Abstract
BACKGROUND: Neoadjuvant chemoradiotherapy (nCRT) followed by total mesorectal excision (TME) is the current standard for locally advanced rectal cancer. This study aimed to evaluate the need for adjuvant chemotherapy and clinical outcomes in patients with ypT3-4N0M0 rectal cancer. METHODS: This is a retrospective cohort study. We reviewed the patients with locally advanced rectal cancer who had undergone radical resection after nCRT between 2010 and 2016. A total of 69 patients with ypT3-4N0M0 rectal cancer were included. The prognostic factors affecting disease-free and overall survival were analyzed. RESULTS: With clinical stage II-III and pathological stage II disease, the overall survival in the adjuvant chemotherapy group (n = 38) was better than that of the group without adjuvant chemotherapy (n = 31) (86.8%, vs 74.2%, P = 0.016). The disease-free survival was better in 2 groups, but the difference was not statistically significant (73.7%, vs 67.4%, P = 0.193). CONCLUSIONS: In patients with clinical stage III rectal cancer downstaged to ypStage II after nCRT and TME, adjuvant chemotherapy may improve overall survival. nCRT combined with postoperative adjuvant chemotherapy remains an effective strategy for patients unsuitable for complete total neoadjuvant therapy protocols.