Neoadjuvant radiotherapy improves overall survival for T3/4N+M0 rectal cancer patients: a population-based study of 20300 patients

Neoadjuvant radiotherapy (RT) has been shown to improve local control; however, whether it can improve overall survival (OS) in locally advanced rectal cancer (LARC) patients remains controversial. We therefore aimed to examine the benefits of surgery alone, neoadjuvant radiotherapy (RT), adjuvant R...

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Published in:Radiation oncology (London, England) England), 2020-02, Vol.15 (1), p.49-11, Article 49
Main Authors: Zhao, Feng, Wang, Jili, Yu, Hao, Cheng, Xiaofei, Li, Xinke, Zhu, Xuan, Xu, Xiangming, Lin, Jianjiang, Chen, Xin, Yan, Senxiang
Format: Article
Language:English
Subjects:
Adolescent
Adult
African Continental Ancestry Group
Age
Age Factors
Aged
Aged, 80 and over
Cancer patients
Cancer research
Cancer therapies
Cancer treatment
Care and treatment
Chemotherapy
Colorectal cancer
Development and progression
Epidemiology
Female
Health risk assessment
Humans
Intelligence gathering
Male
Marital status
Medical research
Methods
Middle Aged
Neoplasm Staging
Overall survival (OS)
Patient outcomes
Patients
Population
Population studies
Population-based studies
Prognosis
Proportional Hazards Models
Radiation
Radiation therapy
Radiotherapy
Radiotherapy (RT)
Radiotherapy, Adjuvant
Rectal cancer
Rectal Neoplasms - mortality
Rectal Neoplasms - pathology
Rectal Neoplasms - radiotherapy
Rectum
Regression analysis
Retirement benefits
Studies
Surgery
Therapeutics
Tumors
Young Adult
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container_title Radiation oncology (London, England)
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creator Zhao, Feng
Wang, Jili
Yu, Hao
Cheng, Xiaofei
Li, Xinke
Zhu, Xuan
Xu, Xiangming
Lin, Jianjiang
Chen, Xin
Yan, Senxiang
description Neoadjuvant radiotherapy (RT) has been shown to improve local control; however, whether it can improve overall survival (OS) in locally advanced rectal cancer (LARC) patients remains controversial. We therefore aimed to examine the benefits of surgery alone, neoadjuvant radiotherapy (RT), adjuvant RT, and surgery plus chemotherapy in stage II (T3/4N0M0) and III (any T and N + M0) on the OS of rectal cancer patients. Date from the Surveillance, Epidemiology, and End Results (SEER) database diagnosed between 2004 and 2016 were used. Kaplan-Meier analyses were used to compare patient prognoses across different treatment modalities. Cox hazard regression analysis were used to identify independent predictors of OS. For stage T3/4N0M0 patients, neoadjuvant RT, adjuvant RT, and surgery plus chemotherapy resulted in similar OS (all p > 0.05; mean survival, 115.89 months (M), 111.97 M, and 117.22 M, respectively), with better OS observed in these patients than in patients who underwent surgery alone (all p  0.05; mean survival, 121.50 M, 124.25 M, and 121.20 M, respectively), with better OS observed in these patients than in patients who underwent surgery alone (all p 
doi_str_mv 10.1186/s13014-020-01497-4
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We therefore aimed to examine the benefits of surgery alone, neoadjuvant radiotherapy (RT), adjuvant RT, and surgery plus chemotherapy in stage II (T3/4N0M0) and III (any T and N + M0) on the OS of rectal cancer patients. Date from the Surveillance, Epidemiology, and End Results (SEER) database diagnosed between 2004 and 2016 were used. Kaplan-Meier analyses were used to compare patient prognoses across different treatment modalities. Cox hazard regression analysis were used to identify independent predictors of OS. For stage T3/4N0M0 patients, neoadjuvant RT, adjuvant RT, and surgery plus chemotherapy resulted in similar OS (all p &gt; 0.05; mean survival, 115.89 months (M), 111.97 M, and 117.22 M, respectively), with better OS observed in these patients than in patients who underwent surgery alone (all p &lt; 0.001, mean survival, 88.96 M). For stage T1/2N + M0 patients, neoadjuvant RT, adjuvant RT, and surgery plus chemotherapy resulted in similar OS (all p &gt; 0.05; mean survival, 121.50 M, 124.25 M, and 121.20 M, respectively), with better OS observed in these patients than in patients who underwent surgery alone (all p &lt; 0.001, mean survival 83.81 M). For stage T3/4N + M0 patients, neoadjuvant RT (HR = 0.436; 95% CI, 0.396~0.478; p &lt; 0.001) resulted in significantly longer OS than adjuvant RT and surgery plus chemotherapy (mean survival, 104.47 M, 93.94 M, and 93.62 M, respectively), with better OS observed in these patients than in patients who underwent surgery alone (all p &lt; 0.001, mean survival 54.87 M). Older age (&gt; 60 years), black race, unmarried status, high tumour grade, and tumour size &gt; 5 cm were all associated with a poor prognosis (all p &lt; 0.05). Neoadjuvant RT, adjuvant RT, and surgery plus chemotherapy results in better OS than surgery alone in LARC patients. Neoadjuvant RT has the potential to be highly recommended over adjuvant RT and surgery plus chemotherapy for T3/4N + M0 patients; however, it showed no OS advantage over adjuvant RT or surgery plus chemotherapy for T3/4N0M0 and T1/2N + M0 patients.</description><identifier>ISSN: 1748-717X</identifier><identifier>EISSN: 1748-717X</identifier><identifier>DOI: 10.1186/s13014-020-01497-4</identifier><identifier>PMID: 32103755</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Adolescent ; Adult ; African Continental Ancestry Group ; Age ; Age Factors ; Aged ; Aged, 80 and over ; Cancer patients ; Cancer research ; Cancer therapies ; Cancer treatment ; Care and treatment ; Chemotherapy ; Colorectal cancer ; Development and progression ; Epidemiology ; Female ; Health risk assessment ; Humans ; Intelligence gathering ; Male ; Marital status ; Medical research ; Methods ; Middle Aged ; Neoplasm Staging ; Overall survival (OS) ; Patient outcomes ; Patients ; Population ; Population studies ; Population-based studies ; Prognosis ; Proportional Hazards Models ; Radiation ; Radiation therapy ; Radiotherapy ; Radiotherapy (RT) ; Radiotherapy, Adjuvant ; Rectal cancer ; Rectal Neoplasms - mortality ; Rectal Neoplasms - pathology ; Rectal Neoplasms - radiotherapy ; Rectum ; Regression analysis ; Retirement benefits ; Studies ; Surgery ; Therapeutics ; Tumors ; Young Adult</subject><ispartof>Radiation oncology (London, England), 2020-02, Vol.15 (1), p.49-11, Article 49</ispartof><rights>COPYRIGHT 2020 BioMed Central Ltd.</rights><rights>2020. 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For stage T1/2N + M0 patients, neoadjuvant RT, adjuvant RT, and surgery plus chemotherapy resulted in similar OS (all p &gt; 0.05; mean survival, 121.50 M, 124.25 M, and 121.20 M, respectively), with better OS observed in these patients than in patients who underwent surgery alone (all p &lt; 0.001, mean survival 83.81 M). For stage T3/4N + M0 patients, neoadjuvant RT (HR = 0.436; 95% CI, 0.396~0.478; p &lt; 0.001) resulted in significantly longer OS than adjuvant RT and surgery plus chemotherapy (mean survival, 104.47 M, 93.94 M, and 93.62 M, respectively), with better OS observed in these patients than in patients who underwent surgery alone (all p &lt; 0.001, mean survival 54.87 M). Older age (&gt; 60 years), black race, unmarried status, high tumour grade, and tumour size &gt; 5 cm were all associated with a poor prognosis (all p &lt; 0.05). Neoadjuvant RT, adjuvant RT, and surgery plus chemotherapy results in better OS than surgery alone in LARC patients. Neoadjuvant RT has the potential to be highly recommended over adjuvant RT and surgery plus chemotherapy for T3/4N + M0 patients; however, it showed no OS advantage over adjuvant RT or surgery plus chemotherapy for T3/4N0M0 and T1/2N + M0 patients.</description><subject>Adolescent</subject><subject>Adult</subject><subject>African Continental Ancestry Group</subject><subject>Age</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cancer patients</subject><subject>Cancer research</subject><subject>Cancer therapies</subject><subject>Cancer treatment</subject><subject>Care and treatment</subject><subject>Chemotherapy</subject><subject>Colorectal cancer</subject><subject>Development and progression</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Health risk assessment</subject><subject>Humans</subject><subject>Intelligence gathering</subject><subject>Male</subject><subject>Marital status</subject><subject>Medical research</subject><subject>Methods</subject><subject>Middle Aged</subject><subject>Neoplasm Staging</subject><subject>Overall survival (OS)</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Population</subject><subject>Population studies</subject><subject>Population-based studies</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Radiation</subject><subject>Radiation therapy</subject><subject>Radiotherapy</subject><subject>Radiotherapy (RT)</subject><subject>Radiotherapy, Adjuvant</subject><subject>Rectal cancer</subject><subject>Rectal Neoplasms - mortality</subject><subject>Rectal Neoplasms - pathology</subject><subject>Rectal Neoplasms - radiotherapy</subject><subject>Rectum</subject><subject>Regression analysis</subject><subject>Retirement benefits</subject><subject>Studies</subject><subject>Surgery</subject><subject>Therapeutics</subject><subject>Tumors</subject><subject>Young Adult</subject><issn>1748-717X</issn><issn>1748-717X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNptUl1rFDEUDaLYuvoHfJCAj2Xam-9ZH4RS_CjU-lLBt5DJJNsss5MxmRnYV3-52W5duyCBm-Tm3MM9NwehtwTOCanlRSYMCK-AQlX2par4M3RKFK8rRdTP50_OJ-hVzmsALhgsX6ITRgkwJcQp-n3romnX02z6ESfThjjeu2SGLQ6bIcXZZVxCMl2H85TmMJsO-5jwHbvgt2ffACdnx5Kzprcu4cGMwfVj_oANHuIwdeUe-6ox2bU4j1O7xdFjCgzggH2NXnjTZffmcV-gH58_3V19rW6-f7m-uryprJBsrKRomqa1zHLhRQkSvPNtzUE55rlljXUgGGtaboylUDvJlSdSCMo49TVjC3S9522jWeshhY1JWx1N0A-JmFbapDHYzumaEaACuF0Syp1XDeXQgGNCCGmV4IXr455rmJqNa23RUWZ0RHr80od7vYqzVuUPeBn-Ar1_JEjx1-TyqNdxSn3RrylTNV8Cl-wfamVKV6H3sZDZTchWX0oiOVVC7VDn_0GV1bpNsLF3PpT8UQHdF9gUc07OHxonoHfW0ntr6WIt_WAtvZP87qnkQ8lfL7E_q5_I8Q</recordid><startdate>20200227</startdate><enddate>20200227</enddate><creator>Zhao, Feng</creator><creator>Wang, Jili</creator><creator>Yu, Hao</creator><creator>Cheng, Xiaofei</creator><creator>Li, Xinke</creator><creator>Zhu, Xuan</creator><creator>Xu, Xiangming</creator><creator>Lin, Jianjiang</creator><creator>Chen, Xin</creator><creator>Yan, Senxiang</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><general>BMC</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-4441-9992</orcidid></search><sort><creationdate>20200227</creationdate><title>Neoadjuvant radiotherapy improves overall survival for T3/4N+M0 rectal cancer patients: a population-based study of 20300 patients</title><author>Zhao, Feng ; Wang, Jili ; Yu, Hao ; Cheng, Xiaofei ; Li, Xinke ; Zhu, Xuan ; Xu, Xiangming ; Lin, Jianjiang ; Chen, Xin ; Yan, Senxiang</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c563t-65bbbdc3c45f5c4560fefd8407e3f4c3bce0533bd4aac208e647f16552342f833</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>African Continental Ancestry Group</topic><topic>Age</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cancer patients</topic><topic>Cancer research</topic><topic>Cancer therapies</topic><topic>Cancer treatment</topic><topic>Care and treatment</topic><topic>Chemotherapy</topic><topic>Colorectal cancer</topic><topic>Development and progression</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Health risk assessment</topic><topic>Humans</topic><topic>Intelligence gathering</topic><topic>Male</topic><topic>Marital status</topic><topic>Medical research</topic><topic>Methods</topic><topic>Middle Aged</topic><topic>Neoplasm Staging</topic><topic>Overall survival (OS)</topic><topic>Patient outcomes</topic><topic>Patients</topic><topic>Population</topic><topic>Population studies</topic><topic>Population-based studies</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Radiation</topic><topic>Radiation therapy</topic><topic>Radiotherapy</topic><topic>Radiotherapy (RT)</topic><topic>Radiotherapy, Adjuvant</topic><topic>Rectal cancer</topic><topic>Rectal Neoplasms - mortality</topic><topic>Rectal Neoplasms - pathology</topic><topic>Rectal Neoplasms - radiotherapy</topic><topic>Rectum</topic><topic>Regression analysis</topic><topic>Retirement benefits</topic><topic>Studies</topic><topic>Surgery</topic><topic>Therapeutics</topic><topic>Tumors</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zhao, Feng</creatorcontrib><creatorcontrib>Wang, Jili</creatorcontrib><creatorcontrib>Yu, Hao</creatorcontrib><creatorcontrib>Cheng, Xiaofei</creatorcontrib><creatorcontrib>Li, Xinke</creatorcontrib><creatorcontrib>Zhu, Xuan</creatorcontrib><creatorcontrib>Xu, Xiangming</creatorcontrib><creatorcontrib>Lin, Jianjiang</creatorcontrib><creatorcontrib>Chen, Xin</creatorcontrib><creatorcontrib>Yan, Senxiang</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>ProQuest - Health &amp; 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however, whether it can improve overall survival (OS) in locally advanced rectal cancer (LARC) patients remains controversial. We therefore aimed to examine the benefits of surgery alone, neoadjuvant radiotherapy (RT), adjuvant RT, and surgery plus chemotherapy in stage II (T3/4N0M0) and III (any T and N + M0) on the OS of rectal cancer patients. Date from the Surveillance, Epidemiology, and End Results (SEER) database diagnosed between 2004 and 2016 were used. Kaplan-Meier analyses were used to compare patient prognoses across different treatment modalities. Cox hazard regression analysis were used to identify independent predictors of OS. For stage T3/4N0M0 patients, neoadjuvant RT, adjuvant RT, and surgery plus chemotherapy resulted in similar OS (all p &gt; 0.05; mean survival, 115.89 months (M), 111.97 M, and 117.22 M, respectively), with better OS observed in these patients than in patients who underwent surgery alone (all p &lt; 0.001, mean survival, 88.96 M). For stage T1/2N + M0 patients, neoadjuvant RT, adjuvant RT, and surgery plus chemotherapy resulted in similar OS (all p &gt; 0.05; mean survival, 121.50 M, 124.25 M, and 121.20 M, respectively), with better OS observed in these patients than in patients who underwent surgery alone (all p &lt; 0.001, mean survival 83.81 M). For stage T3/4N + M0 patients, neoadjuvant RT (HR = 0.436; 95% CI, 0.396~0.478; p &lt; 0.001) resulted in significantly longer OS than adjuvant RT and surgery plus chemotherapy (mean survival, 104.47 M, 93.94 M, and 93.62 M, respectively), with better OS observed in these patients than in patients who underwent surgery alone (all p &lt; 0.001, mean survival 54.87 M). Older age (&gt; 60 years), black race, unmarried status, high tumour grade, and tumour size &gt; 5 cm were all associated with a poor prognosis (all p &lt; 0.05). Neoadjuvant RT, adjuvant RT, and surgery plus chemotherapy results in better OS than surgery alone in LARC patients. Neoadjuvant RT has the potential to be highly recommended over adjuvant RT and surgery plus chemotherapy for T3/4N + M0 patients; however, it showed no OS advantage over adjuvant RT or surgery plus chemotherapy for T3/4N0M0 and T1/2N + M0 patients.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>32103755</pmid><doi>10.1186/s13014-020-01497-4</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-4441-9992</orcidid><oa>free_for_read</oa></addata></record>
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source Open Access: PubMed Central; Publicly Available Content Database
subjects Adolescent
Adult
African Continental Ancestry Group
Age
Age Factors
Aged
Aged, 80 and over
Cancer patients
Cancer research
Cancer therapies
Cancer treatment
Care and treatment
Chemotherapy
Colorectal cancer
Development and progression
Epidemiology
Female
Health risk assessment
Humans
Intelligence gathering
Male
Marital status
Medical research
Methods
Middle Aged
Neoplasm Staging
Overall survival (OS)
Patient outcomes
Patients
Population
Population studies
Population-based studies
Prognosis
Proportional Hazards Models
Radiation
Radiation therapy
Radiotherapy
Radiotherapy (RT)
Radiotherapy, Adjuvant
Rectal cancer
Rectal Neoplasms - mortality
Rectal Neoplasms - pathology
Rectal Neoplasms - radiotherapy
Rectum
Regression analysis
Retirement benefits
Studies
Surgery
Therapeutics
Tumors
Young Adult
title Neoadjuvant radiotherapy improves overall survival for T3/4N+M0 rectal cancer patients: a population-based study of 20300 patients
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