Abstract
Introduction
Patients with cT1-2N0M0 rectal cancer are often treated with up-front surgical resection,
with adjuvant treatment reserved for patients upstaged with pathologic node-positive
(pN+) disease at surgery. This study evaluates practice patterns and clinical outcomes
when comparing different forms of adjuvant treatment for this patient population.
Methods
The National Cancer Data Base was queried for cT1-2N0M0 rectal cancer patients between
2004 and 2015 with postoperative pN+ disease treated without neoadjuvant treatment.
Patients were divided into groups receiving observation, chemotherapy, or chemoradiotherapy
(CRT). Multivariable logistic regression determined factors associated with receipt
of adjuvant treatment. Kaplan-Meier curves compared overall survival (OS), and Cox
regression determined patient factors associated with OS.
Results
Altogether, 1466 patients met the inclusion criteria; 536 patients (36.6%) received
adjuvant chemotherapy, 413 (28.2%) received adjuvant CRT, and 517 (35.3%) were observed
postoperatively. Use of adjuvant treatment was associated with superior median OS
(124.1 vs. 51.1 months, P < .001), persisting after propensity score matching (124.0 vs. 61.9 months, P < .001), but not between adjuvant CRT versus chemotherapy on subset analysis. Patients
with positive surgical margins receiving adjuvant CRT showed a trend toward OS improvement
compared to patients managed with chemotherapy (54.9 vs. 47.4 months, P = .10). Increased age, pN2 status, positive margin status, and observation were associated
with poorer OS.
Conclusion
Most patients found to have pN+ disease after up-front surgery for cT1-2N0 rectal
cancer receive adjuvant treatment, which is associated with improved OS. Chemotherapy
or CRT are appropriate options, although there was a trend toward higher OS for patients
with positive surgical margins receiving CRT.
Keywords
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Article info
Publication history
Published online: April 20, 2018
Accepted:
April 14,
2018
Received:
March 22,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
