Necessity of neoadjuvant chemoradiation therapy in extremely low rectal cancer initially requiring abdominoperineal resection retrospective study in Korea.

Korean journal of clinical oncology Pub Date : 2025-08-01 Epub Date: 2025-08-31 DOI:10.14216/kjco.24316
Go Woon Park, Na Hyeon Park, Dae Ro Lim, Jung Cheol Kuk, Eung Jin Shin
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Abstract

Purpose: This study aimed to analyze the benefit of neoadjuvant chemoradiation therapy (nCRT) versus adjuvant chemotherapy alone after surgery without nCRT on oncologic and perioperative outcomes of patients with extremely low rectal cancer requiring abdominoperineal resection (APR) when initially diagnosed.

Methods: Between March 2001 and December 2018, 88 patients who underwent APR for low rectal adenocarcinoma (anal verge < 4 cm) with clinical stage II and III (clinical T3/4, N -/+) were retrieved from a retrospective database. Sixty-eight patients received adjuvant chemotherapy alone after APR without nCRT, and 20 patients received nCRT before APR.

Results: Median follow-up was 59.7 months. The 5-year disease-free survival rate was significantly higher in the nCRT group compared to in chemotherapy alone group (85.5% vs. 58.2%, P= 0.022). The 5-year overall survival rate was also significantly higher in nCRT group compared to in chemotherapy alone group (79.6% vs. 60.0%, P= 0.042). The total recurrence rate was 45.6% in chemotherapy alone group and 15.0% in the nCRT group (P= 0.010). There was no significant difference in circumferential resection margin positive rate, postoperative morbidity, and mortality between the two groups.

Conclusion: Based on present data, the oncologic outcomes are better in nCRT compared to adjuvant chemotherapy alone after surgery without nCRT in patient with extremely low rectal cancer requiring APR initially diagnosed, even if curative resection is possible at first.

Abstract Image

韩国原发性腹会阴切除的极低位直肠癌新辅助放化疗的必要性。
目的:本研究旨在分析新辅助放化疗(nCRT)与单纯辅助化疗(非nCRT)对初诊时需要腹会阴切除术(APR)的极低位直肠癌患者的肿瘤和围手术期预后的益处。方法:从回顾性数据库中检索2001年3月至2018年12月期间88例临床分期为II和III期(临床T3/4, N -/+)的低位直肠腺癌(肛门边缘< 4 cm)行APR的患者。APR后单独辅助化疗68例,APR前单独辅助化疗20例。结果:中位随访时间59.7个月。nCRT组5年无病生存率明显高于单纯化疗组(85.5% vs. 58.2%, P= 0.022)。nCRT组5年总生存率明显高于单纯化疗组(79.6% vs. 60.0%, P= 0.042)。单纯化疗组复发率为45.6%,非crt组复发率为15.0% (P= 0.010)。两组在环切缘阳性率、术后发病率和死亡率方面无显著差异。结论:根据目前的资料,对于早期诊断需要APR的极低直肠癌患者,即使一开始有治愈性切除的可能,在手术后不进行nCRT治疗的肿瘤预后优于单纯辅助化疗。
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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