched cohorts of mid/high LARC patients, surgery alone provided comparable oncological outcome, when compared with NCRT. CRM involvement was the only risk factor for local recurrence in mid/high rectal cancer. NCRT may not be always needed in mid/high LARC. A threatened CRM could be diagnosed up front and prevented by selecting CRT for these patients.



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