The role of adjuvant chemotherapy in rectal cancer: A nationwide cohort study from the Netherlands

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease Pub Date : 2025-03-09 DOI:10.1111/codi.70054

Aaya Darai, Tijmen Koëter, Felice N. van Erning, Robbert J. van Alphen, Henk M. W. Verheul, Marcel Verheij, David D. E. Zimmerman, Pauline A. J. Vissers, Johannes H. W. de Wilt

{"title":"The role of adjuvant chemotherapy in rectal cancer: A nationwide cohort study from the Netherlands","authors":"Aaya Darai, Tijmen Koëter, Felice N. van Erning, Robbert J. van Alphen, Henk M. W. Verheul, Marcel Verheij, David D. E. Zimmerman, Pauline A. J. Vissers, Johannes H. W. de Wilt","doi":"10.1111/codi.70054","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Aim</h3>\n \n <p>Treatment of rectal cancer has improved significantly over the past decades. However, the role of adjuvant chemotherapy remains a matter of debate. The aim of this study is to evaluate the association between adjuvant chemotherapy and overall survival of patients with rectal cancer.</p>\n </section>\n \n <section>\n \n <h3> Method</h3>\n \n <p>Data from the Netherlands Cancer Registry were used to evaluate all nonmetastatic pathological node-positive patients who underwent treatment for rectal cancer during the time period 2009–2020 in the Netherlands. Patients were grouped according to whether they received adjuvant chemotherapy. Patients were further divided into three groups according to the type of preoperative treatment. Propensity score matching (PSM) was applied based on patient-related variables, tumour-related variables and treatment-related variables. The matching procedure for PSM was done with nearest neighbour and without replacement employing a 1:1 ratio. Kaplan–Meier analysis was performed after PSM to compare overall survival.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>A total of 7479 patients were included, of whom 865 (11.6%) underwent adjuvant chemotherapy. After PSM the no neoadjuvant treatment group included 240 patients per study arm, the neoadjuvant radiotherapy group 317 and the neoadjuvant chemoradiation group 182 patients. A significant difference in 5-year survival was found comparing adjuvant versus no adjuvant chemotherapy in all subgroups: no neoadjuvant treatment 54.6% vs. 40.8% (<i>p</i> = 0.003), neoadjuvant radiotherapy 77.0% vs. 53.9% (<i>p</i> < 0.001) and neoadjuvant chemoradiation 68.1% vs. 45.6% (<i>p</i> < 0.001).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Adjuvant chemotherapy was associated with an improved 5-year survival in all subgroups. The role of adjuvant chemotherapy in the treatment of rectal cancer should be reconsidered in node-positive patients.</p>\n </section>\n </div>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 3","pages":""},"PeriodicalIF":2.9000,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/codi.70054","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Colorectal Disease","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/codi.70054","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Aim

Treatment of rectal cancer has improved significantly over the past decades. However, the role of adjuvant chemotherapy remains a matter of debate. The aim of this study is to evaluate the association between adjuvant chemotherapy and overall survival of patients with rectal cancer.

Method

Data from the Netherlands Cancer Registry were used to evaluate all nonmetastatic pathological node-positive patients who underwent treatment for rectal cancer during the time period 2009–2020 in the Netherlands. Patients were grouped according to whether they received adjuvant chemotherapy. Patients were further divided into three groups according to the type of preoperative treatment. Propensity score matching (PSM) was applied based on patient-related variables, tumour-related variables and treatment-related variables. The matching procedure for PSM was done with nearest neighbour and without replacement employing a 1:1 ratio. Kaplan–Meier analysis was performed after PSM to compare overall survival.

Results

A total of 7479 patients were included, of whom 865 (11.6%) underwent adjuvant chemotherapy. After PSM the no neoadjuvant treatment group included 240 patients per study arm, the neoadjuvant radiotherapy group 317 and the neoadjuvant chemoradiation group 182 patients. A significant difference in 5-year survival was found comparing adjuvant versus no adjuvant chemotherapy in all subgroups: no neoadjuvant treatment 54.6% vs. 40.8% (p = 0.003), neoadjuvant radiotherapy 77.0% vs. 53.9% (p < 0.001) and neoadjuvant chemoradiation 68.1% vs. 45.6% (p < 0.001).

Conclusion

Adjuvant chemotherapy was associated with an improved 5-year survival in all subgroups. The role of adjuvant chemotherapy in the treatment of rectal cancer should be reconsidered in node-positive patients.

Abstract Image

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.