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Adjuvant Radiotherapy Is Not Necessary for Stage III Mucinous Rectal Cancer: Evidence Based on Long Survival Analysis from SEER Data

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Although rectal mucinous adenocarcinoma (RMC) is less sensitive to radiotherapy, adjuvant radiotherapy is still recommended for RMC patients. This study aimed to explore whether adjuvant radiotherapy is necessary for stage III RMC.

Methods

Data of patients with stage III RMC were obtained from the National Cancer Institute’s SEER database (2004–2015). The survival rates were calculated by Kaplan–Meier method and compared by log-rank test. Univariate and multivariate Cox regression analyses were used to assess the impact of clinicopathological parameters on overall survival (OS) and cancer-specific survival (CSS).

Results

RMC has a worse T and N stage at diagnosis than rectal adenomatous carcinoma (RAC) (all p < 0.001). Multivariate Cox regression analyses revealed that histopathological type MC was an independent poor prognostic factor for OS (HR 1.27; 95%CI 1.14–1.41; p < 0.001) and CSS (HR 1.34; 95%CI 1.18–1.51; p < 0.001). Subgroup analysis based on different treatment regimens showed no significant difference between chemotherapy group and chemotherapy plus radiotherapy group. After the propensity score matching, no significant difference was also found in OS and CSS between chemotherapy group and chemotherapy plus radiotherapy group.

Conclusions

RMC is an independent poor prognostic factor for OS and CSS. Adjuvant radiotherapy for RMC was not beneficial in improving survival outcomes.

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Data Availability

The patients' data are publicly available in the SEER database (www.seer.cancer.gov).

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Funding

This work was supported by National Natural Science Foundation of China (grant no. 81860519; 82160561), Key project of Natural Science Foundation of Jiangxi, China (grant no. 20192ACBL21043), and Natural Science Foundation of Jiangxi, China (grant no. 20181BBG78043).

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Authors and Affiliations

  1. Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China

    Hualin Liao, Cheng Tang, Tao Li, Yahang Liang, Mingming Li, Taiyuan Li & Xiong Lei

  2. Gastrointestinal Surgical Institute, Nanchang University, Nanchang, 330006, Jiangxi, China

    Hualin Liao, Cheng Tang, Zhen Zhou, Haoran Shi, Tao Li, Yahang Liang, Mingming Li, Taiyuan Li & Xiong Lei

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  1. Hualin Liao
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  2. Cheng Tang
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Contributions

Xiong Lei conceived and designed the study. Hualin Liao was involved in the interpretation of data and drafting of the manuscript; Hualin Liao, Zhen Zhou, Tao Li, Yahang Liang, Haoran Shi, and Mingming Li were involved in the analysis, acquisition and interpretation of data. Xiong Lei and Taiyuan Li were involved in the critical revision of the manuscript for important intellectual content.

Corresponding authors

Correspondence to Taiyuan Li or Xiong Lei.

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Supplement Fig. 1

Kaplan–Meier survivalcurves for cancer-specific survival between RAC and RMC were compared accordingto T stage (A, B), N stage (C, D), surgical approach (E, F). (PNG 82 kb)

High resolution image (TIF 561 kb)

Supplement Fig. 2

Kaplan–Meier curvesfor overall survival (A, C) and cancer-specific survival (B, D) in patientswith RAC according to different treatment regimens. (PNG 98 kb)

High resolution image (TIF 563 kb)

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Liao, H., Tang, C., Zhou, Z. et al. Adjuvant Radiotherapy Is Not Necessary for Stage III Mucinous Rectal Cancer: Evidence Based on Long Survival Analysis from SEER Data. J Gastrointest Surg 27, 2857–2866 (2023). https://doi.org/10.1007/s11605-023-05765-y

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