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Oncologic Outcomes of Postoperative Chemoradiotherapy Versus Chemotherapy Alone in Stage II and III Upper Rectal Cancer

Annals of Coloproctology 2019년 35권 3호 p.137 ~ 143
윤지은, 이수영, Kwak Han-Duk, Yeom Seung-Seop, 김창현, 주재균, 김형록, 김영진,
소속 상세정보
윤지은 ( Yoon Ji-Eun ) - Chonnam National University Hwasun Hospital Department of Surgery
이수영 ( Lee Soo-Young ) - Chonnam National University Hwasun Hospital Department of Surgery
 ( Kwak Han-Duk ) - Chonnam National University Medical School Department of Surgery
 ( Yeom Seung-Seop ) - Chonnam National University Hwasun Hospital Department of Surgery
김창현 ( Kim Chang-Hyun ) - Chonnam National University Hwasun Hospital Department of Surgery
주재균 ( Joo Jae-Kyun ) - Chonnam National University Medical School Department of Surgery
김형록 ( Kim Hyeong-Rok ) - Chonnam National University Hwasun Hospital Department of Surgery
김영진 ( Kim Young-Jin ) - Chonnam National University Hwasun Hospital Department of Surgery

Abstract


Purpose: The aim of this study was to assess oncological outcomes of postoperative radiotherapy plus chemotherapy (CRT) versus chemotherapy alone (CTx) in stage II or III upper rectal cancer patients who underwent curative surgery.

Methods: We retrospectively reviewed 263 consecutive patients with pathologic stage II or III upper rectal cancer who underwent primary curative resection with postoperative CRT or CTx from January 2008 to December 2014 at Chonnam National University Hwasun Hospital. Multivariate and propensity score matching analyses were used to reduce selection bias.

Results: Median follow-up was 48.1 months for the entire cohort and 53.5 months for the matched cohort. In subgroup analysis of the propensity score matched cohort, the 3-year local recurrence-free survival was 94.1% (95% confidence interval [CI], 87.8%?100%) in the CRT group and 90.1% (95% CI, 82.8%?97.9%) in the CTx group (P = 0.370). No significant difference in disease-free survival was observed according to treatment type. On multivariate analysis, circumferential resection margin involvement (hazard ratio [HR], 2.386; 95% CI, 1.190?7.599; P = 0.032), N stage (HR, 6.262; 95% CI, 1.843?21.278, P = 0.003), and T stage (HR, 5.896, 95% CI, 1.298?6.780, P = 0.021) were identified as independent risk factors for local recurrence of tumors of the upper rectum.

Conclusion: Omission of radiotherapy in an adjuvant treatment setting may not jeopardize oncologic outcomes in stages II and III upper rectal cancer.

키워드

Rectal neoplasms; Recurrence; Chemoradiotherapy; Drug therapy

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