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Is Early Initiation of Adjuvant Chemotherapy Beneficial for Locally Advanced Rectal Cancer Following Neoadjuvant Chemoradiotherapy and Radical Surgery?

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Abstract

Aim

This study aimed to evaluate whether earlier initiation (< 4 weeks) of adjuvant chemotherapy (ACT) confer any oncological benefits for locally advanced rectal cancer (LARC) patients undergoing neoadjuvant chemoradiotherapy (nCRT) and radical surgery.

Method

Clinicopathological and survival outcomes were compared. Propensity score matching (PSM) was performed to adjust for differences between groups. Cox regression analysis was performed to evaluate the impact of earlier ACT initiation on overall survival (OS) and disease-free survival (DFS).

Results

Totally, 443 eligible patients were included. More laparoscopic surgeries, less postoperative complications, and more ACT completion were observed in patients whose ACT was initiated within 4 weeks after surgery (all P < 0.001). With a mean follow-up of 59 months, the 5-year OS and DFS rate was 89.8% and 82.0% in the early group, significantly higher than 81.6% and 73.1% in the late group (P = 0.007, and P = 0.022, respectively). After PSM, the 5-year OS and DFS rate was 90.9% and 84.4% in the early group, significantly higher than 83.4% and 68.8% in the late group (P = 0.047, and P = 0.017, respectively). Cox regression analysis demonstrated that time to ACT initiation (early vs. late, HR = 0.486, P = 0.008) was independently associated with OS.

Conclusion

Early initiation of ACT (<4 weeks) confers a survival benefit, and is an independent prognostic factor of OS in LARC patients following nCRT. Further investigations are needed to define the role of earlier initiation of ACT in patients with LARC after nCRT.

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Acknowledgements

The authors thank all the staff in the Department of colorectal surgery, FMUUH, Fuzhou, Fujian Province, People’s Republic of China.

Funding

This study was supported by Construction Project of Fujian Province Minimally Invasive Medical Center (Grant Number: [2017]171), Startup Fund for Scientific Research, Fujian Medical University (Grant Number: 2017XQ1028), Joint Funds for the Innovation of Science and Technology, Fujian province (Grant Number: 2018Y9030), and Young and Middle-aged Backbone Training Project in the Health System of Fujian province (Grant Number: 2019-ZQN-45).

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Author notes

  1. Yanwu Sun, Zhekun Huang, and Yiyi Zhang have contributed equally to this work.

Authors and Affiliations

  1. Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, Fujian, 350001, People’s Republic of China

    Yanwu Sun, Zhekun Huang, Yiyi Zhang, Huiming Lin, Xingrong Lu, Ying Huang & Pan Chi

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  1. Yanwu Sun
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  2. Zhekun Huang
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Correspondence to Pan Chi.

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Sun, Y., Huang, Z., Zhang, Y. et al. Is Early Initiation of Adjuvant Chemotherapy Beneficial for Locally Advanced Rectal Cancer Following Neoadjuvant Chemoradiotherapy and Radical Surgery?. World J Surg 44, 3149–3157 (2020). https://doi.org/10.1007/s00268-020-05573-4

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  • DOI: https://doi.org/10.1007/s00268-020-05573-4

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