Neoadjuvant Chemoradiotherapy Plus Local Excision vs. Radical Surgery in T1-2N0M0 Rectal Carcinoma: A SEER-based...

Neoadjuvant chemoradiotherapy (NCRT) following local excision (LE) presents a potential strategy for organ preservation in the treatment of early-stage rectal carcinoma that is better than radical surgery (RS), such as Total Mesorectal Excision (TME). Nonetheless, the precise oncological outcomes associated with this approach remain uncertain.

We collected clinicopathological data from the Surveillance, Epidemiology, and End Results (SEER) database. To rectify the imbalances in baseline covariates (P < 0.05) between the local excision group and the radical resection group, we employed a 1:1 propensity score matching (PSM) approach. A logistic proportional odds ratio (OR) was employed for the purpose of discerning the factors linked to cancer-specific survival (CSS) and overall survival (OS).

A total of 4882 eligible patients were enrolled in this research. 72 patients were treated with NCRT plus local excision (NCRT + LE group), and 4810 were treated with radical surgery (RS group). Before propensity score matching (PSM), the 3-year, 5-year, and 10-year overall survival (OS) rates were 98.5%, 83.3%, and 46.3% in the NCRT + LE group and 88.8%, 81.8%, and 67.1% in the RS group (P = 0.487, HR = 0.843, 95% CI 0.522-1.363), respectively. In the CSS cohort before PSM, the 3-year, 5-year, and 10-year OS rates were 98.2%, 92.5%, and 45.6% in the NCRT + LE group and 96.8%, 93.3%, and 76.1% in the RS group (P = 0.374, HR = 0.719, 95% CI 0.347-1.492). After 1:1 PSM, each group had 65 patients. The 3-year, 5-year, and 10-year survival rates were 98.3%, 92.5%, and 70.8% in the NCRT + LE group and 94.8%, 92.2%, and 86.4% in the RS group (P = 0.350, HR = 0.701, 95% CI 0.331-1.483), respectively. In the CSS cohort after PSM, the 3-year, 5-year, and 10-year survival rates were 98.2%, 92.3%, and 70.1% in the NCRT + LE group and 96.8%, 93.3%, and 91.1% in the RS group (P = 0.219, HR = 0.560, 95% CI 0.176-1.179), respectively.

In this SEER-based analysis, no statistically significant difference in OS or CSS was detected. However, due to limited statistical power, these findings do not indicate equivalence and are hypothesis-generating only.