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

Naffouje, Samer A.; Liu, Yuen-Joyce; Kamarajah, Sivesh K; Salti, George I.; Dahdaleh, Fadi S.

doi:10.1007/s00384-022-04245-0

Cited by 4 publications

(6 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The included studies were published between 2008 and 2023, with 9 [ 18 , 26 , 29 , 31 , 35 , 38 , 39 , 43 , 47 ]. of them sourced from the NCBD database.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 29 [ 15 – 19 , 26 , 28 – 31 , 33 – 52 ]. studies, including 9 [ 18 , 26 , 29 , 31 , 35 , 38 , 39 , 43 , 47 ]. from the NCBD database, provided reporting on OS.…”

Section: Resultsmentioning

confidence: 99%

“…This brings into question the necessity of ACT for rectal cancer patients with pCR and raises concerns regarding overtreatment. Several cohort studies from the NCBD database have retrospectively analyzed the prognosis of pCR rectal cancer patients with ACT or observation [ 18 , 26 , 29 , 31 , 35 , 38 , 39 , 43 , 47 ]. The results have consistently demonstrated that ACT is beneficial in improving OS in rectal cancer patients with pCR.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Effect of adjuvant chemotherapy on the oncological outcome of rectal cancer patients with pathological complete response

Yang,

Deng,

Cheng

et al. 2024

World J Surg Onc

View full text Add to dashboard Cite

Background Locally advanced rectal cancer is typically treated using a combination of neoadjuvant chemoradiotherapy and total mesorectal resection. While achieving pathological complete response following neoadjuvant chemoradiotherapy has been recognized as a positive prognostic factor in oncology, the necessity of adjuvant chemotherapy for locally advanced rectal cancer patients with pathological complete response after surgery remains uncertain. The objective of this meta-analysis was to examine the impact of adjuvant chemotherapy on the oncological outcomes of rectal cancer patients who attain pathological complete response after neoadjuvant chemoradiotherapy. Methods This meta-analysis followed the guidelines outlined in the preferred reporting items for systematic review and meta-analysis (PRISMA). The Web of Science, PubMed, and Cochrane Library databases were systematically searched to identify relevant literature. Results A total of 34 retrospective studies, including 9 studies from the NCBD database, involving 31,558 patients with pathological complete response rectal cancer, were included in the meta-analysis. The included studies were published between 2008 and 2023. The pooled analysis demonstrated that adjuvant chemotherapy significantly improved overall survival (HR = 0.803, 95% CI 0.678–0.952, P = 0.011), and no heterogeneity was observed (I2 = 0%). Locally advanced rectal cancer patients with pathological complete response who underwent adjuvant chemotherapy exhibited a higher 5-year overall survival rate compared to those who did not receive adjuvant chemotherapy (OR = 1.605, 95% CI 1.183–2.177, P = 0.002). However, the analysis also revealed that postoperative ACT did not lead to improvements in disease-free survival and recurrence-free survival within the same patient population. Subgroup analysis indicated that pathological complete response patients with clinical stage T3/T4, lymph node positivity, and younger than 70 years of age may benefit from adjuvant chemotherapy in terms of overall survival. Conclusions The findings of this meta-analysis suggest that adjuvant chemotherapy has a beneficial effect on improving overall survival among rectal cancer patients with pathological complete response. However, no such association was observed in terms of disease-free survival and recurrence-free survival.

show abstract

“…The included studies were published between 2008 and 2023, with 9 [ 18 , 26 , 29 , 31 , 35 , 38 , 39 , 43 , 47 ]. of them sourced from the NCBD database.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 29 [ 15 – 19 , 26 , 28 – 31 , 33 – 52 ]. studies, including 9 [ 18 , 26 , 29 , 31 , 35 , 38 , 39 , 43 , 47 ]. from the NCBD database, provided reporting on OS.…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of adjuvant chemotherapy on the oncological outcome of rectal cancer patients with pathological complete response

Yang,

Deng,

Cheng

et al. 2024

World J Surg Onc

View full text Add to dashboard Cite

show abstract

Section: Certainty Of Evidencementioning

confidence: 99%

“…32,33 However, cohort and database studies that report on patients outside of clinical trials often have much lower completion rates ranging from 32% to 42%, depending on age, comorbidities, surgical complications, and final pathology. 31,34,35 To improve chemotherapy completion rates, the concept of TNT emerged. This approach has patients complete all intended radiation therapy and chemotherapy before undergoing surgery with curative intent.…”

Section: Tnt Is Typically Recommended For Stage II or Iii Mid Or Low ...mentioning

confidence: 99%

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Rectal Cancer 2023 Supplement

Langenfeld,

Davis,

Vogel

et al. 2023

Diseases of the Colon &Amp; Rectum

View full text Add to dashboard Cite

he American Society of Colon and Rectal Surgeons (ASCRS) is dedicated to ensuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The Clinical Practice Guidelines (CPG) Committee is composed of society members who are chosen because they have demonstrated expertise in the specialty of colon and rectal surgery. This committee was created to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus and develop CPG based on the best available evidence.Although not proscriptive, these guidelines provide information on which decisions can be made and do not dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, health care workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines. These guidelines should not be deemed inclusive of all proper methods of care nor exclusive of methods of care reasonably directed toward obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician considering all the circumstances presented by the individual patient. STATEMENT OF THE PROBLEMColorectal cancer is the third most common cancer and the third most common cause of cancer-related deaths in the United States. 1 Approximately 30% of these cancers will originate in the rectum, and the American Cancer Society estimated a total of 44,850 new rectal cancer diagnoses in the United States for 2022. 2 Adenocarcinoma of the rectum is inherently complex. Surgery for rectal cancer is technically challenging and is associated with major alterations in GI, urinary, and sexual functions and with decreased quality of life. [3][4][5] The treatment of rectal cancer is also rapidly evolving, with new data emerging on a regular basis.In 2020, the ASCRS published its most recent CPG for rectal cancer. 6 This was a comprehensive assessment covering a wide spectrum of topics. Since then, there have been Earn continuing medical education (CME) credit online at cme.lww. com. This activity has been approved for AMA PRA category 1 credit.Funding/Support: None reported.

show abstract

Impact of adjuvant chemotherapy on survival after pathological complete response in rectal cancer: a meta-analysis of 31,558 patients

de Moraes,

Kelly,

Souza

et al. 2024

Int J Colorectal Dis

View full text Add to dashboard Cite

Background Locally advanced rectal cancer (LARC) typically involves neoadjuvant chemoradiotherapy (nCRT) followed by surgery (total mesorectal excision, TME). While achieving a complete pathological response (pCR) is a strong indicator of a positive prognosis, the specific benefits of adjuvant chemotherapy after pCR remain unclear. To address this knowledge gap, we conducted a systematic review and meta-analysis to assess the potential advantages of adjuvant therapy in patients who achieve pCR. Methods In this study, we searched Medline, Embase, and Web of Science databases for relevant research. We focused on binary outcomes, analyzing them using odds ratios (ORs) with 95% confidence intervals (CIs). To account for potential variability between studies, all endpoints were analyzed with DerSimonian and Laird random-effects models. We assessed heterogeneity using the I2 statistic and employed the R statistical software (version 4.2.3) for all analyses. Results Thirty-four studies, comprising 31,558 patients, were included. The outcomes demonstrated a significant difference favoring the AC group in terms of overall survival (OS) (HR 0.75; 95% CI 0.60–0.94; p = 0.015; I2 = 0%), and OS in 5 years (OR 1.65; 95% CI 1.21–2.24; p = 0.001; I2 = 39%). There was no significant difference between the groups for disease-free survival (DFS) (HR 0.94; 95% CI 0.76–1.17; p = 0.61; I2 = 17%), DFS in 5 years (OR 1.19; 95% CI 0.82–1.74; p = 0.36; I2 = 43%), recurrence-free survival (RFS) (HR 1.10; 95% CI 0.87–1.40; p = 0.39; I2 = 0%), and relapse-free survival (OR 1.08; 95% CI 0.78–1.51; p = 0.62; I2 = 0%). Conclusion This systematic review and meta-analysis found a significant difference in favor of the ACT group in terms of survival after pCR. Therefore, the administration of this treatment as adjuvant therapy should be encouraged in clinical practice.

show abstract

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

Cited by 4 publications

References 17 publications

Effect of adjuvant chemotherapy on the oncological outcome of rectal cancer patients with pathological complete response

Effect of adjuvant chemotherapy on the oncological outcome of rectal cancer patients with pathological complete response

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Rectal Cancer 2023 Supplement

Impact of adjuvant chemotherapy on survival after pathological complete response in rectal cancer: a meta-analysis of 31,558 patients

Contact Info

Product

Resources

About