The Impact of Adjuvant Chemotherapy on Clinical Outcomes in Locally Advanced Rectal Cancer: A CHORD Consortium Analysis.
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 (p < 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 (p < 0.001). On multivariate analysis, patients who received AC had improved DFS (HR 0.6, 95% CI: 0.49-0.73, p < 0.001) and OS (HR 0.46, 95% CI: 0.36-0.58, p < 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.
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 (p < 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 (p < 0.001). On multivariate analysis, patients who received AC had improved DFS (HR 0.6, 95% CI: 0.49-0.73, p < 0.001) and OS (HR 0.46, 95% CI: 0.36-0.58, p < 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.
Authors
Farrokhi Farrokhi, Marginean Marginean, Al Ghamdi Al Ghamdi, Al Mansor Al Mansor, Dudani Dudani, Goodwin Goodwin, Asmis Asmis, Powell Powell, Tang Tang, Lee-Ying Lee-Ying, Vickers Vickers
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