Farrokhi Kaveh, Marginean Horia, Al Ghamdi Anas, Al Mansor Essa, Dudani Shaan, Goodwin Rachel A, Asmis Timothy R, Powell Erin, Tang Patricia A, Lee-Ying Richard, Vickers Michael M
The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada.
Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada.
Curr Oncol. 2025 Jun 26;32(7):371. doi: 10.3390/curroncol32070371.
The impact of adjuvant chemotherapy (AC) on outcomes in real-world patients with locally advanced rectal cancer (LARC) remains uncertain.
Consecutive patients with LARC (stage II/III) undergoing neoadjuvant chemoradiation before curative-intent surgery from 2005 to 2013 were identified in the Canadian Health Outcomes Research Database. The impact of AC on clinical outcomes, including disease-free survival (DFS) and overall survival (OS), was evaluated using the Kaplan-Meier method and Cox proportional hazards modeling.
A total of 1448 patients had sufficient data available to be included for analysis with 1085 (74.9%) receiving AC. Of AC patients, 40.5% received oxaliplatin-based treatments. With a median follow-up of 66.43 months, the 5-year DFS rate was 67.7% (95% CI: 64.5-70.1%) vs. 58.7% (95% CI: 52.8-64.2%) in the AC group and non-AC group, respectively ( < 0.001). The 5-year OS rate of the whole cohort was 74.3% (95% CI: 71.5-76.85%) while the 5-year OS rate of the AC group was 77.8% (95% CI: 74.7-80.6%) compared with 63.8% (95% CI: 57.9-69.2%) for the non-AC group ( < 0.001). On multivariate analysis, patients who received AC had improved DFS (HR 0.6, 95% CI: 0.49-0.73, < 0.001) and OS (HR 0.46, 95% CI: 0.36-0.58, < 0.001).
This large multi-institutional database analysis supports the use of AC in real-world LARC patients treated with nCRT followed by surgical resection.
辅助化疗（AC）对局部晚期直肠癌（LARC）真实世界患者预后的影响仍不确定。
在加拿大健康结局研究数据库中确定了2005年至2013年期间接受根治性手术前新辅助放化疗的连续LARC患者（II/III期）。使用Kaplan-Meier方法和Cox比例风险模型评估AC对临床结局的影响，包括无病生存期（DFS）和总生存期（OS）。
共有1448例患者有足够的数据可纳入分析，其中1085例（74.9%）接受了AC。在接受AC的患者中，40.5%接受了以奥沙利铂为基础的治疗。中位随访66.43个月，AC组和非AC组的5年DFS率分别为67.7%（95%CI：64.5-70.1%）和58.7%（95%CI：52.8-64.2%）（<0.001）。整个队列的5年OS率为74.3%（95%CI：71.5-76.85%），而AC组的5年OS率为77.8%（95%CI：74.7-80.6%），非AC组为63.8%（95%CI：57.9-69.2%）（<0.001）。多因素分析显示，接受AC的患者DFS（HR 0.6，95%CI：0.49-0.73，<0.001）和OS（HR 0.46，95%CI：0.36-0.58，<0.001）均有所改善。
这项大型多机构数据库分析支持在接受nCRT后手术切除的真实世界LARC患者中使用AC。
