Τίτλος:
Adjuvant chemotherapy in rectal cancer: Defining subgroups who may
benefit after neoadjuvant chemoradiation and resection A pooled analysis
of 3,313 patients
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Recent literature suggests that the benefit of adjuvant chemotherapy
(aCT) for rectal cancer patients might depend on the response to
neoadjuvant chemoradiation (CRT). Aim was to evaluate whether the effect
of aCT in rectal cancer is modified by response to CRT and to identify
which patients benefit from aCT after CRT, by means of a pooled analysis
of individual patient data from 13 datasets. Patients were categorized
into three groups: pCR (ypT0N0), ypT1-2 tumour and ypT3-4 tumour. Hazard
ratios (HR) for the effect of aCT were derived from multivariable Cox
regression analyses. Primary outcome measure was recurrence-free
survival (RFS). One thousand seven hundred and twenty three (1723)
(52%) of 3,313 included patients received aCT. Eight hundred and ninety
eight (898) patients had a pCR, 966 had a ypT1-2 tumour and 1,302 had a
ypT3-4 tumour. For 122 patients response, category was missing and 25
patients had ypT0N+. Median follow-up for all patients was 51 (0-219)
months. HR for RFS with 95% CI for patients treated with aCT were
1.25(0.68-2.29), 0.58(0.37-0.89) and 0.83(0.66-1.10) for patients with
pCR, ypT1-2 and ypT3-4 tumours, respectively. The effect of aCT in
rectal cancer patients treated with CRT differs between subgroups.
Patients with a pCR after CRT may not benefit from aCT, whereas patients
with residual tumour had superior outcomes when aCT was administered.
The test for interaction did not reach statistical significance, but the
results support further investigation of a more individualized approach
to administer aCT after CRT and surgery based on pathologic staging.
What’s new? Most patients with locally advanced rectal cancer receive
adjuvant chemotherapy after neoadjuvant treatment and surgery. Based on
a pooled analysis of individual patient data from 13 datasets, this
study however shows that the benefit of adjuvant chemotherapy differs
between subgroups, based on the response of patients to previous
neoadjuvant chemoradiation. Patients with a complete response after
chemoradiation may not benefit from adjuvant chemotherapy, whereas
patients with residual tumour have superior outcomes when adjuvant
chemotherapy was administered. The results support further investigation
of a more individualized approach based on pathologic staging for the
administration of adjuvant chemotherapy after chemoradiation and
surgery.
Συγγραφείς:
Maas, Monique
Nelemans, Patty J.
Valentini, Vincenzo
Crane,
Christopher H.
Capirci, Carlo
Roedel, Claus
Nash, Garrett M.
and Kuo, Li-Jen
Glynne-Jones, Rob
Garcia-Aguilar, Julio and
Suarez, Javier
Calvo, Felipe A.
Pucciarelli, Salvatore and
Biondo, Sebastiano
Theodoropoulos, George
Lambregts, Doenja M.
J.
Beets-Tan, Regina G. H.
Beets, Geerard L.
Περιοδικό:
International Journal of Cancer
Λέξεις-κλειδιά:
rectal cancer; neoadjuvant treatment; adjuvant chemotherapy; survival;
response
