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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Evaluating the benefit of adjuvant chemotherapy in patients with ypT0–1 rectal cancer treated with preoperative chemoradiotherapy
Ye Won Jeon, In Ja Park, Jeong Eun Kim, Jin-Hong Park, Seok-Byung Lim, Chan Wook Kim, Yong Sik Yoon, Jong Lyul Lee, Chang Sik Yu, Jin Cheon Kim
Ye Won Jeon, Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul 05505, South Korea
In Ja Park, Seok-Byung Lim, Chan Wook Kim, Yong Sik Yoon, Jong Lyul Lee, Chang Sik Yu, Jin Cheon Kim, Department of Colon and Rectal Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul 05505, South Korea
Jeong Eun Kim, Department of Oncology, Asan Medical Center and University of Ulsan College of Medicine, Seoul 05505, South Korea
Jin-Hong Park, Department of Radiation Oncology, Asan Medical Center and University of Ulsan College of Medicine, Seoul 05505, South Korea
Author contributions: Jeon YW and Park IJ conceptualized and designed the study and wrote the manuscript; Jeon YW provided data analysis and literature review; Kim JE and Park JH provided clinical data and critical revision; Lim SB, Lee JL, Yoon YS, Kim CW, Yu CS, and Kim JC critical revision and editing, and all authors approved of the final version.
Institutional review board statement: This study was approved by the Institutional Review Board of the Asan Medical Center, No. 2017-1114.
Informed consent statement: The requirement for obtaining an informed consent was waived.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: Data are available upon reasonable request. We may be able to share de-identified participant data with researchers following the publication of this manuscript. Requests for data should be directed to the corresponding author. Data sharing will need to be approved by third-party data providers.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: In Ja Park, MD, PhD, Doctor, Professor, Surgeon, Department of Colon and Rectal Surgery, Asan Medical Center and University of Ulsan College of Medicine, No. 88 Olympic-ro, Songpa-gu, Seoul 05505, South Korea. ipark@amc.seoul.kr
Received: February 21, 2021
Peer-review started: February 21, 2021
First decision: May 13, 2021
Revised: May 22, 2021
Accepted: August 2, 2021
Article in press: August 2, 2021
Published online: September 27, 2021
Processing time: 209 Days and 9 Hours
ARTICLE HIGHLIGHTS
Research background
In rectal cancer patients after preoperative chemoradiotherapy (PCRT), adjuvant chemotherapy (ACTx) is recommended regardless of post-surgical stage.
Research motivation
It is controversial that ACTx improves the oncologic outcome in patients in the early yp stage expected to have a good prognosis.
Research objectives
This study is a retrospective study that aims to evaluate the survival benefit of ACTx in patients with ypT0–1 who underwent PCRT and surgical resection, including local excision.
Research methods
After identification of patients who received PCRT followed by surgical resection, analysis of the 5-yr recurrence-free survival (RFS) and overall survival (OS) of patients with ypT0–1 rectal cancer was performed according to the status of ACTx.
Research results
There was no significant difference in the 5-year RFS and 5-year OS between the two groups. In the multivariate analysis, cT stage was associated with RFS and OS. Also, ypN stage only analyzed in the radical resection group was associated with RFS and OS.
Research conclusions
Our study demonstrated no oncologic benefit of ACTx in patients with ypT0–1 rectal cancer after PCRT and surgical treatment regardless of the radicality of resection.
Research perspectives
In rectal cancer treated with PCRT, ACTx use, regardless of the final pathologic stage, needs to be carefully reconsidered. For ypT0-1 rectal cancer, ACTx did not show any oncologic benefit. Therefore, risk-stratified risk-benefit consideration is important for rectal cancer patients with good pathologic results after PCRT. Further studies with prospective, large-scale, and randomized trials are needed to evaluate the efficacy of ACTx in patients with early post-treatment stage rectal cancer who have a favorable prognosis.
