Taherioun Maryam, Amoli Hadi Ahmadi, Afrooghe Arya, Nazar Elham, Amoli Arian Ahmadi, Yazdi Seyed Amir Miratashi
Department of Radiation Oncology, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Updates Surg. 2025 Jan;77(1):107-117. doi: 10.1007/s13304-024-02055-3. Epub 2024 Dec 12.
Background Rectal cancer, accounting for a significant proportion of colorectal malignancies, presents unique challenges in treatment. Surgery remains the primary curative approach, but recurrence rates post-surgery poses challenges. While neoadjuvant chemoradiation has improved outcomes, the role of adjuvant chemotherapy is still debated. Herein, we aimed to clarify the efficacy of adjuvant chemotherapy in patients with confirmed pathological stage II rectal cancer. Methods In this retrospective single-center study, we investigated the role of adjuvant chemotherapy in 173 patients with biopsy-proven stage II rectal adenocarcinoma. Participants received neoadjuvant chemoradiation followed by open TME surgery, with or without adjuvant chemotherapy. The study was conducted at Sina Hospital between January 2014 and 2019, and analyzed overall survival (OS) and disease-free survival (DFS) outcomes. Propensity score matching (PSM) was used to adjust for potential confounders. Survival outcomes were assessed using Cox proportional hazards models, and sensitivity analysis was conducted using doubly robust estimation. Results Before matching, 173 patients showed significantly improved overall survival (HR:0.33, 95%C:0.22-0.50, p < 0.001) and disease-free survival (HR:0.41, 95%CI:0.28-0.61, p < 0.001) with adjuvant chemotherapy. Age ≥ 70 years was associated with poorer overall survival (HR:1.76, 95%CI:1.08-2.88, p = 0.02). After matching, in 100 patients (50 with chemotherapy, 50 without), adjuvant chemotherapy remained significantly beneficial for both overall and disease-free survival (p < 0.001), while age ≥ 70 years continued to negatively impact overall survival. Conclusion Our findings suggest that adjuvant chemotherapy provides benefits in terms of OS and DFS in stage II rectal cancer following neoadjuvant chemoradiation and TME surgery. Further prospective studies are warranted to confirm these results and optimize treatment strategies.
直肠癌在结直肠恶性肿瘤中占相当大的比例，在治疗方面存在独特的挑战。手术仍然是主要的治愈方法，但术后复发率带来了挑战。虽然新辅助放化疗改善了治疗效果，但辅助化疗的作用仍存在争议。在此，我们旨在阐明辅助化疗对确诊为病理II期直肠癌患者的疗效。方法：在这项回顾性单中心研究中，我们调查了173例经活检证实为II期直肠腺癌患者中辅助化疗的作用。参与者接受新辅助放化疗，随后进行开放性全直肠系膜切除术，部分患者接受或不接受辅助化疗。该研究于2014年1月至2019年在新浪医院进行，分析了总生存期（OS）和无病生存期（DFS）结果。倾向评分匹配（PSM）用于调整潜在的混杂因素。使用Cox比例风险模型评估生存结果，并使用双重稳健估计进行敏感性分析。结果：匹配前，173例患者接受辅助化疗后总生存期（HR：0.3³，95%CI：0.22 - 0.50，p < 0.001）和无病生存期（HR：0.41，95%CI：0.28 - 0.61，p < 0.001）均有显著改善。年龄≥70岁与较差的总生存期相关（HR：1.76，95%CI：1.08 - 2.88，p = 0.02）。匹配后，100例患者（50例接受化疗，50例未接受化疗）中，辅助化疗对总生存期和无病生存期仍有显著益处（p < 0.001），而年龄≥70岁继续对总生存期产生负面影响。结论：我们的研究结果表明，在新辅助放化疗和全直肠系膜切除术后的II期直肠癌患者中，辅助化疗在总生存期和无病生存期方面具有益处。需要进一步的前瞻性研究来证实这些结果并优化治疗策略。
