Neoadjuvant chemo-radiotherapy for cT3N0 rectal cancer: any benefit over upfront surgery? A propensity score-matched study
| Autor: | Luca Sorrentino, Marco Vitellaro, Giuliano Bonfanti, Marcello Guaglio, Filiberto Belli, Luigi Battaglia, Alessandro Cesa Bianchi, Massimo Milione |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Multivariate analysis Colorectal cancer medicine.medical_treatment Risk Assessment 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine medicine Humans Propensity Score Digestive System Surgical Procedures Aged Neoplasm Staging Retrospective Studies medicine.diagnostic_test Rectal Neoplasms business.industry Gastroenterology Cancer Magnetic resonance imaging Chemoradiotherapy Adjuvant Middle Aged Hepatology medicine.disease Magnetic Resonance Imaging Neoadjuvant Therapy Progression-Free Survival Surgery 030220 oncology & carcinogenesis Propensity score matching Cohort Female 030211 gastroenterology & hepatology Neoplasm Recurrence Local business Adjuvant |
| Zdroj: | International Journal of Colorectal Disease. 34:2161-2169 |
| ISSN: | 1432-1262 0179-1958 |
| DOI: | 10.1007/s00384-019-03446-4 |
| Popis: | Benefits of neoadjuvant chemo-radiotherapy (CRT) are well known for locally advanced and/or node-positive rectal cancer, but the best timing for CRT has been less explored for cT3N0 patients. The aim of the present study was to compare the 5-year disease-free survival (DFS) probability between neoadjuvant CRT and upfront surgery in patients affected by cT3N0 rectal cancer. A retrospective review of 105 patients affected by cT3N0 rectal cancer, staged by pelvic magnetic resonance imaging and treated at the National Cancer Institute of Milan between 2011 and 2017, was performed: 42 (40.0%) were treated by neoadjuvant CRT and 63 (60.0%) by upfront surgery. Propensity score matching was performed to avoid selection bias, and Cox multivariate regression was used to analyze outcomes. The 5-year DFS probability was 87.5% in neoadjuvant CRT patients vs. 90.0% in upfront surgery cases (Log-rank p = 0.76). The 5-year loco-regional recurrence-free survival probability was respectively 96.8% vs. 96.3% (Log-rank p = 0.954). On multivariate analysis, neoadjuvant CRT had no impact on DFS when compared to upfront surgery (adjusted HR 0.71, 95%CI 0.18–2.70, p = 0.613), but 61.9% of upfront surgery cases were treated by adjuvant chemo-radiation (adjusted HR 0.41, 95%CI 0.11–1.57, p = 0.196). The only independent predictor of improved DFS was age at diagnosis (adjusted HR 0.95, p = 0.017). CRT should be considered for cT3N0 patients, but its timing (neoadjuvant vs. adjuvant) seems not to affect the disease-free survival in the present cohort of patients. |
| Databáze: | OpenAIRE |
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