Stage II-III rectal cancer: PNI presence indicates ACT benefit

  • Radiother Oncol

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Perineural invasion (PNI) is an indicator of better distant failure-free survival (DFFS) with adjuvant chemotherapy (ACT) among patients with stage II-III rectal cancer who have undergone long-course preoperative chemoradiotherapy (CRT) followed by total mesorectal excision (TME).
  • There was no significant DFFS benefit for ACT among patients with lymphovascular invasion (LVI).

Why this matters

  • ACT is routinely used after TME, but previous studies have failed to establish a benefit, leading to uncertainties about patient selection.

Study design

  • Retrospective analysis of 1232 patients treated at 6 tertiary institutions in Korea (median age, 62 years; 31.8% women; 75.6% clinical N stage positive).
  • Funding: None.

Key results

  • 15.0% of patients had LVI, 17.1% had PNI, 6.5% had both, and 74.3% had neither.
  • 5-year OS, recurrence-free survival, and DFFS were highest in the group with no PNI or LVI (89.1%, 78.7%, and 84.6%, respectively), followed by LVI only (77.9%, 58.7%, 61.4%), PNI only (67.6%, 44.6%, 54.2%), and both (56.2%, 38.6%, 48.6%; P<.001 for all>
  • Adjuvant chemotherapy was associated with improved 5-year DFFS in patients with PNI (44.9% vs 54.6%; P=.048), but not patients with LVI.

Limitations

  • Retrospective analysis.
  • Korean cohort.

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