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Survival Following Neoadjuvant Chemoradiation in Rectosigmoid Junction Adenocarcinoma: Surveillance, Epidemiology,
Sameh Hany Emile1, Nir Horesh2, Anjelli Wignakumar3
1Colorectal Surgery Department, Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida; General Surgery Department, Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura, Egypt.
Introduction:
Cancers of the rectosigmoid junction (RSJ) may pose a surgical challenge, given their unique anatomic location and behavior. The present study aimed to investigate the association between neoadjuvant chemoradiation therapy (nCRT) use and survival among patients with RSJ adenocarcinomas.
Methods:
A retrospective analysis was conducted, including all patients in the Surveillance, Epidemiology, and End Results database (2000-2020) with stage II-III RSJ adenocarcinomas treated with radical resection, with and without nCRT. Patients who received and did not receive nCRT were equally matched for age, sex, disease stage, and marital status using the propensity-score method. The primary outcomes were 5-y overall survival (OS) and cancer-specific survival (CSS). Secondary outcomes included the receipt of adjuvant therapy and the number of harvested and positive lymph nodes.
Results:
The study included 13,825 patients (56.7% males); nCRT was given to 1863 (13.5%) patients. After matching, 1790 patients were included in each group. Matched patients who received nCRT had similar 5-y OS (73.5% versus 71.6%, P = 0.837) and CSS (76.3% versus 77.1%, P = 0.552) to patients who did not receive neoadjuvant CRT. nCRT was not significantly associated with increased OS (hazard ratio: 0.86, 95% confidence interval: 0.73, 1.01, P = 0.073) or CSS (hazard ratio: 0.90, 95% confidence interval: 0.74, 1.10, P = 0.31) after adjusting for survival confounders. Stratified survival analyses of the unmatched cohort showed a survival benefit of nCRT in females, White patients, stage III disease, nonmucinous adenocarcinoma, tumors >5 cm, and elevated carcinoembryonic antigen. Matched patients who received nCRT less often received adjuvant chemotherapy (odds ratio [OR]: 0.44, P < 0.001) and adjuvant radiotherapy (OR: 0.14, P < 0.001) and had fewer harvested and positive lymph nodes.
Conclusions:
nCRT was not significantly associated with an increase in OS or CSS in rectosigmoid cancers. However, exploratory subgroup analyses found a potential survival benefit in White female patients with large stage III nonmucinous adenocarcinomas and carcinoembryonic antigen elevation.
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