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Downstaging and Survival Outcomes Associated With Neoadjuvant Adoption of Total Neoadjuvant Therapy for Locally Advanced
Chemotherapy Regimens Among Patients With Bladder Cancer Rectal Cancer
Research | August 30, 2018 Research | June 14, 2018
Research
Editorial Adoption of Total Neoadjuvant Therapy for
Comment
Locally Advanced Rectal Cancer
June 14, 2018
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Text
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Key Points "Continue," you are agreeing to our cookie policy | Continue Chemotherapy Plus Hyperthermia for
Patients With High-Risk Soft Tissue
Question Does adjuvant chemotherapy provide a survival benefit to patients with locally advanced Sarcoma
rectal cancer who demonstrate a complete pathological response following neoadjuvant April 1, 2018
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and resection, patients who received adjuvant chemotherapy demonstrated better 5-year overall
survival than those who did not receive adjuvant treatment (95.0% vs 88.2%).
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Meaning In this subgroup of patients with excellent prognosis, the administration of adjuvant
chemotherapy may provide additional survival benefits; however, these benefits need to be weighed
against the risks of chemotoxic effects.
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Abstract Adjuvant Chemotherapy and Overall Survival
in Patients With Rectal Cancer and pCR After
Neoadjuvant Chemotherapy and Resection
Importance Although American guidelines recommend use of adjuvant chemotherapy in patients
PracticeUpdate
with locally advanced rectal cancer, individuals who achieve a pathological complete response
Association of Adjuvant Chemotherapy With
(pCR) following neoadjuvant chemoradiotherapy are less likely to receive adjuvant treatment than
Overall Survival in Rectal Cancer and pCR
incomplete responders. The association and resection of adjuvant chemotherapy with survival in Following Neoadjuvant Chemotherapy and
Resection
patients with pCR is unclear.
PracticeUpdate
Objective To determine whether patients with locally advanced rectal cancer who achieve pCR
Lymph node yield is an independent predictor
after neoadjuvant chemoradiation therapy and resection benefit from the administration of of survival in rectal cancer regardless of
receipt of neoadjuvant therapy
adjuvant chemotherapy.
Zhaomin Xu et al., J Clin Pathol
Design, Setting, and Participants This retrospective propensity score–matched cohort study
identified patients with locally advanced rectal cancer from the National Cancer Database from Powered by
2006 through 2012. We selected patients with nonmetastatic invasive rectal cancer who achieved
pCR after neoadjuvant chemoradiation therapy and resection.
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Exposures We matched patients who received adjuvant chemotherapy to patients who did not cookies across the TrendMD network (widget, website,
receive adjuvant treatment in a 1:1 ratio. We separately matched subgroups of patients with node-
blog). Learn more
positive disease before treatment and node-negative disease before treatment to investigate for
Yes No
effect modification by pretreatment nodal status.
Main Outcome and Measures We compared overall survival between groups using Kaplan-Meier
survival methods and Cox proportional hazards models.
Results We identified 2455 patients (mean age, 59.5 years; 59.8% men) with rectal cancer with
pCR after neoadjuvant chemoradiation therapy and resection. We matched 667 patients with pCR
who received adjuvant chemotherapy and at least 8 weeks of follow-up after surgery to patients
with pCR who did not receive adjuvant treatment. Over a median follow-up of 3.1 years
(interquartile range, 1.94 4.40 years), patients treated with adjuvant chemotherapy demonstrated
better overall survival than those who did not receive adjuvant treatment (hazard ratio, 0.44; 95%
CI, 0.28 0.70). When stratified by pretreatment nodal status, only those patients with
pretreatment node-positive disease exhibited improved overall survival with administration of
adjuvant chemotherapy (hazard ratio, 0.24; 95% CI, 0.10 0.58).
Conclusions and Relevance The administration of adjuvant chemotherapy in patients with rectal
cancer with pCR is associated with improved overall survival, particularly in patients with
pretreatment node-positive disease. Although this study suggests a beneficial effect of adjuvant
treatment on survival in patients with pCR, these results are limited by the presence of potential
unmeasured confounding in this nonrandomized study.
Editorial
Validity in Propensity Score–Matched Estimates of Adjuvant Chemotherapy Effects in Rectal
Cancer
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Downstaging and Survival Outcomes Associated Results of Consultation on Surgical Margins in Outcomes of Chemoradiotherapy Followed by
With Neoadjuvant Chemotherapy Regimens Resection of Gastric and Gastroesophageal Organ-Sparing Treatment for Distal Rectal Cancer
Among Patients With Bladder Cancer Adenocarcinoma
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JAMA Oncology | Research | August 30, 2018 JAMA Surgery | Research | October 24, 2018
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