Adding Consolidation Capecitabine to Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer: A Propensity-Matched Comparative Study

Yifang Fang, Chengmin Sheng, Feng Ding, Weijie Zhao, Guoxian Guan, Xing Liu, Yifang Fang, Chengmin Sheng, Feng Ding, Weijie Zhao, Guoxian Guan, Xing Liu

Abstract

Aim: To determine whether adding consolidation capecitabine chemotherapy without lengthening the waiting period influences pathological complete response (pCR) and short-term outcome of locally advanced rectal cancer (LARC) receiving neoadjuvant chemoradiotherapy (NCRT).

Method: Totally, 545 LARC who received NCRT and radical resection between 2010 and 2018 were enrolled. Short-term outcome and pCR rate were compared between patients with and without additional consolidation capecitabine. Logistic analysis was performed to identify predictors of pCR.

Results: After propensity score matching, 229 patients were matched in both NCRT and NCRT-Cape groups. Postoperative morbidity was comparable between groups except for operation time, which is lower in the NCRT group (213.2 ± 67.4 vs. 227.9 ± 70.5, p = 0.025). Two groups achieved similar pCR rates (21.8 vs. 22.7%, p = 1.000). Tumor size (OR = 0.439, p < 0.001), time interval between NCRT and surgery (OR = 1.241, p = 0.003), and post-NCRT carcinoembryonic antigen (OR = 0.880, p = 0.008) were significantly correlated with pCR in patients with LARC. A predictive nomogram was constructed with a C-index of 0.787 and 0.741 on internal and external validation.

Conclusion: Adding consolidation capecitabine chemotherapy without lengthening CRT-to-surgery interval in LARC patients after NCRT does not seem to impact pCR or short-term outcome. A predictive nomogram for pCR was successful, and it could support treatment decision-making.

Keywords: capecitabine; neoadjuvant chemoradiotherapy; prognosis; propensity score matched analysis; rectal neoplasm.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Fang, Sheng, Ding, Zhao, Guan and Liu.

Figures

Figure 1
Figure 1
The protocol of the neoadjuvant chemoradiotherapy in the two groups. NCRT, neoadjuvant chemoradiotherapy; NCRT-Cape, neoadjuvant chemoradiotherapy, and additional capecitabine chemotherapy.
Figure 2
Figure 2
The relationship between time intervals and pCR rates. NCRT, neoadjuvant chemoradiotherapy; NCRT-Cape, neoadjuvant chemoradiotherapy, and additional capecitabine chemotherapy.
Figure 3
Figure 3
Nomogram predicting pCR (A) and calibration curves with internal (B) and external (C) validation. (A) A score for each variable can be obtained at the top scale, and the sum of scores indicates a predictive probability of pCR. (B,C) The solid line indicates the actual performance of our nomogram, and the dashed line represents the prediction by an ideal model. CEA, carcinoembryonic antigen.

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