Impact of Adjuvant Chemotherapy Following Neoadjuvant Concurrent Chemoradiotherapy and Total Mesorectal Excision in Rectal Cancer.

IF 1.8 4区医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL

In vivo Pub Date : 2025-07-01 DOI:10.21873/invivo.14027

Yu-Shih Liu, Jen-Kou Lin, Tzu-Chen Lin, Wei-Shone Chen, Shung-Haur Yang, Huann-Shenn Wang, Shih-Ching Chang, Yuan-Tzu Lan, Chun-Chi Lin, Hung-Hsin Lin, Jeng-Kai Jiang

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引用次数: 0

Abstract

Background/aim: This study investigated the efficacy of adjuvant chemotherapy (ACT) after total mesorectal excision (TME) for rectal cancer in patients who responded well to neoadjuvant concurrent chemoradiotherapy (nCCRT).

Patients and methods: This retrospective study included patients with rectal cancer treated at Taipei Veterans General Hospital (2009-2017). Among 302 patients who underwent nCCRT and TME, 178 good responders [pathologic complete response (pCR), pT1, or pT2] were analyzed. Patients were grouped based on ACT administration. Primary outcomes included disease-free survival (DFS) and recurrence. Kaplan-Meier survival analysis and Cox proportional hazards regression were used to assess ACT efficacy.

Results: The ACT group (n=96) had poorer baseline disease characteristics, including higher initial clinical T and N stages. However, recurrence rates did not differ significantly between ACT and non-ACT groups (23.2% vs. 17.7%, p=0.271). DFS curves showed no significant difference between ACT and non-ACT groups (p=0.360). Multivariable analysis confirmed that ACT was not significantly associated with DFS [adjusted hazard ratio (aHR)=0.76, 95% confidence interval (CI)=0.37-1.59]. However, the advanced surgical pT stage (pT3-pT4) was an independent predictor of recurrence (aHR=3.24, 95%CI=1.01-10.38, p=0.047).

Conclusion: The role of ACT remains inconclusive after TME for rectal cancer in patients who respond well to nCCRT. Surgical pT stage, particularly pT3 and pT4, remain a significant predictor of recurrence, emphasizing its importance in risk stratification.

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直肠癌新辅助同步放化疗和全肠系膜切除后辅助化疗的影响。

背景/目的：本研究探讨了对新辅助同步放化疗（nCCRT）反应良好的直肠癌全肠系膜切除（TME）后辅助化疗（ACT）的疗效。患者与方法：本回顾性研究纳入2009-2017年在台北退伍军人总医院治疗的直肠癌患者。在302例接受nCCRT和TME的患者中，分析了178例反应良好的患者[病理完全缓解（pCR）， pT1或pT2]。根据ACT给药情况对患者进行分组。主要结局包括无病生存（DFS）和复发。Kaplan-Meier生存分析和Cox比例风险回归评估ACT的疗效。结果：ACT组（n=96）的基线疾病特征较差，包括较高的初始临床T和n分期。然而，ACT组和非ACT组的复发率无显著差异（23.2% vs. 17.7%, p=0.271）。ACT组与非ACT组DFS曲线差异无统计学意义（p=0.360）。多变量分析证实ACT与DFS无显著相关[校正风险比(aHR)=0.76, 95%可信区间(CI)=0.37 ~ 1.59]。然而，手术晚期pT分期（pT3-pT4）是复发的独立预测因子（aHR=3.24, 95%CI=1.01-10.38, p=0.047）。结论：在对nCCRT反应良好的直肠癌患者TME后，ACT的作用尚不明确。手术pT分期，特别是pT3和pT4，仍然是复发的重要预测因素，强调其在风险分层中的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

In vivo 医学-医学：研究与实验

CiteScore

4.20

自引率

4.30%

发文量

330

审稿时长

3-8 weeks

期刊介绍： IN VIVO is an international peer-reviewed journal designed to bring together original high quality works and reviews on experimental and clinical biomedical research within the frames of physiology, pathology and disease management. The topics of IN VIVO include: 1. Experimental development and application of new diagnostic and therapeutic procedures; 2. Pharmacological and toxicological evaluation of new drugs, drug combinations and drug delivery systems; 3. Clinical trials; 4. Development and characterization of models of biomedical research; 5. Cancer diagnosis and treatment; 6. Immunotherapy and vaccines; 7. Radiotherapy, Imaging; 8. Tissue engineering, Regenerative medicine; 9. Carcinogenesis.